If I were to conjure up a form of torture that did not inflict actual physical pain but had the slow-burning potential to drive one into madness it would perhaps be an unrelenting ringing in the ears. It would sometimes be hushed, almost silent, and at other times, blaring with the intensity of a locust swarm. It would often take on the character of determined mosquito, and just as often, of radio interference. The victim would wonder how or why they found themselves in the clutches of such cruelty, there being no obvious reason for it. And any attempt to escape would only seem to worsen their predicament. Luckily, I am not a sadist, but apparently nature sometimes can be. Tinnitus roughly fits the above description – a persistent ringing in the ears that can be caused by hearing loss, exposure to loud noise, or the result of head or neck injury. It can also arise spontaneously without obvious cause. Medically, it is considered a symptom of an underlying condition and not a condition itself. I have personally suffered from it for about as long as I can recall and it is estimated that about 15% of the general public do as well. The torture metaphor becomes more apt considering there is no cure and no real treatment available other than various noise therapies and ‘brain-retraining’ exercises, which are moderately effective at best. It can be extremely frustrating and has the potential to lead to sleep difficulties, trouble with concentration, anxiety, and depression. This, combined with the lack of sufficient treatment, can have the potential to send sufferers on a spiral into hopelessness. However, having been a meditator for several years, I do believe that the practice, and its wisdom, can indeed help one cope. Tinnitus need not drive one into madness. With proper attention, understanding, and acceptance it is possible to reach a state of equanimity during the quest for silence.

The character of my own tinnitus would be similar to what is laid out above. In the left ear, the sound is something resembling a persistent, monotonous, electric ringing that ranges in volume. In my right ear, the sound is akin to static interference or white noise. It also seems to vary in this ear and, on many days, ceases completely. The noise is exacerbated in both ears by cold temperatures and cold water immersion (which is especially unfortunate as I find it can be therapeutic and there is some research supporting this). Also, exposure to loud noise temporarily increases the volume of the ringing. Aside from this, the intensity seems to be entirely random and can fluctuate drastically. On some days it is almost unnoticeable and on other days it takes on the quality of an Airbus during takeoff. I have been unable to draw any correlation between its strength and general day-to-day activity. Though decreases in stress, limited consumption of caffeine, and healthy sleeping habits can lessen the ringing, but not reliably. My ability to cope is often dependent on the position of the volume knob and I have yet to find any exogenous treatment that is consistent and reliable, though some appear to have had some relief using various herbal supplements. One exception to this, as reported by some sufferers, seems to be MDMA, which has been reported to cancel the noise completely for the duration of its effects. However, this cannot be recommended for a variety of legal and health related concerns. Regarding the latter, there is evidence that MDMA can be neurotoxic and that its ongoing use can lead to serotonin depletion in the brain, among other detrimental effects. I strongly discourage the use of MDMA for the treatment of tinnitus and in general. What I would like to prescribe is a solution to the problem that can be safely and confidently explored by all sufferers. I believe meditation can lead us in that direction.

Attention

We have a limited amount of attention. Meditation enables us to realize that only a single object can be held in attention at any given moment. The felt experience of concentrating on multiple objects simultaneously is, in actuality, attention that is rapidly, and imperceptibly, shifting. There are many sounds, sensations, and images currently happening all around you but you are not aware of most of them. Stop reading momentarily and notice the feeling at the bottoms of your feet. You probably weren’t aware of this sensation a moment ago but it has now flooded your consciousness. And because you’re now paying attention to your feet you’re probably not aware of the sensation in your palms, and so forth. At the risk of banality, it’s worth stating plainly – you’re only aware of what you’re aware of. This is also true of tinnitus, assuming you’re so afflicted. The sound that seems to be so painfully unrelenting is actually only present while you’re aware of it. Any moment that you are aware of something other than your tinnitus is a moment that, as a matter of experience, your tinnitus does not exist. It would be impossible to perpetually hold the sound in awareness unless you were continually (and successfully) making an effort to do so. Boredom, and the desire to shift attention, is the nature of the mind. While meditation can be used to deepen one’s focus on a given object, it can also allow us to decide what we want, and do not want, to pay attention to. In formal meditation practice the approach to tinnitus is the same as with other distractions. The breath is followed as the object of meditation and when distractions arise they are simply acknowledged before returning attention to the flow of breathing. When the ringing is particularly fierce, or when one is first starting a practice, this can be difficult, but adherence to this general instruction is strongly recommended. What is important here is also to make mental notes of the times that you weren’t noticing the tinnitus, which, of course, is only possible once you notice it again. Its recapturing of your attention is evidence that you were unaware of it in the prior moment and that is precisely the point. As your practice grows, you will learn that attention is trainable and how much of it is paid to the ringing can be significantly reduced both in formal practice and daily life.

Understanding

Absent any emotional reaction or frustration, the subjective nature of tinnitus is simply ringing and nothing else. It is difficult to tease apart the sound from the accompanying discomfort but as a matter of experience it is possible. What is important to grasp is that the noise itself is not the problem but rather one’s reaction to it. If you suffer from tinnitus, take a moment now to draw your attention to the sound. What is the experience like? What occurs after noticing the ringing? If our experiences are similar, it is something like the noticing of the sound followed by a cascade of neurotic thoughts and negative emotion. These are, in fact, two separate events. It’s possible to realize that the sound exists independently of any reaction. A clearer understanding and observation of this mental phenomenon through meditation allows one to stand at a sort of crossroads in the mind. At this intersection one is able to notice, with neutral awareness, that the sound itself is separate from the emotions that typically follow its observation. After a momentary acknowledgment, one is then able to choose to let these emotions go instead of following them. While you may dispute the value of this type of Buddhist approach in a general sense, its application in this context can be extremely useful. Put more succinctly, it’s possible to choose how to react to difficult situations, including the experience of tinnitus. Meditation is a skill that, through ongoing practice, can help us cultivate and refine this capability.

Acceptance and Perspective

The reality for many people is that tinnitus will continue for life. Despite honing the skill of sharpened attention and regardless of our ability to more deeply understand emotional reactivity, the ringing will likely persist, often with discomfort. I am not aware of anyone that has been able to completely silence tinnitus through meditation. Given this reality, acceptance becomes the only choice. This is perhaps the most difficult step in the process I am prescribing. Even as our meditation practice becomes stronger there will inevitably be times when we feel we are doomed to float hopelessly and eternally through a droning abyss. But as with other difficult situations in life, and there are many, the aim should be equanimity. During a particularly fierce encounter with tinnitus, nihilism can be tempting. However, we can easily imagine a much worse scenario to find ourselves in. How many people experience sudden blindness? How many lose limbs in horrific accidents? How many become paralyzed? If we were ever to be personally afflicted by such tragedy we would desperately long to return to our annoying soundscape with the rest of our body intact. And if we were able to return, tinnitus would then seem no more disruptive than a fruit fly in a warehouse. The sooner we realize the importance of perspective and accept our own suffering the faster the ringing can move from the foreground to the background of our awareness.

Tinnitus is a challenging ailment which I have not fully come to terms with, despite years of meditation practice. My intention here is not to suggest that meditation is a panacea to the difficult inevitabilities of life in general, or for tinnitus specifically. If a miracle cure arrives tomorrow I will be among the first to sign up. However, admitting that meditation is limited in its application is to reveal something fundamental about the practice and of life more broadly. We will continue to be presented with physical and emotional crises for which there will be no silver bullet. When we fail to find the perfect antidote, meditation can become a tool to help us more effectively navigate the landscape of discomfort and suffering, even when that suffering comes in the form of tinnitus.