Tinnitus Evaluation & Treatment

1)      WHAT IS TINNITUS?

Tinnitus (pronounced TIN-it-us or tin-NIGHT-us) is a condition that affects approximately 10% of the population and is best known as “ringing in the ears.”  There are many different forms of tinnitus that can vary in the way they sound, the severity of the condition as well as the level of annoyance created.  Individuals have reported anything from only occasional episodes that are not very bothersome, to a constant tinnitus with severe impact on daily life.  Tinnitus can take many forms.  For instance, it can be perceived as ringing, chirping, hissing or clicking sounds.  It can occur only a few times a month or many times in a single day.  It can last for several seconds or hours.  It can even be constant without relief while sleeping.  For some individuals, tinnitus has a pulsating or repetitive pattern.

Tinnitus is actually heard by most people at some point in their lives—even individuals with normal hearing.  It can be a by-product of exposure to loud sounds, such as rock concerts or a night out at the symphony. It can also occur spontaneously with any apparent reason and then disappear.

Many researchers believe tinnitus is just a function of the normal hearing system.  It is when the tinnitus starts to negatively affect one’s life or becomes bothersome to a person, that further consultation may be indicated.

Some tinnitus patients find moderately intense sounds very uncomfortable.  This is known as HYPERACUSIS.  When present, hyperacusis should be treated with the tinnitus.

2)      WHAT CAUSES TINNITUS?

The causes of tinnitus vary just as much as an individual’s experience with it.  While researchers do not know all of the specific mechanisms that trigger or intensify tinnitus, they have found that it can be associated with the following:

• Noise exposure
• Ear wax or foreign bodies in the ear canal
• Ear infections, Eustachian tube dysfunction, or middle ear problems (e.g. otosclerosis)
• The natural aging process
• Meniere’s Disease and related ear diseases
• Head and neck trauma
• Medications
• TMJ or jaw joint misalignment
• Stress, depression and anxiety
• Cardiovascular disease
• Systemic disorders including diabetes, anemia, hormonal changes, Lyme disease, aneurysms, high or low blood pressure,  fibromyalgia and thyroid dysfunction
• For many, the cause is unknown

Noise induced tinnitus can be prevented with hearing protection.  See your audiologist to assist you in selecting the appropriate hearing protection for your personal needs.

In additional to what causes tinnitus, there are psychological influences that play a part in the perception of tinnitus.  It is important to consider both of these aspects when trying to find relief from your tinnitus.

One well-accepted theory on tinnitus generation is related to spontaneous activity in the hearing system.  This activity takes place in the absence of sounds in the world around you.  Some experts believe that damage to tiny hair cells in the inner ear can cause tinnitus.  Hair cells typically pick up sounds and transmit them as neural signals to the brain, where they are interpreted as meaningful sound.

When hair cells are damaged, their ability to function normally is compromised.  They experience difficulty controlling sound inputs to the brain.  As a result, even when no sound is actually present (i.e., in silence or very quiet situations) hair cells transmit signals to the brain that are amplified or made louder within the hearing system.  This amplified sound can result in a perceived “ringing” sensation, known as tinnitus.

3)      WHY IS TINNITUS MORE ANNOYING TO SOME PEOPLE THAN OTHERS?

The amount of attention paid to tinnitus can vary from person to person.  In the case where it is ignored, tinnitus is assigned a low priority and often blends into the background where very little attention is paid to it.  In the case where it is assigned a high priority, tinnitus can become a focal point.  When tinnitus is prioritized in this manner and continues for an extended period of time, the brain learns to detect it easily, even when other background sounds are present.

Constant tinnitus can cause anxiety and stress for many individuals who experience it.  Once a connection between tinnitus and anxiety is established, a cycle can begin that includes other parts of the body such as the limbic system (which controls emotions/associations) and the autonomic nervous system (which controls reflexive bodily reactions).  This is referred to as “THE VICIOUS CYCLE OF TINNITUS.”

4)      IS TINNITUS “REAL” AND DOES IT MEAN THAT THERE IS SOMETHING WRONG WITH ME?

Tinnitus is very real, as it is a “sound” that is heard by the person experiencing it.

Tinnitus can be a sign of certain medical complications (mentioned above) and should therefore never be dismissed or underestimated.  Consult an audiologist immediately if you experience persistent tinnitus, if your tinnitus is accompanied by dizziness or balance problems or is a “pulsing” type tinnitus.

Although tinnitus is often harmless and simply a by-product of the normal hearing system, it is generally recommended that you consult an audiologist who is trained and experienced in treating tinnitus patients if you experience any type of tinnitus.

5)      CAN MY TINNITUS BE CURED?

In certain instances, where the origin of the tinnitus is known (for example dietary habits or the side effects of medications), proper management can help reduce and, at times eliminate the tinnitus.

For most tinnitus patients there is no known cure, but there are many treatment options available that are effective in providing some relief.  Many of these options include a component that focuses on helping patients to understand their tinnitus as a part of a treatment program.

Advertisements for ginko biloba, vitamins, herbs and other supplements claim to reduce or eliminate.  There are no proven benefits to these claims, and there is a risk of negative side effects.  Before trying any herbs, vitamins, or supplements, you should consult with one of our audiologists who is trained and experienced in treating tinnitus patients.

A trained and experience audiologist can discuss what treatment options are available.  Because tinnitus can vary widely from person to person, it is important to find a treatment plan that is individualized for your needs and works best for you.

6)      WHOM SHOULD I CONSULT REGARDING MY TINNITUS?

We strongly recommend that you consult an audiologist who is trained and experienced in treating patients with tinnitus.  The professionals at South Shore Hearing Center have in-depth training on different treatment options and will thoroughly discuss your tinnitus problems with you.

A consultation typically begins with a thorough history of your tinnitus by discussing the onset of your tinnitus, traumatic events that may have induced your tinnitus, assessments on how bothersome your tinnitus is, characteristics of your tinnitus and how your tinnitus is affecting your daily life.  These in-depth discussions are critical in order to identify the best course of tinnitus treatment.  Additionally, you may be asked to complete questionnaires for us to gain additional insight into your tinnitus.

A variety of hearing tests may be administered to measure some of the characteristics of your tinnitus.  For instance, tests may attempt to determine the pitch and/or loudness of your tinnitus as well as a level of broad band noise that begins to reduce it.  These results can add valuable data in creating a treatment strategy and help to establish a baseline that will monitor the status of your tinnitus over time.

In addition to audiologists, many other professionals can assist in treating your tinnitus.  Specialists such as Ear Nose & Throat (ENT) physicians, otolaryngologists or otologists can rule out medical complications that could cause or contribute to your tinnitus.  Family physicians or general practitioners (GP) can assist in providing information concerning medications as well as a general medical history that can be helpful in providing a better understanding of your tinnitus.

Depending on the severity of your tinnitus, a psychologist or psychiatrist may be involved in treatment as well.  They often assist in more severe cases in which the tinnitus is intolerable by providing counseling and intervention that may be beyond the scope of an audiologist.

Other health care professionals that sometimes play a role in the treatment of tinnitus include dieticians and massage therapists. Dieticians can offer support in modifying a patient’s diet, as dietary changes, such as reducing sodium or caffeine, can help reduce the perception of tinnitus.  Additionally, because stress can enhance tinnitus, massage therapists can facilitate relaxation as a part of the treatment process.

By utilizing a “team” of professionals who work together in the treatment of treatment of tinnitus, the patient can benefit from the unique expertise and knowledge that each discipline provides.

7)      WHAT TREATMENT OPTIONS ARE AVAILABLE?

There are a number of treatment options available, each with its own procedures and explanations as to why it can be beneficial to someone suffering from tinnitus.  Since different treatment strategies may be more suitable for particular cases of tinnitus, we will focus on your needs and expectations when selecting the appropriate method of treatment.

One treatment strategy that is frequently employed is Sound Therapy, where a sound generator is used to provide relief from tinnitus.  Sound generators can be small noisemakers that resemble hearing aids or can include such things as sound pillows, radios, televisions, etc.

With Sound Therapy, the sound generator helps to reduce the perceived strength of the tinnitus signal by introducing a background noise that partially covers the tinnitus signal.  Ultimately, over time, less priority and importance is assigned to the tinnitus and relief is achieved.

Another well-known treatment strategy is Tinnitus Retraining Therapy (TRT).  In TRT, emphasis is placed on education and how the brain is involved in the perception of tinnitus.  The goal of TRT is to gain knowledge and understanding of the mechanisms underlying your tinnitus which will help you gain more control over your emotions and reactions to the tinnitus.  The desired result is that you will place less importance and priority on your tinnitus, which will then help you cope with it more efficiently.  Sound Therapy is an important component of TRT.  As a result, TRT provides a more effective combined solution to tinnitus treatment.

In addition to Sound Therapy and TRT, there are also psychological models of treatment that may include biofeedback, behavioral treatment, existential treatment and many more.  Depending on the severity of your tinnitus, a psychological approach can be used in conjunction with other types of treatment when indicated.

As with any treatment plan, results take time and there are no “quick fixes.”  Some immediate relief may take place, but ultimately, the goals are to become more comfortable with your tinnitus, realize that it is not life-threatening and, most importantly, know that you have control over your reactions to it.

8)      WHAT IS A TINNITUS SOUND GENERATOR (TSG)?

A tinnitus sound generator (TSG) is a small hearing instrument-like device that delivers sound to the ear to help provide relief from perceived tinnitus.  TSG products come in a variety of shapes and sizes, including instruments that sit over the ear called behind-the-ear (BTE) instruments as well as custom-made options that are designed to fit into the unique contours of your ears.

Like hearing aid technology, TSG technology has improved greatly over the years.  The noise generated by the instruments can be modified to provide individualized and comfortable settings for your specific needs.  The noise can be modulated as needed to provide a more soothing “ocean-like” sound (similar to the tide rolling in and out) that can be more relaxing than the traditional noise provided by previous TSG products.  There are also automatic features which make it easier to you to go through your daily activities without having to “fiddle” with the devices.  The technology will automatically increase the volume of the TSG when you are in quiet (where your tinnitus is more noticeable) but lowers the volume when speech is present or in noisier situations (where your tinnitus is less apparent). 

Should you have complaints of tinnitus AND hearing loss, there are advanced options called combination devices that offer the unique flexibility of having both a TSG and hearing aid in the same device.  Two separate instruments are not necessary to treat two different individual conditions.  Talk to one of our audiologists to determine what options may be most appropriate for you.

Remember that TSG and combination devices are NOT cures.  They are simply tools to be used in conjunction with an individualized treatment plan and proper counseling.  TSG and combination TSG/hearing aids can be very effective when used appropriately, and with the correct treatment plan.

9)      WILL I ALWAYS HAVE TO USE THE TSG?

Tinnitus rehabilitation takes time.  Remember that tinnitus itself does not cause harm.  Rather, it is your reactions to the tinnitus that can affect your life.  Learning to cope with your tinnitus is a process and should be carefully monitored and treated over a period of time.

Some patients report quick relief using TSG or combination devices.  The find that the devices “take the edge” off the tinnitus.  The goal of the devices is to decrease the perceived strength of the tinnitus by suppressing it with the therapeutic noise generated by the instruments.  Over time, it is expected that habituation to (getting used to) the tinnitus will occur.  When this happens, you can learn to live comfortably with your tinnitus. 

Studies have shown that it can take 3-6 months for complete habituation to occur and maximum benefit to be achieved when using TSG or combination devices.  However, others report that treatment is needed for 9-12 months or as long as two years.  Results will vary.  Regardless of the length of your treatment plan, you will need to work with your audiologist to identify what works best for you and to commit to the recommended treatment program.

10)  IS THERE ANYTHING I CAN DO TO HELP REDUCE MY TINNITUS?

For most individuals, there are no quick fixes for tinnitus, but there are some lifestyle changes to manage your tinnitus more effectively.  Here are some tips that may be helpful:

• Maintain good dietary and lifestyle habits (exercise):

Restricting intakes of sodium and caffeine may help to reduce the perceived strength of the tinnitus signal.  Additionally, moderate exercise can aid in stress reduction, general health, sleep patterns, etc.

• Keep busy:  By occupying your time with a variety of enjoyable activities and engaging in tasks that require attention, less time may be spent focusing on your tinnitus. 

• Avoid complete silence:  By adding some light background noise (for example: music, television) the strength of your tinnitus signal may be reduced against the background noise.  This can be useful during quiet times or when trying to fall asleep.  

• Wearing hearing protection only when needed:  Inappropriate use of hearing protection can increase sensitivity of the hearing system, making you more aware of your tinnitus.  Hearing protection should only be used when exposed to hazardous levels of noise that could damage your hearing and potentially make your tinnitus worse.  Hazardous levels of noise can damage, and even destroy the hair cells in your inner ear.  Increased damage to hair cells can magnify your tinnitus. 

11)  WHAT DEFINES SUCCESSFUL TINNITUS TEREATMENT IF THERE IS NO CURE?

Success can be defined in many ways.  As there is no known cure for tinnitus, expectations of completely eliminating the tinnitus are most likely unrealistic.  Therefore, you and your audiologist should set goals that are realistic and achievable.

For some people, providing any amount of relief of their tinnitus could be considered success.  Being able to perform daily activities without the stress and annoyance of their tinnitus on a constant basis would be a great relief.  Overall, most treatment plans agree that habituating to the tinnitus should be your ultimate goal.  By “habituating,” we mean that you will learn to accept and cope with your tinnitus by assigning it less importance and lower priority.  This will allow you to the freedom to focus on more important matters.

As discussed previously, there are questionnaires that can help measure the progress of your tinnitus treatment.  Typically, you will be given these questionnaires when you first visit our center in order to establish baseline data concerning your initial reactions to the tinnitus.  Typically, we administer these tests throughout your treatment to measure the effectiveness of your treatment plan.

The first step is to make an appointment with one of our staff audiologists who is trained and experienced in treating patients with tinnitus.  Together we can discuss your treatment options and determine the best plan of action for your specific needs.

Last, but not least, remain positive.  Severe tinnitus is extremely difficult to live with, but there are solutions and professionals out there who can help you.  Together, we can work to find relief for your tinnitus.

Sources:  GN ReSound Tinnitus Handbook; House Ear Institute; Oregon Health Sciences University; Cleveland Clinic Foundation