However, the multidisciplinary approach based on CBT is not a “cure for tinnitus”, as implied in some papers, but rather a system for managing its symptoms and effects on people’s lives. The differences in outcomes between the treatment and usual care groups were quite small, with the multidisciplinary approach giving a small improvement in quality of life compared with usual care, and moderate improvements in tinnitus severity and impairment. Also, less than 70% of participants completed the trial to 12 months, and this could have affected the reliability of the study’s overall results. Furthermore, as the patients in the study were only followed for 12 months, it is uncertain whether this approach can help in the longer term.
According to ATA, The American Tinnitus Association, 45 million Americans are struggling with tinnitus. In Germany the “Deutsche Tinnitus-Liga” estimates that 19 million Germans have experienced tinnitus, and that 2,7 million Germans have persistent tinnitus, of which 1 million have very severe tinnitus. The British Tinnitus Association estimates that 10% of the UK population suffers from tinnitus. Read more about the prevalence of tinnitus.
Loud noise exposure: Being exposed to occupational loud noise on a regular basis from heavy equipment, chain saws or firearms is a common cause of tinnitus. However, even if you don’t work in a noisy environment, you can still suffer the effects of noise exposure by listening to loud music through headphones, attending live music performances frequently and engaging in noisy hobbies.
Tinnitus is usually described as a ringing in the ears, but it can also sound like clicking, hissing, roaring, or buzzing. Tinnitus involves perceiving sound when no external noise is present. The sound can be very soft or very loud, and high-pitched or low-pitched. Some people hear it in one ear and others hear it in both. People with severe tinnitus may have problems hearing, working, or sleeping.
CBT involves working with a therapist or counselor, typically once per week, to identify and change negative thought patterns. CBT was initially developed as a treatment for depression and other psychological problems, but it seems to work well for people with tinnitus. Several studies and meta-reviews, including one published in the Korean Journal of Audiology, have found that CBT significantly improves irritation and annoyance that often comes with tinnitus.
If cerumen (more commonly known as ear wax) accumulates in your ear canal, it can diminish your ability to hear. Your auditory system may overcompensate for the loss, fabricating noises that do not exist. Your audiologist can safely remove the buildup, and in most cases, this will immediately alleviate your tinnitus. However, sometimes ear wax buildup causes permanent damage, resulting in chronic tinnitus.
Individuals with tinnitus describe perceiving a wide variety of sounds including ringing, clicking, hissing, humming, chirping, buzzing, whistling, whooshing, roaring, and/or whirling. These sounds may be present at all times, or they may come and go. The volume, pitch or quality of tinnitus sounds can fluctuate as well. Some people report that their tinnitus is most obvious when outside sounds are low (i.e. during the night). Other individuals describe their tinnitus as loud even in the presence of external sounds or noise, and some describe it as exacerbated by sounds. Tinnitus can affect one ear or both ears. It can also sound like it is inside the head and not in the ears at all.
Often people bring in very long lists of medications that have been reported, once or twice, to be associated with tinnitus. This unfortunate behavior makes it very hard to care for these patients -- as it puts one into an impossible situation where the patient is in great distress but is also unwilling to attempt any treatment. Specialists who care for patients with ear disease, usually know very well which drugs are problems (such as those noted above), and which ones are nearly always safe.
Tinnitus is commonly thought of as a symptom of adulthood, and is often overlooked in children. Children with hearing loss have a high incidence of tinnitus, even though they do not express the condition or its effect on their lives. Children do not generally report tinnitus spontaneously and their complaints may not be taken seriously. Among those children who do complain of tinnitus, there is an increased likelihood of associated otological or neurological pathology such as migraine, juvenile Meniere’s disease or chronic suppurative otitis media. Its reported prevalence varies from 12% to 36% in children with normal hearing thresholds and up to 66% in children with a hearing loss and approximately 3–10% of children have been reported to be troubled by tinnitus.
Although mitochondrial DNA variants are thought to predispose to hearing loss, a study of polish individuals by Lechowicz et al, reported that "there are no statistically significant differences in the prevalence of tinnitus and its characteristic features between HL patients with known HL mtDNA variants and the general Polish population." This would argue against mitochondrial DNA variants as a cause of tinnitus, but the situation might be different in other ethnic groups.
The physician may also request an OAE test (which is very sensitive to noise induced hearing damage), an ECochG (looking for Meniere's disease and hydrops, an MRI/MRA test (scan of the brain), a VEMP (looking for damage to other parts of the ear) and several blood tests (ANA, B12, FTA, ESR, SMA-24, HBA-IC, fasting glucose, TSH, anti-microsomal antibodies).
Tinnitus retraining therapy (TRT). This technique is based on the assumption that tinnitus results from abnormal neuronal activity (see "What's going on?"). The aim is to habituate the auditory system to the tinnitus signals, making them less noticeable or less bothersome. The main components of TRT are individual counseling (to explain the auditory system, how tinnitus develops, and how TRT can help) and sound therapy. A device is inserted in the ear to generate low-level noise and environmental sounds that match the pitch, volume, and quality of the patient's tinnitus. Depending on the severity of the symptoms, treatment may last one to two years.
Schecklmann et al (2014) suggested that tinnitus is associated with alterations in motor cortex excitability, by pooling several studies, and reported that there are differences in intracortical inhibition, intra-cortical facilitation, and cortical silent period. We doubt that this means that motor cortex excitability causes tinnitus, but rather we suspect that these findings reflect features of brain organization that may predispose certain persons to develop tinnitus over someone else.
Tinnitus habituation therapies, such as tinnitus retraining therapy (TRT), involve using low level sounds in a graduated fashion to decrease the perception of tinnitus. This differs from use of masking devices such as described earlier. TRT involves a wearable device that an affected individual can adjust so that the level of sound emitting from the device is about equal to or matches the tinnitus sound. This may be called the “mixing point” because the sound from the device and the tinnitus sound begin to mix together. An affected individual must repeatedly adjust the device so that the sound is at or just below the mixing point. TRT is supported by counseling with a trained professional who can teach the individual the proper techniques to maximize the effectiveness of TRT. Eventually, by following this method, affected individuals no longer need the external sound generating device. Affected individuals will become accustomed to the tinnitus sound (habituation), except when they choose to focus on it. Even then the sound will not be bothersome or troubling. The theory is akin to a person’s ability to ignore sounds such as the hum of air conditioner, the refrigerator motor turning on, or raindrops falling on the roof when driving a car in the rain.
Practice mindfulness meditation. I’ve written about the power of mindfulness mediation to reduce stress and improve sleep. A 2017 study found mindfulness meditation is also effective in helping people better manage tinnitus. Mindfulness meditation involves sitting comfortably, putting your attention on your natural breathing. When your mind wanders—to irritating tinnitus sounds, to worry about sleep, or wherever else it goes, gently return your attention to your breath. Start with a 5-minute session, and as you grow more comfortable with the practice, you can increase the time. You can practice mindfulness meditation anywhere, at any time of day—including in the shower!
Vitamin Supplements. Vitamin supplements, like Lipo-Flavonoid Plus, contain the vitamins that some studies have shown to be beneficial to inner ear health. These include Vitamin C, B-1, B-2, B-6, B-12, zinc, niacin and calcium. And while I am a proponent of vitamins, I advise my patients to take a regular OTC multivitamin that costs $15, versus Lipo-Flavonoid Plus, which has the same ingredients, but costs up to $90 for the same number of pills, just because it’s packaged and marketed to people that suffer from tinnitus.
While there are many different FDA-approved treatments for tinnitus available, the most important component is finding the right partner (i.e. a Doctor of Audiology), who will work closely with you to help explain your tinnitus and treatment progress over time. In order for the options below to be as successful as possible, the proper support and guidance from an experienced tinnitus specialist is mandatory.
In the advance online edition of Nature on January 12, 2011, the researchers reported that the number of neurons tuned to the high frequency had jumped by 79% compared to control rats. The scientist then tested 2 different tones in a second group of rats but stimulated the vagus nerve only for the higher one. The neurons tuned to the higher tone increased by 70%, while those tuned to the lower one decreased in number. This showed that the tone alone wasn’t enough to initiate the change; it had to be accompanied by VNS.
Being exposed to loud noise on a regular basis from heavy equipment, chain saws or firearms are common causes of hearing loss and tinnitus. Noise-induced hearing loss and tinnitus can also be caused by listening to loud music through headphones or attending loud concerts frequently. It is possible to experience short-term tinnitus after seeing a concert, but long-term exposure will cause permanent damage.
Most people who suffer from tinnitus also experience hearing loss to some degree. As they often accompany one another, the two conditions may be correlated. In fact, some researchers believe that subjective tinnitus can only occur if the auditory system has been previously damaged (source). The loss of certain sound frequencies due to hearing loss may change how the brain processes sound, causing it to adapt and fill in the gaps with tinnitus. The underlying hearing loss typically results from exposure to loud noises or advanced age:
Seek treatment for hearing problems. If you’re experiencing difficulty hearing, talk to your physician and seek help from an otolaryngologist (an ear, nose throat specialist) or an audiologist. In addition to addressing any underlying health issue and improving your quality of life, improving your hearing can make tinnitus less noticeable and less bothersome, during the day and at night when you’re trying to sleep.
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
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We are all different and you may find you prefer one type of relaxation over another. You may find a class that teaches a type you like. However, you may not be able to get to classes or you may just prefer to do something yourself. Using some simple techniques regularly may help you to improve your quality of life and make a real difference to living with tinnitus. It does take practice to develop good relaxation techniques, and what may help one day, may not do so the next – so don’t give up if at first it does not seem to help.
Ringing-in-the-ears or a fullness-of-the-head sensation are the most common symptoms of tinnitus. While ringing is the most common experience, the noise can also sound like a buzzing, hissing or whizzing sound. It can range from a low pitch to a high pitch and may be soft or loud at times. For some, tinnitus seems to get louder at night, just before sleep when no other sounds are competing with it. Tinnitus can remain constant or come and go intermittently. In severe cases, the ringing in the ears is loud enough to interfere with work or daily activity, whereas those with mild tinnitus can experience soft ringing that is no more than a minor annoyance.