In this addendum to Clarity in G-Sharp, author Matt R. Phillips is in conversation with Christopher Norwood, an expert on the disease and an audiology extern at UCSF Medical Center.

Matt R. Phillips: As I write about my own tinnitus, I’ve wondered whether my story is consistent with the experiences of others.

Christopher Norwood: Tinnitus can be so personal and subjective, but at the same time, it is something that millions of people around the world have. And I think an interesting part of tinnitus is that it reveals how we don’t just hear with our ears but really with our brain. And different things like stress or psychological makeup make different experiences for different people. We don’t have right now any different medicines or pharmacological treatments for tinnitus.

MP: What does counseling for tinnitus look like?

CN: When you have a sound in your head, it can be very threatening. Treatment helps with the reduction of tinnitus, but it doesn’t make the problem go away. Still, the same way you wear your shoes and just don’t think about them after a while—just don’t see them as a threat—you can retrain the brain over time, treating the tinnitus just like other sounds that our ears are receiving all day long.

MP: What are some of the recommendations you generally give to patients struggling to cope with this?

CN: Most often treatment is broken down into something like stress management. Tinnitus patients suffer from a positive-feedback loop where the more you focus on the sound, the louder it gets, and the louder it gets, the more you focus on it. Trying to sort of break that loop is easier said than done. So people use different strategies, trying to keep the brain busy, for example, by avoiding quiet settings.

But really our medical treatments are sometimes like band-aids. They’re a temporary fix. They’re not really going to get to the root cause, because this isn’t, in essence, another sound that we’re experiencing. We have to change the emotional connection to that sound. And that’s where extra counseling for people who need more support is often recommended, so they can come to terms with managing the tinnitus.

MP: What was your first experience with tinnitus?

CN: I have tinnitus myself, and I feel like it’s almost like the more I’ve learned about it, the more I can notice it. Like when I’m stressed. It’s wild. It’s almost as if I’ve given it to myself the more I’ve learned about it. It’s not very bothersome for me, but I started learning about it in school, even taking a whole course focused on tinnitus. And during that time, the more I was thinking about it, the more it started raging in my head.

MP: How would you describe tinnitus to someone who doesn’t know what it is?

CN: I would say that it’s just the sensation of sound that different people experience in different ways. Sometimes it can be on one side, sometimes it can be on both sides. Sometimes people don’t even know like where it is. It’s just sort of the sound that they hear. From the time we’re born, the sensation of sound is something that we can’t really turn off. Your ears are always open. They’re always listening.

But then sometimes this tinnitus sensation starts. And most often it’s when there may have been some damage along the auditory pathway, changing how sound travels from the external world up to our brains. So a new sensation forms, and for some people it can be really bothersome. It’s very subjective, something that’s hard sometimes for other people to relate to and know about. It is in your head, and we can’t just take some type of meter up to your head and say, “Oh, we see it. It’s right there.” Tinnitus is something that’s invisible but really powerful. And it affects a lot of people.

[edited for clarity and length]