The #1 Misconception About Tinnitus Treatment
The #1 misconception about tinnitus treatment is that because tinnitus is perceived as a sound, it must be primarily an ear problem. This critical error affects 99% of tinnitus treatment programs, leading people to focus solely on sound-based solutions.
However, my research over the past decade has revealed that tinnitus loudness is driven by the brain, not just the ear, and stems from an underlying neurological and physiological imbalance. In cases of severe tinnitus, the sound itself is not the primary problem—rather, the loud ringing is a symptom of a deeper medical condition of the brain.
This has profound implications about what on the design of tinnitus treatment protocols. To better explain this, I'll cover the following topics:
- What is tinnitus?
- What is clinically significant tinnitus?
- The #1 Misconception About Tinnitus Treatment
- Tinnitus is Due to an Underlying Brain Condition
- What is the best tinnitus treatment approach?
What is tinnitus?
The immediate cause of tinnitus relates to hearing loss (no matter how slight). Sound travels from the eardrum to the inner ear where ‘hair cells’ translate vibrational sound energy into nerve impulses that travel to the hearing part of the brain (auditory cortex).
When hair cells are damaged or the hearing nerve gets detached from them (a condition called cochlear synaptopathy), the signals from the auditory brainstem become hyperactive – not silent. This is the necessary set up for tinnitus; hyperactive and hypersynchrnous firing of auditory neurons that have become detached from inner ear cells.
Tinnitus is a Phantom Sensation
Tinnitus is hearing nerve hyperactivity interpreted by the brain as sound. The hearing center of the brain (the auditory cortex) senses the hyperactive signals coming from the auditory brainstem and says to itself, “I sense nerve activity… there must be sound”.
It’s like a phantom limb sensation. The arm or leg is gone, but the brain still “feels it” because the nerve going to the brain is still alive. Tinnitus is the same thing, a phantom sensation. The hyperactive signaling from the hearing nerves are being interpreted by the brain as sound.
However, this is NOT the root cause of tinnitus loudness. As you'll see below, the root cause of tinnitus loudness is an medical condition related to brain reactivity and sensory hypersensitivity.
What is clinically significant tinnitus?
Around 100 million Americans have some form of tinnitus. If you ask them to concentrate in a quiet environment, they’ll say, “Yes, I can hear it”. However, most of the time, their awareness of it just fades into the background. The hearing nerves are hyperactive per above, but the brain simply ignores the signal as irrelevant. This happens with sensory processing all of the time. It's called habituation.
Imagine the feeling of your socks on your feet. All day long, your brain receives sensory information from your feet, but you never think about it or notice it. However, when I ask you to pay attention to the feeling, you can easily feel the socks on your feet.
This is what it’s like for most people with tinnitus. The sensation is there… they can hear if you ask them to pay attention to it… but most of the time, their brain simply ignores it.
What is different about severe tinnitus?
In around 2-5% of the population, tinnitus becomes something else. It becomes loud, annoying, and intrusive. Functional domains like relaxation, concentration, and sleep become affected. Relationships and job performance suffer. Depression, anxiety, and despair can set in. So what’s going on?
In clinically significant tinnitus, the first problem is tinnitus loudness. This is related to a migraine-related condition that causes increased reactivity and sensory hypersensitivity in the hearing nerve. This amplifies the tinnitus sound, resulting in either fluctuating tinnitus loudness or a constant loud tinnitus.
The second problem is that brain becomes hardwired to amplify tinnitus. When tinnitus becomes loud, it begins to trigger neural connections other areas of the brain. This rewiring process (called neuroplasticity) connects the tinnitus sound to the fear center and attention network of the brain, making it so that the tinnitus sound is annoying and much harder to ignore.
Tinnitus gets hardwired to the brain's fear center. When this neural network gets activated, the ringing becomes coupled with the ‘fight or flight’ response and triggers alarm bells in the brain. We don't feel “fear” per se, but rather hypervigilance, distress, and anxiety.
The fear center is also the annoyance center of the brain. Similar to the sound of a baby crying or nails on a chalkboard, tinnitus activates the annoyance center in a deeply intrusive way, making the sound intensely irritating, which puts us on edge and makes us feel grumpy.
In the brain's attention network, the tinnitus sound gains ‘salience’, meaning that the brain categorizes it as a critical piece of information that cannot be ignored. It's impossible to “just ignore it” because it's no longer a conscious decision. The attention center becomes hardwired to notice the tinnitus.
The #1 Misconception in Tinnitus Treatment
The #1 misconception about tinnitus treatment is that the ear is the primary problem.
Tinnitus may start in the ear, but loud tinnitus is a brain problem, not just an ear problem. When people (and doctors) finally understand this about tinnitus, it changes the way they think about tinnitus treatment. Here are the 3 major ideas that come from this realization:
| New Idea | Impact on Tinnitus Treatment |
|---|---|
| Tinnitus is a medical problem. | Loud, annoying tinnitus is fundamentally a medical problem. For relief, you need a medical approach. |
| There's no quick fix. | Changing the brain's reactivity level and neural networks takes time. You need a rehabilitation approach. |
| It's bigger than you. | Overcoming tinnitus requires structured care. You need an integrative tinnitus treatment approach and a supportive team for success. |
The vast majority of tinnitus programs don't fully understand tinnitus. They may recognize that brain rewiring needs to take place to recover from tinnitus, but don't know why tinnitus loudness occurs… they only understand half the problem.
The fundamental driver of loud tinnitus is a brain reactivity and hypersensitivity. This means that it's related to an atypical migraine-like process. It's critical that you understand this, so please read on! This is what makes our program different and explains why 85-90% of patients improve in our program.
Why is my tinnitus so loud?
Have you ever wondered why tinnitus increases in loudness? It's because the brain goes through cycles of excitation-inhibition imbalance, commonly referred to as a “migraine reaction“. This has nothing to do with headaches!
Tinnitus and migraine are strongly linked. Both conditions are triggered by the same environmental factors such as stress, sleep disturbances, and dietary factors. They’re also both activated by something called “neurogenic inflammation”. And most importantly, they both respond to a similar treatment approach.
The migraine process causes increased sensitivity to sensory information. This increased sensitivity leads the brain to pay more attention to the tinnitus sound and causes it to perceive the tinnitus at a louder level. The greater the activation of migraine process, the louder the tinnitus sound will be.
Our clinical research is proving that atypical migraine drives tinnitus loudness. Further, our clinical studies show that when we treat this migraine process through various therapies, we can reduce tinnitus loudness. Finally, the key to optimal tinnitus treatment and long-lasting recovery!
What about constant loud tinnitus?
Constant loud tinnitus is also consistent with the migraine reaction. Migraine is a threshold condition, meaning symptoms occur when neural activity crosses a certain threshold. With periodic loud tinnitus, you move above and below this threshold. However, with constantly loud tinnitus, it indicates that you are consistently above the threshold.
Through targeted medical interventions, we can help bring your neural activity back below this threshold, reducing the perceived loudness of your tinnitus.
Migraine: A Sensory Processing Disorder
Migraine is a sensory processing disorder, not just a headache disorder. Many people get stuck on the thought, “I don’t have headaches… How can migraine be causing my tinnitus?”
While we all associate “migraine” with “headache”, migraine is something much more than that. Headaches occur because sensory signals from lining of the brain are amplified – the pain signal is amplified. With tinnitus, the migraine reaction affects the sensory signals coming fromm the ear – the tinnitus signal is amplified.
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Our Pioneering Research On Tinnitus Treatment
My university team has pioneered the research on otologic migraine and we were the first to describe it as a clinical entity. Since then, we’ve published over 30 articles on the way that the migraine reaction is involved in ear fullness, hearing issues, vertigo, Meniere’s disease, and tinnitus.
Here are some of our publications just as they concern tinnitus:
Tinnitus and Brain Inflammation
The migraine reaction is related to neurogenic inflammation, an inflammatory response in the brain that’s initiated by the release of chemical messengers called neuropeptides. This inflammatory response is the critical factor that drives the migraine process.
Neurogenic inflammation in migraine is driven by a neuropeptide called calcitonin gene receptor protein (CGRP). Research on CGRP has revolutionized migraine treatment in the past decade.
Most cells in the auditory system have CGRP receptors. When CGRP-mediated neurogenic inflammation occurs, it can directly affect the hearing organ and lead to tinnitus. This is the biochemical link between migraine and tinnitus.
What triggers the migraine reaction?
For people with loud tinnitus, there is a baseline excitation-inhibition imbalance in the brain. The migraine reaction occurs when specific triggers prompt the release of pro-inflammatory molecules (like CGRP). These molecules ignite a neurogenic inflammatory response, leading to alterations in sensory processing. This, in turn, results in sensory hypersensitivity and in this case, loud tinnitus.
Here are some common triggers of the migraine reaction:
- Certain foods
- Sensory overstimulation
- Stress and anxiety
- Poor sleep
- Physical trauma
- Atmospheric changes
- Hormonal changes
Managing Loud Tinnitus
Stopping the migraine process in the brain by managing triggers is a critical part of tinnitus treatment. Much of the initial stages of our tinnitus rehabilitation program concerns trigger identification and management.
Prescription medications can also help dampen the migraine reaction. In our clinical trials, we've discovered that certain migraine medications can significantly improve tinnitus severity. We offer these same medications in NeuroMed's tinnitus protocols.
The Complete Picture & How it Impacts Tinnitus Treatment
Finally, we get a complete picture of what is happening with loud tinnitus:
| Tinnitus Stage | Description |
|---|---|
| Initial Tinnitus Signal | Tinnitus is first caused by hearing cell loss. This results in a hyperactive sensory signal to the brain. In the absence of migraine, this signal is quiet and largely ignored (it's like socks on your feet). |
| The Migraine Reaction | People with loud tinnitus develop a baseline excitation-inhibition imbalance. When the migraine reaction is triggered, neurogenic inflammation causes sensory processing to go into overdrive. The once mild ringing sound now becomes loud and impossible to ignore. |
| Fear Center Activation | The loud tinnitus triggers activation of the fear center of the brain. The brain thinks, “What is this ringing? What’s happening? Am I losing hearing?”. From this point on, the brain registers the ringing sound as a threat. |
| Attention Center Activation | The loud ringing and fear center activate the attention center in the brain. In neurobiology, it has increased ‘salience’, meaning that the signal gets prioritized and registered as important. Now that tinnitus is a threat, it is top of mind. |
| Neural Network Activation | As time goes on, neural networks between the hearing center, the attention center, and the fear center become reinforced, such that the ringing sound becomes permanently registered as a “dangerous sound”. |
| Passive Activation | Now you can hear the tinnitus signal even when the migraine reaction is inactive (albeit not as loud). The more you notice it and worry about it, the stronger the neural networks become. This is passive activation. |
| Clinically Significant Tinnitus | At this point, you have clinically significant tinnitus. You can expect your quality of life to suffer and your emotional health to deteriorate unless you get structured medical attention. |
The good news is that this situation can be reversed. Severre tinnitus is treatable and that’s what the NeuroMed Solution is all about.
Why haven't I heard about tinnitus and migraines?
There's always a gap between when clinical discovers are made and when they're integrated into everyday practice. It’s called the “evidence-practice gap”. Studies have shown that it takes around 17 years for new evidence from medical discoveries to become standard practice.
We’re stuck in a world where doctors are still saying “nothing can be done” for tinnitus, but this is simply not true. Tinnitus is treatable!
What is the best tinnitus treatment?
Our research shows that combining migraine interventions with standard tinnitus treatments can accelerate tinnitus recovery. We're reaching 85-90% success rates with the protocols used at NeuroMed. The reason why most other treatment programs fail is that they ignore the migraine process that drives and amplifies the tinnitus.
This is the problem with ear-centric approaches to treating tinnitus. They’re falling for the #1 misconception about tinnitus treatment. Tinnitus masking alone, tinnitus retraining therapy (like Treble Health), hearing aids, and bimodal stimulation devices (like Lenire) will always fall short because they’re only treating part of the problem.
For true success, brain reactivity and the migraine process must be addressed. This is a medical problem and that means the best tinnitus treatment must come from a medical team. At NeuroMed, we offer true comprehensive tinnitus care. We use a research-based integrative medicine approach to treat tinnitus, ensuring accelerated recovery and providing remarkable outcomes.
Next Steps: Book a FREE Discovery Call
If you’d like to learn more about whether the NeuroMed program is right for you, you can set up a FREE Discovery Consultation, where our team will cover:
- How The NeuroMed Solution works and what's included in the program.
- Our science-backed approach to tinnitus relief with an 85-90% success rate.
- Any questions you have to see if our program is right for you.
- Success stories of patients who've recovered using NeuroMed's protocol.
- How you can “stop living with tinnitus” and get your life back.
Book your FREE Discovery Call today!
