Intentional Stress Challenge: Noise Exposure
Progressive challenge series to train resilience with the use of sound.
As a military audiologist, one of my primary jobs is to prevent the most common injury in the armed forces, noise-induced hearing damage. Loud sounds can chronically and/or instantaneously cause hearing loss. Damaged hearing can have detrimental effects on a person’s performance, especially in regard to communication capability and situational awareness.
Another consequence of injury to the inner ear is tinnitus or a persistent ringing sensation. Like the phantom-limb, where someone has lost an arm or leg but still feels pain, itching, burning, or other sensations where the limb used to be, tinnitus is a brain-derived phenomenon. The damage is in the peripheral nervous system but the bothersome sensation comes from the central nervous system, specifically the mind. These sensations occur because the body is full of nerves continuously communicating back and forth with our brains. The inner ear is lined with hair cells, all coded for different frequencies or pitches, that are constantly sending complex messages down our auditory nerve to our brains that then get decoded into speech, music, or sounds. When the system is disrupted, the brain still has regions coded for the damaged area and attempts to send it signals which can be seen on functional MRIs. If this produces unwanted symptoms like tinnitus, we unfortunately only reinforce that cycle by focusing on it. We often hear high-pitched ringing in response to hearing loss because it is the high frequency hair cell region that is most susceptible to damage. While there are other causes of tinnitus that can be ruled out, there is unfortunately no “cure” for this sensation when caused by permanent hearing loss. Due to its prevalence, however, there are many treatments on the market aimed at reducing or eliminating this phenomenon. Similar to many other medical symptoms and disorders, placebos have been shown to be as effective as any of the pharmaceutical treatments marketed for tinnitus. The most successful treatment for tinnitus has been shown to be habituation training which refers to conditioning of the mind to remove perceived significance from the sensation.
If you had never heard the sound of your refrigerator running before, you’d most likely be at least curious about what that noise was the first time hearing it. If everyone around you said they didn’t hear anything while you continued to be unsure of the sound’s source, it’s likely you’d attach a negative meaning to that sound. Is something broken? Is it a some sort of creature? Has someone secretly planted a device in my house to spy on me?! As you can imagine, a misunderstood sensation can produce significant concern causing that stimulus to become progressively more bothersome over time.
I’ve had patients understandably worried that their tinnitus was a symptom of a brain tumor or other life-threatening medical disorder. In rare cases, this actually is possible but there are many tests that can be done to rule out these scary pathologies. I’ve had other patients believe that their tinnitus was feedback from a medically-implanted device placed by the government, warnings from god for being a sinner, or signals from demons trying to drive them crazy. As you can imagine, it would be pretty difficult to live a normal life having such strong beliefs about the cause of ringing in your ears.
Once I’m able to rule out the possibly concerning causes of tinnitus and then counsel someone on the most common reason persistent tinnitus exists (phantom limb phenomenon), the challenge then becomes making this permanent consequence of hearing damage less bothersome.
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