Tinnitus: the Sound and the Fury
What is Tinnitus? & Why?
Definition: Sounds in the ears or head that occur when there is no sound in the room. Tinnitus ("TIN-a-tus" or "Tin-EYE-tus") may begin gradually or suddenly
The sounds may vary in pitch and loudness or stay the same. It may be a tone or a noise, a roar like a seashell roar, a chirp, hiss, or click or a combination of these.
It may "beat" as your heart beats. The sounds may be louder in one ear or occur only in one ear.
It may prevent sleep, or wake you from a sound sleep. It may be louder in the morning and late at night.
There are about 200 causes for tinnitus- some benign, some quite troublesome. The problem may be in the outer ear, the skeleton, the middle ear, the inner ear, or along the auditory pathway to the brain. The loudness of the sounds has nothing to do with the cause. An experienced audiologist will help you identify the cause and find relief. Causes of tinnitus include:
Loud noise exposure
Hearing loss
Excessive ear wax
Ear infection
High blood pressure
Deficiencies in Vitamin D, Vitamin B12, Zinc
Medications such as certain antibiotics (erythromycin, gentamycin), some cancer treatment medications, unusually high doses of aspirin, and certain diuretics.
Risk Factors for Tinnitus
There are multiple risk factors that can contribute to the onset of tinnitus. These risk factors include:
Age related hearing loss, Meniere Disease
Constant exposure to loud noise, history of a noise trauma event, severe MVA, head trauma
Chronic middle ear or sinus infections
Constricted or poor blood flow due to atherosclerosis and/or kinking in the carotid artery or jugular vein
History of migraine headaches
Approaches to Tinnitus Management
Tinnitus is always a symptom. It is never a disease. It is treatable 85-90% of the time. Before treatment, you need a diagnosis. What is the cause of the tinnitus? The answer will dictate the plan of treatment. Some questions to answer: is the tinnitus objective (usually)
A person who describes successful treatment of tinnitus will say something like, “I have to stop and really concentrate to see if I still hear the sound.” Or, “It is so little a bother, I don’t even think of it.”
Options for relief vary based on the status of hearing, the presence of hyperacusis or mysophonia, phonophobia or recruitment, evidence of Meniere Disease, suggestion of chronic Eustachian tube dysfunction, injuries to C1 or C2, TMJ problems, history of vascular disease, deficiency in B-12, zinc, and/or magnesium. Additionally, vertigo or dizziness may shape how we manage tinnitus.
These services result in a success rate of 85-90%:
Information and counseling. Often, learning that tinnitus is a symptom and not a disease, what makes it so bothersome, and how you can get relief is enough. But not for all.
Current approaches to relieving most types of tinnitus focus on sound de-sensitization, cognitive behavioral therapy, and efforts to moderate the brain sound generator.
One theory advances a masking strategy. For some, the sound should be steady and very soft, for others, the amplitude should vary. Different devices/signal generators are demonstrated. The idea is that sounds wired together fire together, and certain sounds will break the unity, create "chaos" in the site and cause the tinnitus to subside.
Those who have experienced chronic disease, pain or illness will recognize the potential value in Mindful Meditation. This is the treatment primarily recommended by Harvard Medical School and implemented at the Tinnitus Clinic at Mass General Hospital. Some will choose to learn this centuries old method of dealing with a variety of intrusions to the body as an additional asset in reducing tinnitus.
No double blind study to date supports any type of oral medication to relieve the tinnitus sound.
Management approaches to tinnitus focus on the sounds, and/or the effects of the sounds, such as interrupted or poor sleep, concentration difficulties, depression and anxiety, and stress
Manufacturers of hearing aids such as Signia, Resound, Phonak and Widex have released products that provide therapy for tinnitus. The circuit in each model of hearing aid includes a variety of white noise, pink noise, or "Zen" noise. Activated by the audiologist, the customized sounds are mixed into the hearing aid at a loudness level that attenuates the tinnitus and amplifies speech. Over time (six to eighteen months) the user reports diminished perception of tinnitus (the perceived volume level of the tinnitus begins to lessen). A control can be provided to change the ratio of the tinnitus noise to the gain of the hearing aid for those who report fluctuating tinnitus.
Steps to Tinnitus Management
Step 1: Educate yourself!
Tinnitus is a symptom of damage to the hearing system
It is typically a result of hearing loss, but not always
It is a not a measurable sound in your ear, but comes from your brain
It can sound like ringing, buzzing, crickets and can change over time
Why does tinnitus bother some more than others?
Those with bothersome tinnitus have an overactivated “Fight or Flight” response in their brain
Their brain believes it is important and pays attention to it more
Successful treatment is based on activation of “Rest & Relax” Brain centers
Step 2: Hearing & Tinnitus Assessment
Determine if you have hearing loss:
Type and severity
Determine characteristics of your tinnitus:
Pitch & loudness matching
Minimum masking levels
Rule out Red Flags for further ENT/Neuro Medical Work-up
Rule out new medication as cause of tinnitus
Step 3: Tinnitus Treatment Goals
Reduce loudness of tinnitus perception
Reduce awareness & annoyance of tinnitus sound
Reduce interference on concentration and quality of life
Change your reaction to your tinnitus
Step 4: Treatment Options - Why are Hearing Aids the first step tinnitus management?
Hearing loss co-occurs in about85% of individuals with bothersome tinnitus
Treat the hearing loss – Approximately 70% of people with hearing loss and tinnitus report reduced annoyance of the tinnitus just by wearing hearing aids.
Tinnitus Therapy Sound Generators put YOU in control. You can adjust the sounds and volume via on-board push buttons or smart phone app. These therapy signals work to retrain your brain to listen to other sounds and not the tinnitus
Step 5: Treatment Options: What else?
A. Listen to sound machine for sleep. A non-musical sound without any speech is often best for ease of falling asleep.
B. Change your lifestyle: How is your diet? Can you exercise more? Too much salt, caffeine or alcohol? Can you reduce stress? Getting enough sleep? All these can influence severity of tinnitus perception
C. Increase environmental sound to help distract yourself and reduce tinnitus intensity. Find sounds that you find relaxing to play while cooking, cleaning, working, etc: You can find sounds designed for tinnitus relief on Smart Phone Apps:
For example, a candle in a dark room seems very bright. But in the sunlight, that candle isn’t as noticeable. By having more sounds around you, your tinnitus may not be as noticeable.
D. Practice meditation and mindfulness. Increase your ability to control your internal focus.
E. Cognitive Behavioral Therapy – Conquer negative emotions about tinnitus. Are you catastrophizing your thoughts about your tinnitus? See handout of 12 common distorted thoughts people think about their tinnitus. Is tinnitus related to underlying anxiety? Is it affecting your mental health? Can talk therapy or medication be beneficial to you?
F. Tinnitus Activities Treatment – What do you find relaxing? Painting? Puzzles? Gardening? Can you pick up a new hobby?