What Makes a Sound Sound Loud?
There are a number of ways to talk about tinnitus loudness. For instance there is the Tinnitus Loudness Rating, which means how loud your tinnitus sounds to you at any given point in time (typically on a 1 to 10 scale). There is also the Tinnitus Loudness Match, which means the loudness of a sound (typically measured in dB SL, the number of decibels above your threshold of hearing) introduced to an audiology booth under controlled conditions at the pitch (frequency) of your tinnitus that matches the loudness of your tinnitus. Suffice it to say that the terminology can get quite confusing. Also suffice it to say that the only tinnitus loudness that really matters is how loud your tinnitus sounds to you at any given point in time.
So what makes a sound sound loud to you?
By way of illustration, I would like to offer an example from a course I took long ago.
When I was a child in the 1950s we used to have wind-up alarm clocks by our bedside. (There were no iPhones or even electric clocks back then.) And the last thing you would do before going to sleep each night was to wind the clock up and set the alarm – so you would wake up in time to go to school. Well, that’s not exactly right. The last thing you would do was listen to the very soft ticking of the clock (just a few dB) to make sure it was working properly after you had wound it up.
So picture, if you will, the very same scenario … except for changing three parameters. First, I hammer the windows of your bedroom shut, so you cannot open them. Next, I bolt the door to your bedroom from the outside, so you cannot get out that way either. Third, I tell you that the ticking is actually the timing mechanism on a bomb. Now it’s still putting out just a few dB, but to you it sounds thunderous. All your attention is focused on it, the fear and anxiety pathways in your brain are turned way up, and your “fight-or-flight” mechanisms are on high alert. The result? The ticking sounds LOUD to you, even though it is putting out the same number of dB as when it was nothing more than the soft ticking of a clock you had just wound up. And once you believe that the ticking represents a bomb, it is very hard to reverse that process with logic alone. In fact, the harder you try to get the loudness to settle down, the louder it becomes!
The message: The loudness of your tinnitus to you is related not only to the strength of the tinnitus signal at its origin within your brain but also in large part to how your brain processes that signal. The problem is that you have little, if any, direct conscious control over the emotional and fight-or-flight mechanisms that factor into how your brain processes your tinnitus signal. Which is why (until science comes up with a true cure) many tinnitus clinicians believe that in order to overcome severe intrusive tinnitus, you should consider addressing the challenge indirectly through approaches that focus on how you react to your tinnitus rather than on your tinnitus itself.
Stephen M. Nagler, M.D.
Atlanta Tinnitus Consultants, LLC