Can Tinnitus Ever Be Pleasant?
In Romeo and Juliet, Shakespeare places two radically different kinds of sound at opposite ends of human experience. Romeo describes the voice of a lover as “silver-sweet,” like soft music to attentive ears. Elsewhere, he evokes the terrifying shrieks of mandrakes, sounds once imagined to drive listeners mad. More than four centuries later, this contrast offers an unexpected way of thinking about tinnitus.
Tinnitus research and clinical practice have understandably concentrated on why tinnitus becomes distressing. Cognitive behavioural therapy and related approaches have helped us understand how catastrophic interpretations, selective attention, fear, frustration, emotional responses, previous learning and patterns of behaviour can intensify tinnitus-related suffering. However, there may be a question that logically comes before all of these: why does tinnitus have the capacity to become a source of suffering in the first place?
One possibility is that the answer lies partly in the immediate qualitative character of the tinnitus percept itself.
People with tinnitus rarely compare what they hear to birdsong, beautiful music or the reassuring voice of someone they love. Their descriptions more often include hissing, buzzing, distorted static, alarms, screeching, mechanical noises or intrusive throbbing. Literature also contains similar imagery. T. S. Eliot wrote of a dull tom-tom hammering in the brain and the false note of cracked cornets, while Dante described thunder rolling within the head and ears pierced by cries of pain. These accounts do not establish a scientific definition of tinnitus, but they suggest that its perceived sound quality may deserve closer investigation.
The hypothesis explored in this paper is one of “necessary unpleasantness.” Immediate unpleasantness may be a necessary condition for tinnitus-related suffering, but it is not sufficient to produce that suffering by itself. In other words, an unpleasant percept may provide the platform from which suffering can develop, while cognitive, emotional, behavioural and contextual processes determine whether it develops, how severe it becomes and whether it persists.
This does not mean that everyone must find tinnitus equally unpleasant, or that tinnitus inevitably causes distress. Sound sensitivity, hyperacusis, misophonia, fatigue, stress, past learning and personal associations may all influence where an individual tinnitus percept falls on the continuum between attraction and aversion. Many people live with tinnitus without significant distress. The hypothesis concerns the percept’s potential to support suffering, not the inevitability of suffering.
This question may be particularly relevant to CBT practice. CBT does not need to deny or minimise the unpleasant quality of tinnitus. Instead, it can help individuals recognise that immediate unpleasantness and ongoing suffering are not the same thing. Even if the percept itself is unpleasant, the thoughts, emotions, attention patterns and behaviours surrounding it may remain open to change.
Can genuinely pleasant tinnitus exist? We do not yet know. It is an empirical question that may help connect the phenomenology of tinnitus with the psychological processes already studied so extensively. Before asking only why people suffer from tinnitus, perhaps we should also ask what tinnitus sounds and feels like at the moment it enters awareness.
With permission from Audiology News, we are pleased to share the full PDF of the article below.