Tinnitus: An Alarm Inside of You
Guest Blog By Dr. Marcia Dewey
Tinnitus is the sensation of a sound inside of you. Although the majority of those who experience tinnitus are actually not bothered by it, there is a meaningful number of people who suffer not in silence. Tinnitus is driven by neuroplasticity—the brain’s natural ability to create, adapt, and change its neural pathways. Most of the time, it is a sound created by these neural pathways in the brain, not the body. These changes can be in response to actual structural damage, such as an ear infection, injury or trauma to the ear, exposure to loud sounds, or ear diseases such as Meniere’s disease or an acoustic neuroma. Tinnitus can also start with more benign changes to the ear, such as gradual hearing loss due to aging, genetic factors, or prolonged noise exposure. Of course, like many other neuroplastic conditions, tinnitus can start in the absence of any structural damage at all. In these cases, psychosocial stresses influence neuroplastic changes in the hearing areas of the brain, which are perceived as the tinnitus sound.
What is important to understand is that even in cases of structural changes in the ears or gradual hearing loss, because the tinnitus sound is generated by neuroplasticity in the brain, not the ear, this sound perception can change. Just like pain, tinnitus can be a danger alarm that is turned on in the brain. Tinnitus is the ear’s equivalent of pain. And just like pain initiated by the brain with structural damage in the body, the danger signal often goes off once healing occurs. Even with structural changes in the ear that remain, the brain can learn to turn this alarm off once safety is established. This is where education about the benign nature of tinnitus can help to rewire the neural pathways that associate tinnitus with danger.
Here is one of the most powerful pieces of evidence I can offer you that tinnitus is neural pathways in the brain that can change: if you have a structural ear issue, it is either going to gradually heal in time or remain stable with slow, predictable changes. If your tinnitus is worsening over time or varies, meaning it does not follow the pattern of your structural issues, this variability is a major clue. Neuroplastic changes can be directly linked to psychosocial stress. In these cases, the tinnitus changes are occurring in the brain, not the body, due to stress, emotional strain, and factors unrelated to the ear. While structural issues remain constant, these stress-driven neuroplastic changes can fluctuate, spike, calm, and surge depending on what the brain perceives as dangerous in the moment.
Finally, even if you are hearing mechanical processes in your body such as muscles contracting, blood flowing, or your eustachian tube opening, if this is distressing, you can still treat this as a neuroplastic symptom. The sound itself is not harmful. What matters is the meaning your brain has attached to it. If you can shift the learned neural pathways that associate these sounds with threat, the tinnitus can be recognized as a neutral sensation and fall out of your awareness.
Regardless of whether there are structural changes in the ear or even mechanical processes in the body being heard, the neurology around this can change. This is where a shift from fear to curiosity becomes incredibly powerful. Instead of asking, “Why is this happening?” or “What if it gets worse?”, you can begin asking, “What might my brain be reacting to right now?” or “What emotion or moment did this spike coincide with?” When you approach tinnitus this way, the danger alarm loses its urgency. The sound becomes less of an alarm and more of a signal, a message from your nervous system that something emotional may need attention.
Tinnitus is not a life sentence or a sign that your ears are failing. It is an alarm that can be turned down once the brain no longer believes it needs to protect you. When you stop treating the sound as dangerous and start listening to what it represents, the brain no longer needs to keep the alarm switched on. And when the alarm is no longer necessary, it naturally quiets.
Dr. Marcia Dewey is an audiologist specializing in treating tinnitus and sound sensitivities as neuroplastic symptoms. She works at the Froedtert & the Medical College of Wisconsin in Milwaukee, WI. You can follow her on YouTube @Dr.MarciaDewey.
