#1 Critical Error in Tinnitus Treatment

Written by:

Dr. Hamid Djalilian

Otology & Neurotology

11 min read

The #1 Misconception About Tinnitus

The #1 misconception about tinnitus is that it's primarily an ear problem. Here I explain this critical error and how it impacts 99% of tinnitus treatment programs. Topics covered include:

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, the hearing nerves are still alive. Paradoxically, signals from the hearing nerve become hyperactive rather than dormant. These are the inciting factors for tinnitus.

Tinnitus is a Phantom Sensation

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 activity in the hearing nerve (the auditory nerve) 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. It’s hyperactive signaling from the hearing nerve 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 inflammatory reaction in the brain related to atypical migraine.

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, it mostly just fades into the background. The hearing nerve is doing hyperactive signaling, but the brain simply ignores it as irrelevant. This happens with sensory processing all of the time. It's called habituation.

the feeling of socks on your feet is what habituation is in tinnitus, you can ignore it most of the time

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 about severe tinnitus?

In around 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?

Your Brain Becomes Hardwired for Tinnitus

wiring image depicting how the brain becomes hardwired for tinnitus

In clinically significant tinnitus, the ringing becomes coupled with other areas of the brain. The brain undergoes a rewiring process (called neuroplasticity) where the tinnitus signal gets wired to the attention network and the fear center of the brain.

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. If someone says, “just ignore it”, it's impossible because it's no longer a conscious decision. The attention center has been hardwired to notice the tinnitus.

Tinnitus also gets hardwired in the 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 annoyance, distress, and anxiety. It puts us on edge.

The #1 Misconception in Tinnitus Treatment

otoscope and hearing test for tinnitus treatment

The #1 misconception about tinnitus is that it’s primarily an ear problem.

Tinnitus may start in the ear, but loud tinnitus is a brain problem, not 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
There's no quick fix.Changing the brain's neural networks takes time. We need to abandon the search for a “quick fix” and accept that we need a rehabilitation program.
Rehab = workYou’ve heard that it takes 28 days to change a habit? This is much the same. Only by engaging in daily structured activities can brain rewiring occur.
It's bigger than you.If this was easy, everyone would do it. You need medical help (sometimes including medications), regular support, and guidance to overcome tinnitus.
We change how we think about tinnitus when we fully understand the problem.

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 migraine reaction in the brain. 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 Does Tinnitus Fluctuate?

tinnitus is related to atypical migraine

Have you ever wondered why tinnitus fluctuates? It's because the brain goes through cycles of inflammation, commonly referred to as a “migraine reaction“. This has nothing to do with headaches!

Tinnitus and migraines 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 brain 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, the louder the tinnitus sound will be. 

Our clinical research is proving that atypical migraine drives tinnitus loudness. Further, our studies clinical studies show that when we treat the migraine reaction through various therapies, we can reduce tinnitus loudness. Finally, we understand the key to tinnitus rehabilitation and long-lasting recovery!

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. With tinnitus, the migraine reaction amplifies the tinnitus sound signal.

"Book the calI, it's worth it. I learned more about my tinnitus in the discovery call than from my doctor."

– Alice Lee

Female tinnitus patient Alice Lee

Ready for relief? NeuroMed can help.

Our Pioneering Research On Tinnitus

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:

2018The Role of Migraine in Hearing and Balance Symptoms
2021Tinnitus and Subjective Hearing Loss are More Common in Migraine
2022Migrainous Vertigo, Tinnitus, and Ear Symptoms and Alternatives
2022A Proposed Association Between Subjective Nonpulsatile Tinnitus and Migraine
2023Vestibular and auditory manifestations of migraine
2023Management of Migraine-Associated Vestibulocochlear Disorders
2023How Migraine Modulates Tinnitus
How our migraine research is revolutionizing tinnitus treatment.

Tinnitus and Neurogenic Inflammation

tinnitus and neurogenic 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?

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 outcomes like loud tinnitus or headaches. 

Here are some common triggers of the migraine reaction:

Managing Tinnitus Triggers

Stopping the migraine process in the brain by managing triggers is a critical part of tinnitus management. Much of the initial stages of our tinnitus rehabilitation program concerns trigger identification and management. 

You can have the migraine genetic background and never get a headache. Loud tinnitus can be its only manifestation. The good news is this process is reversible. No one has a permanent migraine process – it can be stopped and tinnitus can be made quieter.

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.

Tinnitus: The Complete Picture

ear showing tinnitus

Finally, we get a complete picture of what is happening with loud, clinically significant tinnitus

Tinnitus StageDescription
Initial Tinnitus SignalInitial tinnitus is 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 ReactionWhen 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.
Attention Center ActivationThis sensory perception of loud ringing activates the attention center in the brain. In neurobiology, it has increased ‘salience’, meaning that the signal gets prioritized and registered as important.
Fear Center ActivationThe fear center of the brain (the limbic system) also gets activated. 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
Neural Network ActivationAs 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 ActivationNow 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 TinnitusAt 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. 
Successful tinnitus treatment must address both the migraine reaction and neural network changes.

The good news is that this situation can be reversed. Clinically significant 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 treatment for tinnitus?

man smiling because of successful tinnitus treatment

Our research has revealed 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. Tinnitus masking alone, tinnitus retraining therapy, hearing aids, and bimodal stimulation devices (like Lenire) will always fall short because they’re only treating part of the problem. For true success, the migraine process in the brain must also be addressed.  

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. Moreover, our program empowers you to pinpoint and address the root cause of your tinnitus, offering a lifelong solution to the problem.  

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 by clicking HERE.

Dr. Hamid Djalilian

Otology & Neurotology

Dr. Hamid Djalilian, a tinnitus specialist and distinguished figure in the areas of otolaryngology, neurosurgery, and biomedical engineering, is NeuroMed’s Chief Medical Advisor.

Related topics:

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