TINNITUS MANAGEMENT

Tinnitus, or the perception of sound in the absence of corresponding external sound, is not a disease but rather a symptom of underlying medical pathology. Tinnitus is a common condition. The first step in tinnitus management is a diagnostic hearing test. This hearing test, in addition to a comprehensive case history taken by your audiologist, serves to rule out any treatable medical causes for tinnitus. Medical causes for tinnitus can include certain medications, head or neck injuries, certain diseases, and excessive ear wax. If it is suspected that the cause of your tinnitus is a medically treatable condition, your audiologist will refer you to an Ear, Nose, and Throat (ENT) physician or to a Primary Care Physician as appropriate.

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Cause of Tinnitus

While there are many causes of tinnitus, by far the most common is noise exposure and hearing loss. About 85% of those with tinnitus also have hearing loss. In order to better understand this connection between hearing loss and tinnitus, consider how we hear. Sound enters the ear canal. Then, it strikes the eardrum, causing it to vibrate. These vibrations are carried by tiny bones, called ossicles, to the inner ear. Fluid in the inner ear is then vibrated. When the inner ear hair cells are stimulated by this motion, a chemical signal is carried by the auditory nerve to the brain.


Sound travels along the auditory nerve to the auditory cortex in the brain. Studies analyzing the structure and activity of auditory brain regions have found abnormalities in those who suffer from tinnitus. The auditory cortex in individuals with tinnitus is more active than in those with normal hearing. Whenever there is a hearing loss, certain parts of the brain are deprived of sound. The brain does not like to be deprived of sound stimulation, so it develops its own stimulation in the form of tinnitus. This most commonly accepted scientific theory of a hyperactive auditory cortex as a cause of tinnitus drives many of our management and treatment options.


As a person experiences tinnitus, they may or may not give it much attention, or priority.  When given high priority, tinnitus can become a focal point that the brain will more easily detect with time. When tinnitus is given high priority, it can lead to negative emotions, such as anxiety and stress, which can result in other issues such as insomnia or withdrawal. This connection can lead to a cycle that involves the limbic system (which controls emotional associations) and the autonomic nervous system (which includes physical or bodily reactions).

 

Management Strategies

The most common tinnitus management options work to break or avoid development of the negative emotional cycle. As stress can exacerbate tinnitus, stress management, as well as a focus on overall health and relaxation, is part of a comprehensive tinnitus treatment plan


Consideration of dietary triggers.

Certain dietary factors can exacerbate tinnitus symptoms, especially if consumed in excess. Consider reducing or eliminating one of these substances - nicotine, caffeine, alcohol, salt - for a period of time and keep a journal to track any changes in tinnitus perception.


Stress management.

Stress can cause tinnitus perception to spiral out of control. A particularly stressful situation can cause tinnitus to seem worse, and the worsening of tinnitus can cause even more stress. Breaking this cycle is critical for tinnitus management. Consider guided relaxation exercises, meditation, physical exercise, reading a book, or taking time for yourself in whatever ways you prefer. Check-in with your stress levels often and consider keeping a journal to track your stress/tinnitus relationship.


Avoid loud noise exposure.

Use hearing protection whenever possible to avoid further damage to your 

hearing as well as the increase in tinnitus that is often accompanied by an episode of noise exposure.


Review your medications.

Talk with your physician; if you’re taking a medication that causes tinnitus, discuss alternatives. Note: Do not stop taking any medication without getting clearance from your physician.

Sound Awareness/ Sound Therapy.

Maintain some sound in your environment to help distract the brain from tinnitus (television, music, fan, white noise, etc.) Sound spas/ white noise machines and cell phone apps are cheaper options. There are more expensive sound therapy devices accompanied by programs, but those are rarely used anymore due to advances in hearing device technology that allows hearing aids to perform many of the same functions.

Apps: 

- Starkey Relax

- Widex Zen

- Resound Tinnitus Relief

- Whist

- Rain Rain Sleep Sounds


Hearing devices. 

Hearing devices give the brain back the sounds that it is craving as the result of a hearing loss. Because hearing devices are programmed according to an individual’s specific hearing thresholds, they oftentimes are very effective at reducing the noticeability of tinnitus on a daily basis. They also come with built-in tinnitus maskers which include white noise, harmonic tones, ocean and water noise, and other calming sounds.


Cognitive Behavioral Therapy.

Cognitive Behavioral Therapy (CBT) is a branch of psychology that focuses on retraining the brain to reframe one’s automatic reactions to tinnitus from negative to more positive and realistic thoughts. CBT has been proven effective at reducing tinnitus symptoms.


Not scientifically proven to be effective:

Apple Cider Vinegar

Ginkgo biloba and other herbal supplements

B-vitamins, zinc, magnesium

Antioxidants



Most of these are home remedies and may work via the placebo effect or a trend toward a healthier overall diet and lifestyle. Herbal supplements are not tested or approved by the FDA.