If you experience tinnitus (ringing, buzzing, hissing, roaring or other sounds perceived in the ears or head), you are not alone. Approximately 40 million Ameri-cans hear these “phantom” sounds much or all of the time. I call them “phantom” sounds not because they aren’t real but because they do not have an external source. The perception of tinnitus is as real as the perception of external sounds such as voices, music, laughter or a whistling tea kettle. However, tinnitus is not generated by sound waves hitting the eardrum. Imaging studies (such as functional MRI or Positron Emission Tomography) have shown that tinnitus perceptions are generated by superfluous activity in the brain or auditory system (see Figure 1).
What causes a person’s brain to generate tinnitus sounds? In most cases, the symptom is associated with hearing loss. People with normal hearing in both ears usually have a balanced auditory system. If they sit in a quiet room, most normal-hearing people do not hear tinnitus sounds because brain areas responsible for sound perception are “turned off.” Any cause of hearing loss can disrupt the balance of brain activity within the auditory system (see “Causes of Tinnitus” p. 45). This allows some neurons to become active when they shouldn’t be – namely, in quiet environments. Groups of these neurons firing in auditory regions of the brain can result in tinnitus. Do all people with hearing loss have tinnitus? No, but 90 percent of tinnitus patients have some degree of hearing loss. Furthermore, many tinnitus patients with normal hearing have a history of loud noise exposure or ear infections that damaged their auditory system.
Here is some good news: approximately 75 percent of people who have tinnitus all the time are not bothered by it. Only 25 percent of people who experience chronic tinnitus consider the symptom to be a significant problem. These are the people most likely to seek treatment. What differentiates the majority of people not bothered by tinnitus from the minority who perceive it as a significant, even debilitating problem? My research has shown that severity of tinnitus is often associated with accompanying symptoms such as insomnia, anxiety and depression. Such problems can form a vicious cycle with each one exacerbating the others. Tinnitus is not always the starting point of this cycle – many patients experienced depression, insomnia or anxiety before their tinnitus began.
What can be done to help patients who are bothered by tinnitus? I agree with researchers Duckro, Pollard and Gray who wrote, “As with chronic pain, the treatment of chronic tinnitus is more accurately described in terms of management rather than cure.” The goal of tinnitus management is not necessarily to mask or remove the physical perception of tinnitus sounds. Instead, individuals need to learn how to pay less attention to their tinnitus so that it bothers them less. The realistic goal of an effective tinnitus management program is to help patients understand and gain control, rather than be controlled by tinnitus. Ultimately, individuals should progress to the point where tinnitus is no longer a negative factor in their lives.
Here are some tinnitus management strategies that have proven effective.
Using External Sounds for Tinnitus Relief
Tinnitus is usually more noticeable in quiet environments. Therefore, people with tinnitus should add pleasant sounds to any environment that is too quiet. Some who suffer from tinnitus have already figured this out for themselves and routinely turn on a radio or television when they are at home. Unfortunately, this is not always possible away from home, especially at the workplace. Another problem with radio or television is the variability of sounds emanating from these devices: music, talk, commercials, etc. During the day this variety of sounds might provide a welcome distraction from tinnitus. However, if people with tinnitus want to add sounds to the bedroom to improve their sleeping patterns, I would recommend more consistent and less distracting sources such as table-top sound machines, like the Homedics® Sound Spa™ number SS-400B, or CDs, such as those available at www.purewhite noise.com, that produce sounds such as rain, wind, a waterfall, a brook or ocean waves. A Sound Pillow™ (www.soundpillow.com) or a pillow speaker (available at RadioShack®) can be plugged into sound machines or CD players to facilitate sleep.
For tinnitus sufferers with normal or nearly normal hearing, custom-made in-the-ear sound generators (made by General Hearing Instruments) can provide immediate relief from tinnitus. These devices (sometimes called “maskers”) deliver a broad band of frequencies, typically between 100-8,000 hertz, and sound like rain or a waterfall. Sound generators can muffle the piercing quality of high-pitched tinnitus, making it more tolerable and easier to ignore. This can also relieve the frustration of tinnitus by allowing people to exert some control over the symptom. However, it may not be possible to completely mask tinnitus with sounds generated by in-the-ear devices. Acoustic therapy may result in complete masking of tinnitus, although that is not necessarily the goal of tinnitus management.
Hearing aids are another form of acoustic therapy that can be beneficial for people with tinnitus who also have significant hearing loss. Some people attribute their communication difficulties to tinnitus though they are actually caused by hearing loss. This is understandable because hearing loss often progresses slowly over time and people do not always realize what they have been missing. Tinnitus, on the other hand, sometimes has a sudden onset, and it can be easier to notice the addition of this sudden unpleasant perception than a gradual loss of hearing.
It is important to understand the relationship between hearing loss and tinnitus. Here are some key points to remember:
Tinnitus does not cause hearing loss but hearing loss makes it more likely for a person to hear tinnitus.
Even if tinnitus were to stop completely, people with significant hearing loss would still have communication difficulties.
Hearing aids do not amplify tinnitus. In fact, hearing aids usually reduce the loudness of tinnitus by amplifying external sounds. Therefore, tinnitus sufferers whose hearing can improve with hearing aids should use them as much as possible.
Improving Sleep Patterns
My colleagues and I have found that people who experience insomnia tend to experience more severe tinnitus than people who do not have trouble sleeping. If you are not sleeping long enough or restfully enough, you should:
bring pleasant sounds into the bedroom to reduce your perception of tinnitus;
consider using a non-habit-forming, over-the-counter sleep medication such as Alluna™, Sominex®, melatonin, Tylenol PM or Benadryl®;
if necessary, talk to your physician about using prescription sleep medication such as Ambien® or trazodone. Sleep medications should be used as needed, not necessarily every night. After sleep patterns stabilize, reduce usage of sleep medications;
follow the recommendations provided by the National Sleep Foundation www.sleepfoundation.org;
pursue activities and develop strategies that promote stress reduction and relaxation. If necessary, pursue relaxation and stress management therapy; if insomnia persists, go to a specialized sleep clinic for evaluation and treatment.
Reducing Anxiety or Depression
Tinnitus tends to be more severe for people who also experience high levels of anxiety; therefore, stress reduction is imperative. You may benefit from hypnosis, biofeedback, an exercise program, yoga, meditation or regular massage. Almost anything that reduces stress or anxiety levels will decrease the severity of tinnitus and will also help you relax and sleep. If you have struggled with anxiety, it is advisable to have a psychiatrist evaluate you, preferably one who specializes in stress management. Some people may benefit from stress reduction or relaxation techniques taught by licensed therapists or counselors. The Anxiety Disorders Association of America (www.adaa.org) can help you locate a qualified therapist. Medication can also alleviate severe anxiety.
Because people who are depressed perceive their tinnitus to be more severe, identifying and treating depression are essential elements of tinnitus management. You can perform a very simple self-evaluation by answering these two questions: During the past two weeks, have you felt down, depressed or hopeless? During the past two weeks, have you felt little interest or pleasure in doing things? If you answered “yes” to these questions, you should be evaluated professionally for an analysis of these depressive symptoms. An initial evaluation by a psychiatrist should be followed by an ongoing series of psychotherapy sessions and possibly antidepressant medication for people who are suffering from depression as well as tinnitus.
Hope for a Cure?
If sensorineural hearing loss could be repaired or restored, many cases of tinnitus would be cured. Researchers around the world are working to better understand how our auditory system functions. Eventually, I believe scientists will figure out how to restore hearing by regenerating hair cells and associated neural structures, although no one knows when this complex task might be accomplished.
In the meantime, people with tinnitus should not be enticed by every new product or procedure that promises “a cure.” Be skeptical about claims of a device, procedure, potion or pill that can silence tinnitus. To my knowledge, no such treatment exists. Yet, there are reasons to be hopeful. Even though a true cure for most cases of chronic tinnitus is not yet available, you can obtain relief from tinnitus by following the recommendations I’ve described here. These are not quick fixes; they are reasonable steps to improvement. My research has shown that if you implement these recommendations, your overall condition will improve and the severity of your tinnitus should decrease. The key word in this process is “implementation.” You must make concrete and consistent efforts to follow specific recommendations formulated by healthcare professionals. Have a positive attitude about trying some of these strategies and give them a chance to work. You can take responsibility for your improvement. For chronic conditions such as tinnitus, much of the healing must come from within.
