What Is Tinnitus?
Tinnitus is a common disorder affecting over 50 million people in the United States. It is often referred to as “ringing in the ears,” although some people hear hissing, roaring, whistling, chirping, or clicking or other sound. Tinnitus can be intermittent or constant, with single or multiple tones. Its perceived volume can range from very soft to extremely loud. Tinnitus is not well understood but is reported in 85% of those with hearing loss and in as many as 60% of those exposed to excessive noise. Tinnitus generally does not get worse once it surfaces.
What Causes Tinnitus?
There are many causes: at the American Tinnitus Association (ATA) notes, “almost anything that can go wrong with the near has tinnitus associated with it a symptom. The causes car range from something as simple as too much ear wax to an ear infections to something more serious like a benign tumor on the hearing nerve”. Even stress, jaw disorders or high blood pressure can cause tinnitus. However, the most common causes of tinnitus are excessive noise exposure (eg. construction, music industry, hunting and shooting) and age related hearing loss. The actual mechanism responsible for tinnitus is not yet well understood. The prevailing theory is that something has compromised the delicate hearing nerve and its receptors and that either the faulty nerve is not creating the tinnitus or the faulty hearing nerve damage is causing the brain to misinterpret signals from the hearing nerve. Either way, the individual “hears” tinnitus. Tinnitus can be made worse by loud noise so wearing hearing protection once tinnitus has started is essential. Stress can make tinnitus worse so managing one’s stress is essential for tinnitus sufferers.
How Is Tinnitus Treated?
Generally, most patients will not need any medical treatment for tinnitus. The most effective treatments to help with the management of tinnitus are as follows:
Some tinnitus patients with hearing loss experience total or partial tinnitus relief while wearing hearing aids. It is unclear why this is so. It is speculated that hearing aids bring back sound to the wearer that “masks” or covers up the annoying tinnitus or that the hearing nerve receptors are being stimulated by sound and thus the brain is receiving true sound and is no longer “starving”, thus ceasing to create the tinnitus.
This is a broad term and there are a number of products and individual clinics that report various degrees of success. In general, sound therapy means the use of external sound to alter a patient’s perception of, or reaction to, tinnitus. Like other tinnitus treatments, sound therapies may not completely eliminate tinnitus, but may significantly lower the perceived burden and intensity of tinnitus. Each case is unique and statistical successes from clinical studies are not high for tinnitus sufferers as a population, although some individuals report good success. It is best to seek audiologists or other hearing healthcare providers who specialize in tinnitus treatments when considering sound therapy treatments. Sound-based therapies available are:
- Maskers: these can be wearable devices (like hearing aids or a special feature in most of today’s hearing aids) or external device (like a fan or television) that creates an external “white-noise” sound that covers the sound of the tinnitus.
- Neuromodulation: sound therapy that uses specialized sound to minimize neural hyperactivity of the hearing nerve believed to the underlying cause of tinnitus. Available products that require significant investment of time and money are Neuromonics and Levo System by Otoharmonics.
Biofeedback is a relaxation technique that teaches people to regulate certain body functions like pulse rate, breathing and muscle tension which in turn helps to better manage stress. The ATA notes that some people report a reduction in the volume of the tinnitus when they are able to modify their reaction to the stress in their lives and the stress due to the tinnitus.
Cognitive Behavioral Therapy (CBT)
This is a specialized form of counseling by a hearing health care provider highly trained in this therapy. It is based on treating a patient’s emotional reaction to tinnitus rather than the tinnitus itself and thus is individually designed for patients and their negative behaviors and thoughts to the tinnitus. CBT is shown statistically to provide benefit but only to those who complete the therapy which can take up to 6 months.
There are no FDA-approved drugs approved to alleviate tinnitus. However, patients who experience significant stress, anxiety or depression from the effects of tinnitus can be prescribed psychotropic medications by a physician to reduce the suffering they are feeling.
The ATA reports the search for new tinnitus treatments and potential cures is on-going. The following are some cutting-edge therapies currently in development but which have not been fully validated for clinical use:
- Repetitive Transcranial Magnetic Stimulation
- Transcranial Direct Current Stimulation
- Deep Brain Stimulation
- Vagus Nerve Stimulation
There are dietary supplements, herbs and other over-the-counter products marketed to alleviate tinnitus but there is little to no data to support tinnitus relieving claims. Speak with a physician first before considering use of such products as they could be hazardous when mixed with other medications or if you have an on-going health problem(s).