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Rob

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Posts: 4,049
Reply with quote  #1 
I do not like the popularized term "reactive tinnitus" because I feel it is imprecise and inexact. Also, the term 'reactive' can unintentionally promote some less-than-realistic thinking about tinnitus, lead folks to avoid sound, and contribute to making it more difficult for them to manage and habituate their tinnitus.  The term 'reactive' tinnitus, a term which is used nowhere in the tinnitus literature, as far as I know, is a counterproductive term for our community.  
 
Just to clarify, I'm not saying this variant of tinnitus does not exist.  My tinnitus reacts to sound.  Even so, I think the term is counterproductive and I'll try to explain why.  
 
Reactive tinnitus is an over-generalized, inexact term. Nearly everyone's tinnitus reacts to something. Some folks' tinnitus reacts to stress; some tinnitus reacts when we wake up from a nap or a night's sleep; when some of us are tired, our tinnitus reacts to not getting enough sleep; and when some tinnitus sufferers consume alcohol, coffee, or salt, or take medicine, or eat too many sweets, their tinnitus reacts in turn.
 
And yet, although tinnitus reacts to all sorts of things -- to stress, to anxiety, to sleeplessness, to waking up -- still the term reactive tinnitus is somehow not about any of these things tinnitus reacts to, is it?  Rather, the term refers to how tinnitus reacts to exposure to some sound. Why aren't all these other things that I've listed examples of reactive tinnitus too?  Why only call it reactive tinnitus when our tinnitus appears to react to sound? That is what I meant when I said reactive tinnitus is an imprecise term. If everyone's tinnitus reacts to something, then everyone has reactive tinnitus, no?  Why use the term reactive tinnitus at all if we have to rule out some things tinnitus reacts to, but not other things it reacts to? How long must one's tinnitus react before we consider it reactive? If our tinnitus reacts for a half hour is it reactive? Or does it have to last for 24 hours? Or is it more than 24 hours?
 
But I have a much more important objection to the term.  It lends itself to folks' thinking unrealistically about tinnitus. Any number of times, folks participate on support boards like this one and claim that because their tinnitus reacts to some aural environments (or even all aural environments), it is therefore worse tinnitus than folks whose tinnitus does not react to sound in this way. Not only can this be a dismissive thing for people to hear whose tinnitus is not as reactive to certain aural environments but is extremely reactive to salt, sleeplessness, sugar, antibiotics, aspirin, alcohol, etc., but the folks with tinnitus that reacts to sound honestly believe their chances of turning the corner on tinnitus are significantly worse than someone whose tinnitus does not react to sound in this way. And in believing this, they are setting themselves up for a miserable ride.
 
We should never underestimate the power of what we tell ourselves when it comes to tinnitus. Most folks who honestly believe they are genuinely untreatable are unaware that many tinnitus sufferers with precisely the same symptoms have turned the corner on tinnitus. Not only isn't it true that people whose tinnitus reacts to sounds have worse tinnitus than people whose tinnitus doesn't react to sounds, it's not true that people whose tinnitus reacts to sounds can't habituate tinnitus and feel better. I believe the use of the term reactive tinnitus conditions those of us who use it to believe deep down that we are unfixable.  And I have seen this repeatedly based on the anecdotal reports of folks on Internet support boards.   
 
The words we use when we think about tinnitus are very important. If we use the term 'reactive tinnitus' and believe we have a type of tinnitus that is qualitatively different from another person's tinnitus, much worse than someone who does not have 'reactive' tinnitus, and nearly impossible to treat, we are setting ourselves up for a lot of heartache. There is an enormously powerful correspondence between the way we think about tinnitus and the way we end up feeling. And there is proof that the more realistically we think about tinnitus, the less intrusive it can become over time
 
I believe many of us can make an enormous difference in our lives with regard to getting a handle on intrusive tinnitus by doing three things:
 
1.) See an ENT, neurotologist or otoneurologist to make sure our tinnitus isn't due to some other treatable challenge.
 
2.) Educate ourselves about tinnitus so that we understand the basics.
 
3.) Work hard to identify any distorted thinking we have about tinnitus and replace it with more realistic thinking.
 
It isn't coincidental that folks with "reactive" tinnitus are more difficult to treat than other folks with tinnitus.  In my view, the reason this is so is due to the deeply-held views of folks with "reactive" tinnitus.  These views can impact their ability to successfully manage their tinnitus.  
 
Although people with reactive tinnitus are indeed more difficult to treat than others, there are no data to suggest that folks who have tinnitus that reacts to sound are more difficult to treat than tinnitus that reacts to stress, barometric pressure, anxiety, fatigue, wine, coffee, Chinese food, a stubbed toe, or standing on line at the grocery next to a garrulous giant who is reading the newspaper into our ear. 
 
Folks with reactive tinnitus are more difficult to treat not because of their tinnitus per se, but because of their beliefs about tinnitus and the beliefs held by their clinicians who, because they feel as they do, make no effort to challenge their patient's thinking in this regard.       
 
Rob
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cbBen

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Reply with quote  #2 
At first it may seem life-depleting but in time you learn to see the tinnitus as the lack of a threat that it is, and then think about it less and less. 

I never thought I'd "turn the corner," but know that now I most definitely have.

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Please resist the temptation to pick apart my post by quoting it piece by piece.
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Rob

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Reply with quote  #3 
I've put a few ideas about tinnitus in a separate thread because I don't want to argue about my views with anyone.  Arguing about tinnitus is like arguing about politics with a goldfish.  If these views are useful for you, I'm glad.  
 
I'm all for describing the attributes of one's tinnitus to our clinicians in the same way we would describe our symptoms about a flu.  In this respect, I agree with Debbie, Marsha, and anyone else who thinks it can be helpful to draw a picture of tinnitus for our clinician.    
 
I also believe it is axiomatic that making distinctions about the behavior of tinnitus often results in our remaining overly engaged with it in an unhealthy manner. Internet support boards are filled with individuals who are writing the biography of their 'reactive' tinnitus.  For example: 
 
-  I ran a fan and my tinnitus reacted to it. 
-  Because I was upset my tinnitus went through the roof. 
-  I had coffee and my tinnitus kept pace. 
-  I had wine and my tinnitus sounds like a mosquito on Quaaludes. 
-  I drove to the park and now my tinnitus is twice is loud as ever.
 
There is a fellow I know from the gym who is overly fond of regarding his musculature in the mirrors which, naturally, are all over the gym and create an immediate opportunity for the guy to fetishize his romance with steroids. He is the preening biographer of his muscles but, in one sense, he is not that different from folks who study their tinnitus and remain overly engaged with it to a degree where it contributes to their remaining emotionally overwhelmed by it. It is a short step from thinking in terms of how one's tinnitus 'reacts' to sound to avoiding exposure to normal environmental sound due to fear.
 
In most cases, the term 'reactive' tinnitus is used to connote tinnitus that is not the run-of-mill tinnitus and is accordingly far more difficult to treat and habituate than "normal" tinnitus. There is a belief amongst a lot of folks that when tinnitus fluctuates in this way due to exposure to certain sounds, it is not typical tinnitus. In fact, the opposite is the case. Fluctuating tinnitus which responds in some way to certain aural stimuli is normal tinnitus behavior.  
 
The term is also imprecise and overly general; everyone's tinnitus reacts to one thing or another. Is my tinnitus reactive because it tends to be very noticeable to me after I've had a nap or when I awaken from a night's sleep? Or is it more productive to describe my experience as 'an awakening response', a perfectly normal physiological event? If everyone's tinnitus reacts to something, does the term 'reactive' tinnitus have any descriptive utility? If the term can be detached from that unhelpful (and possibly inaccurate) subtext, we may ask what is the purpose of using a word which describes everyone's tinnitus if the word is intended to separate one type of tinnitus (purportedly easier to habituate) from another (supposedly more difficult to habituate)? 
 
A number of folks use the term to hang a well-developed sense of victimhood and hopelessness as if they were hanging a Christmas wreath outside a condemned home. I rarely hear anyone use the term in purely descriptive terms.   
 
And is the term even accurate if by 'reactive' we mean a tinnitus signal that has become louder upon exposure to certain sounds? A fairly good argument can be made via comparative tinnitus loudness matching tests that what changes is how one's brain processes the tinnitus rather than an increase in amplitude of the tinnitus signal when one is exposed to certain sounds.
 
My main objection to the term is that when folks use it, there is a subtext which goes "I have something unfixable, something far worse than garden-variety tinnitus." In other words, the prognosis for habituation is poor. That's why, in my view, to become too attached to the term is to risk participating in one's own negative counseling. I don't mean to generalize and say this is true of everyone -- only that it appears to be true of most folks who use the term.  It isn't the tinnitus per se that trips them up; it is their beliefs about the tinnitus that trips them up.   
 
It's true that the term 'reactive' is more explicable to folks, easy to grasp. The term honestly mirrors their experience, and they praise clinicians who use the term because they feel understood. But when the term is used as code for untreatable, its promotion by well-intended clinicians and patients alike is unhelpful to their cause and contributes to their remaining in a stuck place. I would argue that the very explicability of the term isn't helpful to tinnitus patients.
 
When the language we use to describe tinnitus to ourselves serves to sustain or preserve our sense of victimhood, or our sense of being stuck or untreatable, perhaps it's time to find another way to talk about tinnitus. That's why I like to refer to tinnitus as an 'aural apostrophe' and describe myself as a slumlord to tinnitus which rents space in my head.  Once, when tinnitus did not pay its rent on time, I threw its furniture out in the street.  You would be surprised how quickly tinnitus ponied up the rent after that.  If that description sounds like I'm making light of tinnitus -- of course I am.  I'm also completely serious, as well as one heckuva landlord.
 
Rob   
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