Broadly speaking, tinnitus is the perception of a sound that doesn’t correspond with an external sound. Practically speaking, that usually means that a person hears something like a ring, hum, buzz or some other type of noise that is apparent only to them; it’s internally generated.
Tinnitus is fairly common, with an estimated 10 to 15 percent of the general population having constant tinnitus. It causes a moderate degree of disturbance in about a third, and severe disturbance in about a tenth of those who perceive it. The impact of tinnitus can range from being barely discernible to debilitating.
Tinnitus is typically accompanied by some degree of hearing loss and some sufferers may also report decreased tolerance of loud sounds, which tend to worsen its effects. As it is most bothersome at quiet times, tinnitus can greatly disrupt sleep patterns, relaxation times and concentration. Stress almost invariably makes the symptoms worse but simply having tinnitus is also stress producing, so it can be self-perpetuating. People with this condition often experience anxiety and depression and indeed the outlook for those with severe tinnitus can appear bleak when they are given the prognosis,
“There’s nothing you can do for tinnitus so you’ll just have to try to learn to live with it.”
In the past, it was thought to be the result primarily of damage to the ear because excessive noise exposure most commonly preceded tinnitus. As there was rarely any treatment for that kind of hearing damage, patients were usually told that it was untreatable. In recent years, clear evidence has emerged that tinnitus can actually be triggered by damage anywhere along the auditory pathway from the ear canal to the highest parts of the brain. Current thinking is that tinnitus is simply our body’s normal “internal noise” which is always present but not usually noticeable because normal hearing ensures that the outside sounds are louder than the internal noise. Hearing loss disturbs that natural balance, “uncovering” the internal noise.
What seems to make tinnitus disturbing is how the brain responds to the damage that has occurred. The brain automatically attempts to compensate for the hearing loss by turning up the sensitivity of the hearing system, which also increases the perception of tinnitus and decreases sound tolerance. The brain also engages a filtering mechanism that results in the tinnitus being readily detected among other signals along the auditory pathways.
Also, emotional centers of the brain are triggered around the fight or flight response, which creates stress and, in turn, makes tinnitus worse. These compensation mechanisms of the brain actually constitute good news for the tinnitus sufferer as they are an indication of the ability of the brain to adapt and change, which can be used in the treatment of the condition.
Hearing aids can be helpful for people with mild tinnitus, particularly for those with a marked hearing loss within the speech range, normal sound tolerance and no difficulties with sleeping, concentrating and relaxing. Among more severe sufferers, typically seen by specialist tinnitus clinics, hearing aids are fitted in around 20 to 25 percent of cases.
Tinnitus maskers or noise generators are devices that look similar to hearing aids and produce a constant noise that serves as a distraction from the tinnitus. When used in treatment protocols such as Tinnitus Retraining Therapy (TRT), they are set at a level at which the patient can still hear the tinnitus while the noise is playing. When these devices are worn for at least eight hours a day they may provide noticeable benefit after 18 to 24 months. However, they have not shown consistent effectiveness and have declined in popularity, causing two of the leading global manufacturers to stop producing them.
Some studies by clinical psychologists who have used a counseling-intensive approach called cognitive behavior therapy to relieve phobia-like symptoms caused by tinnitus have shown that this approach is able to help some people change their attitude towards their tinnitus. However, it doesn’t directly address the neurological and audiological components of tinnitus distress, such as the discomfort caused by decreased sound tolerance.
My own research into new ways of making tinnitus treatment more efficient and pleasant to use has led to the development of a new treatment approach called the Neuromonics Tinnitus Treatment. After 15 years of development, including several clinical trials involving over 200 people with tinnitus, this treatment is now available in specialist tinnitus clinics across the country. It simultaneously addresses the audiological, neurological and psychological aspects of tinnitus distress through a combination of a novel type of sound, which is provided together with a tailored support program by a trained clinician, typically over a six-month period.
The Neuromonics Tinnitus Treatment includes relaxation music as part of the treatment sound – which is more pleasant to listen to than the noise provided by maskers or amplified everyday sounds when using hearing aids. Ordinary music typically will not provide relief from tinnitus at comfortable listening levels because of the acoustic properties of music, decreased sound tolerance and the effects of hearing loss. In the Neuromonics approach, these factors are addressed by modifying the music in a way that adjusts for each person’s particular hearing loss profile. As a result, in the early stages of treatment, tinnitus sufferers experience relief from their tinnitus sound at a comfortable listening level that promotes relaxation and sleep onset. Then in the later stages of treatment, they typically find they become progressively less aware of their tinnitus and less disturbed by it.
The acoustic stimulus provided by the Neuromonics device is designed to address the neurological processes underlying tinnitus, yet at the same time provide patients with a pleasant and comfortable listening experience – something that many patients find difficult to achieve with other devices prescribed for tinnitus, such as maskers or hearing aids. The Neuromonics device provides relaxing music combined with a broad frequency neural stimulus, which is customized for each person’s hearing profile to provide a high level of relief from the tinnitus at a comfortable listening volume. Rather than simply providing a distraction from the tinnitus, the Neuromonics stimulus helps the process of desensitization through its dynamic properties.
The Neuromonics approach has been shown in extensive clinical trials to provide consistently positive results for tinnitus sufferers. In a recent clinical study published in the journal Ear and Hearing, Neuromonics Tinnitus Treatment provided consistently positive outcomes for tinnitus patients. Key results are summarized as follows: 95 percent of patients reported improvement in tinnitus disturbance of at least 40 percent (as measured by Tinnitus Reaction Questionnaire score) after six months. Eighty-four percent of patients reported improvement in tinnitus awareness of at least 40 percent after six months. There was a 74 percent mean improvement in tinnitus disturbance after 12 months and a 60 percent mean improvement in tinnitus disturbance after two months. Greater than 89 percent of patients reported improved sleep, relaxation and general well being. Many reported improved tolerance of loud sounds as well.
Because tinnitus can occasionally be a symptom of a condition that may require medical treatment, and because suitability for Neuromonics does vary, the best place to start in addressing ringing, hissing, buzzing and other phantom sounds is with a diagnostic assessment in a clinic specializing in tinnitus. With the outlook for people suffering from tinnitus much improved, owing to better understanding of what causes it and the availability of new and effective treatment options, it can no longer be said that nothing can be done for tinnitus.
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