Before I begin, I want to express my deep respect for those living with tinnitus. My hope is to offer comfort and relief to those who are struggling, reminding them that they are not alone and that, with time and support, things can improve

If you’re struggling with tinnitus and have ventured onto YouTube, you’ve likely been flooded with endless advice: ‘It’s because of loud music!’ or ‘You just need to clean your ears.’ Everyone seems to have a quick fix, yet you’re still left asking: Why is my ear ringing like an alarm clock that never turns off?”

Let’s be honest, if everyone knew what caused tinnitus, we’d all be sitting in blissful silence right now, wouldn’t we? But no, tinnitus sufferers are still here, ears buzzing away, trying to figure out which of the thousand causes is the real culprit.

I would like to metaphorically compare my journey to the book We’re Going on a Bear Hunt because, in a way, the “bear” can represent the noise and discomfort of tinnitus itself. It’s been a journey of facing obstacles with different strategies, much like the family in the book traverses rivers, mud, and forests.

“Uh oh! A river! A deep, cold river! We can’t go over it. We can’t go under it. Uh oh! We’ve got to go through it!”

 Just like in the book, some challenges with tinnitus must be faced head-on; they can’t be avoided or sidestepped. When the tinnitus intensifies (like the bear suddenly appearing), it can feel overwhelming, and you might feel the urge to retreat into coping mechanisms, seeking relief from the discomfort. Here, I’ll also discuss masking and avoidance strategies. However, these challenges often can’t be avoided, and they can’t always be fully resolved by running away.

So let’s break down all the things that could be causing tinnitus. But spoiler alert — by the end, we’ll all probably still be scratching our heads (and maybe our ears).

And so it begins…

1. Earwax Build-up: The Classic Suspect

Everyone’s favourite go-to cause: earwax. Yes, that tiny, sticky villain that apparently has the power to make your ears scream. In England, that’s where your tinnitus journey likely begins. You try hard to book a GP appointment, hoping and praying it’s just an infection. But once that’s ruled out, your GP sends you to the pharmacist, who kindly suggests olive oil drops. Voilà! Your tinnitus will magically disappear, right? Well, unless it doesn’t. In which case, back to square one.

Uh oh! A river! A deep, cold river! We can’t go over it. We can’t go under it. Uh oh! We’ve got to go through it!

2. Bad Posture: Wait, My Neck is the Problem?

Did you know your neck could be the reason your ears are ringing? You’ve been hunched over your laptop, neck craned forward like a giraffe, and somehow that causes tinnitus. Apparently, poor posture can trigger hyperactivity in your neck muscles, which in turn makes your ears decide they’re a concert hall. An orthopaedic pillow might just be the thing to calm your neck down, and with it, your tinnitus. Or at least make your naps more comfortable. And so I went to check this research by consulting an orthopaedic specialist.

Voilà! Despite all my efforts — countless downward dogs, hours spent perfecting warrior poses, and my relentless dedication to daily yoga — apparently (or so the specialist noticed; I can’t judge based on this X-ray), my head has decided to lean into a more “forward-thinking” position.

However, the screen below was much clearer to interpret and revealed that my head is 2.79 cm forward! What an interesting discovery. These deviations are a crucial factor for cervical pain and tinnitus.

There is growing evidence suggesting a connection between cervical spine dysfunction, muscle tension, posture, and tinnitus. Now, let’s take a closer look at cervical pain together to see if you have any of these symptoms…

Cervical pain, commonly referred to as neck pain, is associated with a variety of symptoms. Here are some of the most common ones:

• Neck Pain or Stiffness: This can range from a dull ache to sharp pain when moving the neck.
• Limited Range of Motion: This involves difficulty turning or tilting the head due to stiffness or pain.
• Headaches: Often located at the base of the skull and sometimes radiating toward the forehead or behind the eyes (cervicogenic headaches).
• Pain Radiating to Shoulders or Arms: When nerves are irritated or compressed, pain can radiate from the neck down to the shoulders, arms, or hands.
• Muscle Spasms: Involuntary tightening of neck muscles, leading to stiffness and pain.
• Tingling or Numbness: This is often felt in the arms, hands, or fingers if nerves are involved.
• Weakness: Affected muscles in the arms or hands may feel weak, a sign of nerve compression.
• Grinding or Popping Sensations: This involves feeling grinding, popping, or clicking when moving the neck, often indicating joint issues.
• Dizziness or Lightheadedness: These can occur with certain types of cervical issues, particularly when blood flow or nerve function is affected.
• Tinnitus: Cervical pain, especially due to postural issues or muscle tension, can contribute to the perception of ringing in the ears. This is actually the reason I’m writing this.
• Fatigue: Ongoing pain can lead to tiredness and a lack of energy.
• Difficulty Sleeping: Pain and discomfort may interfere with sleep, particularly if lying down aggravates the symptoms.

So, not only is tinnitus a pain in the neck, but it may also be caused by pain in the neck! Please forgive my cheap humour, but in a way, I want to subtly convey throughout the article, and between the lines, the idea that we should remind ourselves to be more relaxed and playful in life, as this can also help with tinnitus

Uh oh! A river! A deep, cold river! We can’t go over it. We can’t go under it. Uh oh! We’ve got to go through it!

3. Vitamin B12 Deficiency: Oh, I’m Just Low on B12?

For those who thought tinnitus was all in the ears, think again! Turns out, low Vitamin B12 can make your ears buzz like a broken TV. So, is the solution as simple as popping a B12 pill? Maybe. But even if you gulp down supplements like sweets, don’t be too surprised if that ringing doesn’t pack its bags and leave overnight.

As for me? I checked my B12, and it was fine.

Uh oh! A river! A deep, cold river! We can’t go over it. We can’t go under it. Uh oh! We’ve got to go through it!

4. Blood Sugar Levels: Yes, Even Your Sweet Tooth Can Cause Tinnitus

Oh, you thought sugar was just bad for your teeth and waistline? Think again! High blood sugar doesn’t just give you cravings — it can also throw your inner ear into a tailspin. Too much sugar? Say hello to buzzing ears. Too little sugar? You guessed it: more buzzing. It’s like your ears are stuck in a never-ending sugar crash.

Research proves that tinnitus can be caused by high levels of insulin and sugar in the blood. This is because the inner ear and brain depend on blood sugar, and high insulin levels can deplete vital nutrients, such as B vitamins, leading to nerve damage (here we are again!).

Interestingly enough, I was pre-diabetic, but with a different diet, as shown below, I completely reversed the problem. This may also be why my tinnitus is no longer an issue. Keep in mind, I exercise every day and am not overweight, so don’t rule out insulin resistance as a potential factor.

According to studies, anywhere from 84% to 92% of people with tinnitus have been found to have insulin resistance. This was observed in clinical studies conducted in Brazil and published in the International Tinnitus Journal. So maybe your pancreas has been keeping this little secret from you all along.

Perhaps you may want to consider asking your doctor to check your insulin levels when diagnosing tinnitus.

Uh oh! A river! A deep, cold river! We can’t go over it. We can’t go under it. Uh oh! We’ve got to go through it!

5. Genetics

• Genetics: Ah, here’s something. Some people are just genetically predisposed. My grandmother had severe tinnitus, but the good news is, it mysteriously disappeared after she retired. Interesting, right?
• Polycystic Ovary Syndrome (PCOS): This is usually linked to insulin resistance in women.

Uh oh! A river! A deep, cold river! We can’t go over it. We can’t go under it. Uh oh! We’ve got to go through it!

6. Hyperactivity in the Auditory Cortex: The Brain’s Version of “Let’s Make Noise!”

More sciencey stuff. Take your time, but if you have tinnitus, I highly recommend listening to this great talk by Josef Rauschecker:

Tinnitus: Ringing in the Brain | TEDxCharlottesville.

Sometimes, tinnitus is not about your ears at all — it’s your brain that’s to blame. When your ears aren’t sending normal sound signals, your brain decides to step in and create its own noise. It’s like your brain got bored and thought, “Hey, let’s fill the silence with some buzzing!” I’ve summarised some key points for you:

👂 Tinnitus is not a real sound but a phantom sound generated by the brain.

🤯 The brain compensates for damage to hair cells in the inner ear by filling in gaps, which leads to tinnitus.

🧠 Tinnitus is not purely an auditory disorder; it is also influenced by the limbic system, the part of the brain responsible for regulating emotions.

Tinnitus is strongly affected by emotional and stress systems in the brain, especially in a part called the limbic system, which controls our emotions. When you’re feeling stressed or upset, your tinnitus is likely to get worse. Josef Rauschecker explains that this system in the brain communicates with our senses, like hearing, and can either make sounds seem louder or quieter.

At the heart of the issue is a “noise cancellation” system in the brain, which normally filters out unnecessary internal sounds, like the ringing in tinnitus. In people with tinnitus, however, this system — particularly in areas like the ventral medial prefrontal cortex and the nucleus accumbens — doesn’t work properly. These brain regions usually help to block out unwanted noise, but when they malfunction, the brain struggles to cancel out the phantom sounds, which results in tinnitus.

The below slide is illustrating hyperactivity in the auditory cortex as observed in patients with tinnitus compared to individuals without it (controls). Here’s a breakdown of what it shows:

1. FMRI: This stands for functional Magnetic Resonance Imaging, a technique that measures and maps brain activity. In this case, it’s being used to observe how the brain’s auditory cortex responds.
2. Controls: This refers to people without tinnitus. In the image of their brain scan (on the left), you can see some activity in the auditory cortex (the area that processes sound), but it’s more subdued.
3. Patients: This refers to people with tinnitus. In their brain scan (on the right), you can see much more activity in the auditory cortex — shown by the bright orange areas. This “hyperactivity” suggests that the brain is still processing sound even when there isn’t any external sound present, which could explain why people with tinnitus perceive that constant ringing or buzzing.

Essentially, the brain is “creating” noise that isn’t really there!

Why is that?

Tinnitus occurs because of changes in how the brain processes sound. This can happen for several reasons:

1. Hearing loss: As we get older (yep, the joy of aging — hello grey hairs, creaky knees, and now… tinnitus!), the brain gets less input from the ears. In response, the auditory cortex may become hyperactive, trying to “fill in” the missing sounds, which leads to the ringing or buzzing.
2. Damage to the ear: Damage to the inner ear or the auditory nerve can cause faulty signals to be sent to the brain, which it misinterprets as sound.

3. Neural rewiring: The brain is always adapting. When it doesn’t receive normal sound signals, it may “rewire” itself in ways that cause overactivity, leading to tinnitus.

😥 Stress plays a major role in tinnitus, often making it worse by increasing the brain’s sensitivity to the phantom noise. When you’re stressed or anxious, your brain chemicals like dopamine and serotonin, which regulate mood, can become imbalanced. This imbalance can lead to depression, which in turn might amplify your perception of tinnitus.

Stress and anxiety may not cause tinnitus directly, but they certainly turn up the volume. It’s like having a smoke detector that goes off for burnt toast — not a real fire, but the alarm makes it feel like an emergency. And if you’ve been through a traumatic experience (like a real fire in the past), that alarm feels even more frightening. Stress heightens your brain’s sensitivity, so even the mild buzzing of tinnitus can suddenly feel like a full-blown siren. Your brain, already on high alert, starts treating that background noise like a significant threat, even when it’s just minor static.

Essentially, the brain compensates for lost or altered sound signals by producing its own noise, leading to the sensation of tinnitus.

Uh oh! A river! A deep, cold river! We can’t go over it. We can’t go under it. Uh oh! We’ve got to go through it! And you decide to see a CBT therapist

And they will explain like this:

I am going to simply this for you and break down:

1. Normal Hearing Process:

• Sound waves enter the ear and cause vibrations in the eardrum and inner ear structures.
• These vibrations are converted into electrical signals and sent to the brain via the auditory nerve.
• The brain processes these signals, and “noise” is filtered out, only allowing meaningful sound to reach your awareness.
• Finally, the sound is perceived.

2. Tinnitus Onset:

• Tinnitus can occur after a concert, an infection, hearing loss, or trauma.
• During tinnitus, the brain might hear sound even when no external sound is present. The filter (which normally blocks irrelevant sounds) may become faulty, allowing the brain to perceive “phantom” sounds like ringing, buzzing, or humming.

3. Worrying Thoughts:

• When tinnitus occurs, it’s common to have worrying thoughts about the noise. Some common thoughts might be:
• “My ears are damaged.”
• “I can’t cope with this.”
• “It will never stop.”
• These thoughts often lead to emotional distress, causing feelings of anger, fear, or frustration.

4. Associating Noise with Danger:

• The brain begins to associate the noise with danger because of the negative thoughts and emotional distress.
• This creates a cycle where the brain filters the sound as something that signals danger (even though it’s harmless).

5. The Filter Malfunction:

• If your brain believes tinnitus is dangerous, it becomes hypersensitive, and the brain allows the noise to come through constantly to “keep you safe” by making you aware of the sound.
• The problem is that tinnitus isn’t dangerous, but the brain’s “filter” is now set too high, making the sound more intrusive than necessary.

But what’s the implication?

This implication is that the cycle can continue unless interrupted by challenging negative thoughts, managing emotional reactions, and changing behaviours.

Traditional CBT focused heavily on changing negative thoughts, but modern CBT places more emphasis on a Biopsychosocial model and mindfulness (thank goodness for that!).

A possible Traditional CBT formulation:

• Trigger: (Tinnitus or Ear Damage) sets off the cycle.
• Negative Thoughts: (“I can’t cope”, “It’s permanent”) arise in response to the tinnitus.
• Emotions: (Anxiety, Fear, Frustration) are triggered by these thoughts.
• Physical Symptoms: (Increased awareness of tinnitus, stress) result from heightened anxiety and focus.
• Behaviours: (Checking, Avoiding quiet environments) are efforts to cope but often reinforce the cycle by keeping attention on the tinnitus.

Weaknesses of Traditional CBT in Tinnitus Management

Cognitive Restructuring Limitations:

The essence of traditional CBT is about reshaping thoughts, as if it’s trying to reprogram your brain to handle challenges — like the constant ringing of tinnitus — by encouraging different ways of thinking. But let’s be honest, tinnitus isn’t simply a trick of the mind. It’s more like an annoying, persistent roommate who refuses to leave, no matter how much logic you throw at it. While cognitive reframing can be useful in some situations, when it comes to tinnitus, it can feel like trying to solve a jigsaw puzzle with missing pieces. It often risks overlooking the deeper emotional layers of frustration and exhaustion that come with tinnitus, leaving you feeling like you’ve been told to ‘just think positive’ while an alarm blares in your ear.

As we’ve discussed before, tinnitus is strongly influenced by emotional and stress systems in the brain, particularly in the limbic system, which controls our emotions. Because of this, addressing tinnitus requires more than just rethinking thoughts — it’s about working with emotions, too. Traditional CBT focuses on changing thought patterns, but when it comes to tinnitus, a more effective approach might involve working with emotional regulation and stress management. The goal is not just to “reframe” your thinking but to address the underlying emotional responses that keep the tinnitus signal heightened, which could lead to more lasting relief.

Lack of Addressing Subconscious Influences:

The automatic negative thoughts that people with tinnitus experience are often echoes of deeper subconscious fears, rooted in trauma or unresolved emotional pain. To truly heal, we need to go beyond the surface and explore the unresolved emotions at their core. This requires bringing understanding and compassion to the subconscious mind, making the unconscious conscious and addressing the pain where it truly begins.

Behavioural Interventions Can Reinforce Attention:

Traditional CBT focuses heavily on behavioural modification, encouraging patients to reduce checking behaviours or avoid quiet environments that may amplify their tinnitus. Yet, these interventions often overlook the root cause of the behaviour — an anxious mind striving for control. When behaviours are merely suppressed without addressing the underlying emotional distress, the mind’s vigilance is heightened, not lessened. These attempts to control or avoid tinnitus may actually reinforce its presence, keeping it firmly in the foreground of awareness. The mind, like the body, cannot be controlled into submission; it must be approached with compassion and understanding.

I don’t think it’s possible to simply say to yourself, ‘Okay, stop checking’ or ‘Decrease the amount of checking.’ However, I’m open to hearing your thoughts on this. I suggest that instead of trying to resist or constantly monitor the tinnitus, you should observe it from a detached space. By doing so, you stop feeding energy into the fear or anxiety around it. Bringing attention back to the present moment and not being consumed by the checking allows you to gradually move into a state of acceptance and peace.

I’ve learned that the more you fight something, the stronger it becomes. When you obsess over your tinnitus, you give it power. Instead, observe it. Be a witness to the sound without reacting. Let it be, and see that you are separate from it. The mind will try to create an issue, but with awareness, you can transcend it.

Gently inquiring into your need to constantly check can help you uncover the emotional or psychological triggers behind this behaviour.

How?

Rather than judging or counting the checking, you can ask yourself, ‘What is this trying to tell me?’ or ‘What am I afraid of if I don’t check?’ Through gentle self-inquiry, you can bring understanding and compassion to your experience rather than resisting it.

Compulsive checking can be a way of distracting yourself from deeper emotional pain or discomfort. Some of my clients know this all too well — checking can often be rooted in unresolved stress or trauma, and tinnitus becomes a focal point for these unresolved feelings. I encourage a compassionate exploration of your emotional history to understand why the mind clings to these habits. The goal isn’t just to stop the behaviour, but to heal the underlying wounds that drive it.

Focus on Symptom Reduction vs. Acceptance:

Much of traditional CBT is geared toward reducing symptoms, aiming for relief through behavioural change. However, when tinnitus is chronic and unresolvable in a literal sense, symptom reduction becomes a limited goal. Efforts to eliminate distress may paradoxically keep attention fixed on the tinnitus itself, feeding a cycle of resistance. What is often needed is not to manage or eliminate the sound, but to accept it. The pain lies not in the sound itself but in our resistance to it. Acceptance shifts the paradigm from control to peace — allowing the sound to exist without the constant fight against it.

Over-Focus on Thought Change:

While cognitive restructuring seeks to target and change maladaptive thoughts, it often neglects the more intense and visceral emotions that people with tinnitus feel. Anxiety, fear, and frustration are not mere mental constructs to be reprogrammed; they are the body’s signals, cries for attention to the underlying emotional distress that demands validation and care. These emotions are not obstacles to be overcome but messengers of deeper needs that have been long ignored. True healing requires us to move beyond thought correction and toward emotional processing and integration.

Inadequate Addressing of the Persistent Nature of Tinnitus:

Traditional CBT is built on the premise that maladaptive thoughts can be corrected, leading to a reduction in distress. But when tinnitus is a constant and persistent presence, there is no quick fix or “cure” for the condition itself. Traditional CBT, with its focus on eliminating symptoms, may inadvertently foster unrealistic expectations, leading individuals to believe that their distress can be entirely erased. This can set them up for disappointment and further emotional turmoil. Instead, a more compassionate approach would prepare clients for the ongoing nature of tinnitus, helping them build resilience through acceptance, not the promise of eradication. Acceptance is the key to living fully even in the presence of the unchangeable.

Uh oh! A river! A deep, cold river! We can’t go over it. We can’t go under it. Uh oh! We’ve got to go through it! And you decide to see a CBT therapist (with Tinnitus, maybe they know a bit better)

However, there has been a focus shift in modern CBT:

My Alternative Formulation:

1. Trigger: (Tinnitus or Ear Damage)

• The sound or sensation of tinnitus is still present, but this formulation reframes how we respond to it.

2. Mindful Acceptance:

• Instead of viewing tinnitus as something to fear or fight, the individual practices acceptance of the sound. The thought process changes from “I can’t cope” to “I can notice this sound without reacting to it.”
• Thoughts like “It’s just sound, not danger” or “I don’t have to like it, but I can allow it to be there without judgment” begin to replace negative interpretations.

3. Calm Emotions:

• With acceptance, emotions shift from fear and anxiety to calmness and tolerance.
• By not treating tinnitus as a threat, there’s less emotional escalation. This reduces the body’s stress response and encourages emotional resilience.

4. Physical Relaxation:

• As the emotional distress lessens, physical symptoms such as heightened awareness and stress also decrease. Mindful breathing, body scanning, or relaxation exercises can help the individual feel more grounded and reduce tension associated with tinnitus.
• This approach encourages feeling bodily sensations without interpreting them as danger.

5. Adaptive Behaviours:

Most people, myself included, are often unaware of the effects that sound and silence have on the body and mind, even amidst the noise pollution so characteristic of cities. We should, in fact, talk about a BioPsychoSocial Model to better understand tinnitus. It’s essential for our emotional well-being to take control of the soundscape around us. You can perhaps read between the lines my first hypothesis: our nervous system is already overstimulated by sounds, and the last thing you want to do is add more noise. While masking noise may provide short-term relief, it ultimately causes harm and certainly offers no freedom in the long run.

This idea of habituation applies not only to tinnitus but also to our emotions and feelings. Just like with tinnitus, when we experience strong emotions like anxiety, sadness, or anger, our first instinct might be to suppress or mask them, hoping they’ll go away. However, by doing so, we never give our brain the chance to get used to or process these emotions. This is similar to how masking tinnitus prevents habituation.

Feelings and Thought Suppression:

When we suppress our emotions, we’re essentially telling our brain that these feelings are dangerous or too overwhelming to handle. Much like the brain that doesn’t habituate to tinnitus (represented by the green line), it keeps paying attention to the emotions, amplifying them instead of allowing them to naturally fade.

On the other hand, when we allow ourselves to fully feel and express our emotions — without judgment or suppression — our brain learns that these emotions, while uncomfortable, are not dangerous. Over time, just as with habituating to tinnitus, the brain’s response to these emotions decreases, and we become better equipped to handle them. This is akin to the healthy control in the blue line — our brain begins to habituate to these feelings, reducing their intensity over time.

So, whether it’s tinnitus or difficult emotions, the key is to stop masking or suppressing them. Instead, allow yourself to acknowledge and sit with the discomfort. In doing so, you help your brain gradually adjust, leading to greater peace and less distress in the long run.

This is why I’m against masking the noise, as awareness is often far more effective than simply covering up the sound. I advocate for mindfulness over avoidance, emphasising the power of embracing discomfort rather than trying to escape it. In both my personal experience and in working with others, I’ve seen that true transformation arises from awareness, acceptance, and understanding of one’s inner experiences, including sounds that might initially cause distress.

If you really feel the need to mask the noise, white noise, which resembles the sound of hissing air or rushing water, can help block out unwanted sounds. But beyond neutralising or masking noise, you can consciously choose to listen to sounds that have a positive impact on your mood. Unlike most artificial sounds, nature’s sounds — such as wind rustling through trees or water flowing over rocks — are complex and may provide nourishment for the brain.

By bringing attention to the sound without resistance or judgement, you begin to see it for what it is — just a sensation. Once you fully accept it, you stop being its victim.

Alternative CBT Formulation Diagram Summary:

• Trigger (Tinnitus or Ear Damage) ➜ Mindful Acceptance (“It’s just sound, not a threat”) ➜ Calm Emotions (Tolerance, Calm) ➜ Physical Relaxation (Lowered stress) ➜ Adaptive Behaviors (Engagement in meaningful activities, mindful presence)

I used the word trauma didn’t I? How can trauma impact?

Uh oh! A river! A deep, cold river! We can’t go over it. We can’t go under it. Uh oh! We’ve got to go through it

Heightened Sensitivity and Trauma: The Body is Always Listening

I want to illustrate the idea that the brain and body unconsciously detect threats, often based on something similar to a past event. These threats might come in the form of reminders — a smell, a sound, an image — that can trigger a response, even when we aren’t aware of it. Much like Alexa in many households, our body-mind system is always listening and vigilant, especially when there are unresolved traumatic experiences.

When trauma remains unresolved, it often leaves individuals in a state of hypervigilance, where the mind and body are constantly on high alert, scanning for potential threats. This heightened sensitivity makes internal sensations, like tinnitus, feel more intrusive and distressing. Of course, people may feel stuck or feel as if the threat is real — even when it’s not. Regardless of whether the threat is real or perceived, the stress response in the body becomes very active, leading to increased cortisol levels, which can further aggravate symptoms like tinnitus.

Some clients often say, “But nothing really triggers me.” Yet, just like Alexa, your body is always listening — scanning, filtering, and ready to respond to any cue, even when you’re not consciously aware of it.

In psychology, Alexa’s constant scanning can be explained and proven by the cocktail party effect, where the brain filters through a noisy environment and focuses on a single conversation, even picking out your name in the background without conscious effort. The brain is constantly monitoring its surroundings, sorting out what is important and what isn’t. In the case of trauma, the body-mind system is doing something similar — staying hypervigilant, always on guard, even when people aren’t aware of it. This scanning keeps the body in a state of stress, reinforcing a loop of anxiety and tension that maintains the body in a heightened state of alert.

Trauma often leaves people with an overactive stress response system!

When the brain is used to being in “fight-or-flight” mode, the stress hormone cortisol is constantly elevated.

Hypervigilance, then, is the body’s way of maintaining this survival mode, where even if no clear threat is present, the nervous system remains wired for danger. This leads to the feeling of always being “on edge,” making it harder to relax, sleep, or stay in the present moment. Understanding that your body is constantly scanning, much like Alexa, helps explain why certain symptoms, like tinnitus, worsen under stress.

Triggers

In therapy, we often talk about triggers, and I think no one explains this better than Dr. Gabor Maté, a renowned physician and trauma expert who focuses on the connection between mind, body, and illness. He illustrates the concept of triggers with a powerful analogy:

“I want you to think about the trigger as part of a weapon. The trigger is just a small piece, but the real issue is the loaded gun — the explosive material inside. When you’re triggered, it’s not the external event that’s the problem; it’s the ammunition within you that’s ready to explode. That’s the pain, the trauma, you’ve carried for years. Instead of focusing solely on the trigger, the rich learning is in becoming curious about your ammunition.”

In therapy, both the therapist and the client must explore this “ammunition” — the deeper emotional wounds carried within, often stored in the subconscious mind.

I propose that working with tinnitus is not just about managing the symptom; it’s about uncovering and healing the deep-rooted wounds that drive this ailment, transforming the way we relate to ourselves and the world.

Emotions, thoughts and trauma.

Our emotions are not just fleeting feelings; they carry deep memories and unresolved pain. When we experience stress or emotional distress, it can lead to patterns like overthinking, analysis paralysis, and catastrophising — cognitive distortions that serve as coping mechanisms, albeit unhealthy ones. These patterns attempt to shield us from unprocessed pain, but in doing so, they magnify our stress response. This prolonged stress raises cortisol levels, affecting not only our mental health but also contributing to physical ailments. The body and mind are deeply interconnected, which is why symptoms like chronic pain or tinnitus often worsen when emotional distress is present.

Tinnitus, on its own, can be emotionally distressing, but for someone with a history of trauma, it can feel even more overwhelming. Trauma survivors often struggle with anxiety, depression, or PTSD, and tinnitus amplifies these challenges. For many, tinnitus feels like another uncontrollable element in their lives, echoing the helplessness and lack of control they once experienced during their trauma.

As Josef Rauschecker’s research shows, tinnitus is closely tied to the emotional brain, particularly the limbic system. Trauma makes the brain more sensitive, both emotionally and physically, which heightens the perception of tinnitus. This isn’t just a psychological experience — it’s a physiological one. The nervous system remains in a state of hypervigilance, making it harder for the brain to filter out the constant ringing. The heightened emotional circuits amplify the noise, compounding stress, anxiety, and the feeling of being overwhelmed.

Moreover, trauma often disrupts sleep and concentration, and tinnitus exacerbates these very symptoms. Difficulty sleeping or focusing makes the tinnitus more noticeable, creating a vicious cycle where trauma and tinnitus feed off each other. The mind, already on high alert from past wounds, struggles to manage both the emotional and auditory disturbances.

In essence, unprocessed trauma sensitises the brain to both emotional and physical stimuli, making tinnitus feel more intense and difficult to manage. True healing involves addressing these emotional roots. By becoming aware of and working through the unresolved pain, we can reduce the brain’s heightened responses — leading to greater balance and ease, both emotionally and physically.

My Tinnitus Diary:

Through my observations, I’ve noticed certain conditions that seem to exacerbate my tinnitus. Overtraining, having COVID, or the flu all seem to trigger it. Swimming in the sea during the English winter also used to trigger my tinnitus, although this has improved over time as I do it less frequently. However, staying in a cold environment without moving seems to be a major factor. Oddly, if I play football outside in 5-degree weather, I have no issues, but staying inactive in cold weather or being exposed to a cold wind aggravates it. Sleep deprivation, overthinking, and seeing too many clients also seem to make my tinnitus worse. Loud environments like concerts, gigs, or even just general noise can trigger my tinnitus as well. Interestingly, I once noticed that ice cream immediately triggered my tinnitus. On the flip side, using the sauna, steam rooms, or being in the warm Scirocco winds in Sicily never seem to trigger my tinnitus.

Additional observations about my neck pain and body:

• Neck Pain or Stiffness: I always experience stiffness at the end of my workday.
• Limited Range of Motion: While I don’t have major issues with range of motion, my neck does feel very stiff after work.
• Headaches: I only experience headaches very rarely.
• Pain Radiating to Shoulders or Arms: I no longer have this issue, but I suffered from pain in my hand due to a pinched nerve for six months. Interestingly, my acupuncturist was convinced that the problem originated from my neck, not my hand.
• Muscle Spasms: I don’t experience muscle spasms.
• Tingling or Numbness: I haven’t experienced these symptoms.
• Weakness: Thankfully, I haven’t experienced weakness.
• Grinding or Popping Sensations: I frequently experience this after work.
• Dizziness or Lightheadedness: I do notice this when I’ve been working more than usual.
• Fatigue: Fortunately, I don’t have this problem.
• Difficulty Sleeping: This happens very rarely for me

My Take:

Please note that I am speaking from my own experience, and what works for me may not apply to everyone, as tinnitus causes can vary greatly from person to person.

Upon reflection, I’ve noticed that my tinnitus seems to be influenced by a combination of cold, stress, and auditory surroundings, though the cold itself isn’t always the primary factor. I’ve observed that the cold causes my shoulders to tense up, leading to stiffness in my neck. This tension spreads throughout my body, tightening the muscles around my neck and shoulders. I suspect that this tension could be compressing nerves or restricting blood flow, particularly when my posture is poor. It’s almost as if the cold amplifies the tension, making my neck even tighter and increasing my perception of tinnitus. This pattern seems especially clear after sitting for long periods with my head slightly leaning forward, which exacerbates the situation.

During the day, my tinnitus is almost absent, but at night, when I lie down and place my head on the pillow, it becomes more noticeable. This could be due to the quiet environment, where distractions are minimal, and my focus shifts inward. However, I’ve come to believe that the root cause has more to do with the tension in my neck and muscles because I tested this theory in isolated and quiet places. Even when I focused intently on my hearing, I heard nothing. This challenges a common myth — at least for me. While it’s true that focusing on tinnitus tends to make me notice it, I’ve also realized that when I don’t have tinnitus, even deliberately focusing on my ears doesn’t bring it about.

Interestingly, even in very quiet environments, such as isolated places, I rarely notice tinnitus during the day. This reinforces my suspicion that it’s more related to muscular tension, posture, and stress in general — even trauma, which I believe can manifest as a stress response — rather than sound alone. For instance, when I play football outside in cold weather, my tinnitus doesn’t flare up. Perhaps it’s because I’m moving and concentrating on the game. But when I’m inactive in the cold, such as standing in cold winds, my tinnitus tends to worsen.

Loud environments, such as concerts or noisy places, seem to overstimulate my auditory system, worsening my tinnitus. On the other hand, warmth and relaxation — like being in a sauna or during the warm Scirocco winds in Sicily — seem to soothe it. These environments help calm both my mind and body, reducing the symptoms. However, stress is highly subjective — what’s relaxing for me, like a sauna, might be stressful for someone else. This reminds me that people respond to different triggers and remedies in unique ways.

Mental stressors also contribute — overthinking, lack of sleep, or seeing too many clients seem to heighten my sensitivity to tinnitus. When I’m mentally drained, it becomes more prominent. However, in more relaxed environments, my nervous system calms down, and so does the tinnitus.

What fascinates me is that my tinnitus isn’t constant, which makes me question whether it’s truly caused by hearing loss or nerve damage. If that were the case, wouldn’t it be persistent? Instead, it comes and goes, particularly at night when the world quiets down, and my body relaxes. White noise, warmth, and relaxation help manage it, while overstimulation — whether physical, auditory, or psychological — tends to worsen it.

Here are some key strategies that have helped me better understand my tinnitus:

• 🔍 Identify Triggers
• 📊 Observe Patterns
• 🧘‍♂️ Manage Physical Tension
• 🛏️ Create a Calming Sleep Environment
• 🎧 Limit Exposure to Loud Noises
• 🌿 Relaxation Techniques

Austin Goh, a natural health consultant, shares a helpful method in his video “How to Get Rid of Tinnitus Naturally”

• 🧠 Address Mental Stress
• 💤 Prioritise Rest and Recovery
• 🌳 Spend Time in Nature
• 🌟 Acknowledge Improvements
• 💭 Consider Trauma’s Impact
• 🧘‍♀️ Incorporate Mindfulness Practices
• 🔊 Experiment with White Noise
• 🧎 Stretch and Strengthen Neck Muscles

The exercises provided by Dr. Jon Saunders in “Fix Forward Head Posture in 4 Minutes” (https://www.youtube.com/watch?v=_xg9z3bY90E) have been very helpful.

I have also done plenty of helpful yoga postures, but I believe two exercises make the most difference: stretching the subscapularis (the muscles around the shoulder) in a door frame and hanging from a pull-up bar

• 🧠 Reduce Overthinking and Mental Overload
• 💊 Benfotiamine, a fat-soluble B vitamin, can help repair damaged nerves. What I have integrated into my diet is millet, which is rich in B vitamins:

1. 💊Vitamin B1 (Thiamine): Helps convert carbohydrates into energy and is vital for nerve function.
2. 💊Vitamin B2 (Riboflavin): Important for energy production and the metabolism of fats, drugs, and steroids.
3. 💊Vitamin B3 (Niacin): Supports the digestive system, skin health, and nerve function.
4. 💊Vitamin B5 (Pantothenic Acid): Crucial for producing energy and synthesizing hormones.
5. 💊Vitamin B6 (Pyridoxine): Helps with amino acid metabolism, red blood cell production, and neurotransmitter function.
6. 💊Vitamin B7 (Biotin): Important for healthy hair, skin, and nails, and helps in fat and carbohydrate metabolism.
7. 💊Vitamin B9 (Folate or Folic Acid): Essential for cell growth, DNA synthesis, and during pregnancy for fetal development.
8. 💊Vitamin B12 (Cobalamin): Important for nerve tissue health, brain function, and red blood cell production.

• 🥑 A new diet — I wouldn’t call it strictly Keto, Paleo, or Mediterranean, but rather a blend tailored to what I feel I need. It’s focused on being mindful of foods that can reduce inflammation and help regulate insulin levels, which in turn can positively impact blood vessels and nerves.
• 🚶‍♂️Going for walks has helped me to improve, and I’ve made it a regular part of my routine. It could be because walking relaxes me, or perhaps the movement of looking around, turning my head left and right, helps relieve stiffness in my neck. It might also be that walking naturally improves my posture, easing tension throughout my body — or perhaps the ambient noise of the outdoors acts like a kind of white noise, distracting me from focusing on the tinnitus. Additionally, walking helps me process my thoughts, emotions, and the events of my day, which in turn seems to alleviate some of the mental stress that can worsen my symptoms.

For those who have tinnitus and have lost hope of healing, I want to share that my grandmother got rid of hers when she was 70! So, don’t lose hope. At the same time, try to accept your tinnitus with serenity — total surrender and acceptance can facilitate healing and definitely lead to a better quality of life.

Please, do not isolate yourself. Be authentic with others if you are struggling. Opening up can provide support and connection.

Like the family in We’re Going on a Bear Hunt (spoiler alert) who find safety at home, managing tinnitus may involve finding safe spaces, methods of relaxation, and moments of calm that allow you to cope with the symptoms without letting them dominate your life. The journey isn’t necessarily about defeating the bear (or eliminating tinnitus entirely — though that can happen too, as it did with my grandmother), but about learning how to coexist with it and finding ways to feel safe and secure despite its presence.

This article is a work in progress, and I intend to expand it over time based on people’s inputs, experiences, and suggestions. Please feel free to share your reflections — I welcome your thoughts and insights.