Dr. Julie Prutsman’s team of audiologists offer a higher standard of expertise. She has been deeply involved with tinnitus for more than 15 years, long before effective treatments had been developed beyond hearing aids and maskers. Dr. Julie also studied under one of the industry’s most respected and leading medical experts, Dr. Pawel Jastreboff, and she has personally trained each and every one of her doctors.
A diagnosis of tinnitus is based upon identification of characteristic symptoms, a detailed patient history, a thorough clinical evaluation and complete audiologic testing. These steps will help to differentiate rhythmic tinnitus from non-rhythmic tinnitus. It cannot be overemphasized that tinnitus is a symptom of another underlying condition and not a diagnosis in and of itself. Because of the high number of underlying causes of tinnitus, a variety of specialized tests to detect the specific cause may be necessary. Attempting to identify the underlying cause of tinnitus is the first step in evaluating a person with tinnitus.
Ear protection can mitigate the negative effects of loud noises and prevent the exacerbation of tinnitus. This is especially important if you work in a loud environment or regularly visit loud places, like shooting ranges, concerts, and clubs. Wearing custom earplugs or special earmuffs can go a long way toward preventing your tinnitus from worsening.
Age-Related Hearing Loss: Also known as presbycusis, age-related hearing loss results from the cumulative effect of aging on hearing. This permanent, progressive, and sensorineural condition is most pronounced at higher frequencies. It commonly impacts people over the age of 50, as all people begin to lose approximately 0.5% of the inner ear’s hair cells annually starting at age 40.
Even with all of these associated conditions and causes, some people develop tinnitus for no obvious reason. Most of the time, tinnitus isn’t a sign of a serious health problem, although if it’s loud or doesn’t go away, it can cause fatigue, depression, anxiety, and problems with memory and concentration. For some, tinnitus can be a source of real mental and emotional anguish.
Auditory-somatosensory stimulation is a similar treatment approach to Kilgard’s, in that its goal is to retune the faulty patterns of brain activity that can cause tinnitus. It involves pairing sounds played in the ear with specially timed electric impulses, which are administered to touch-sensitive nerves using a pad attached to the neck, Dr. Shore explains about the research she’s working on.
The researchers next tested whether tinnitus could be reversed in noise-exposed rats. The animals received VNS paired with various tones other than the tinnitus frequency 300 times a day for about 3 weeks. Rats that received the treatment showed behavioral changes indicating that the ringing had stopped. Neural responses in the brain's auditory cortex returned to their normal levels as well, indicating that the tinnitus had disappeared.
ABR (ABR) testing may show some subtle abnormalities in otherwise normal persons with tinnitus (Kehrle et al, 2008). The main use of ABR (ABR test) is to assist in diagnosing tinnitus due to a tumor of the 8th nerve or tinnitus due to a central process. A brain MRI is used for the same general purpose and covers far more territory, but is roughly 3 times more expensive. ABRs are generally not different between patients with tinnitus with or without hyperacusis (Shim et al, 2017).
Antidepressants. Antidepressants, such as nortriptyline and amitriptyline, have been used as mood enhancers to help someone with tinnitus cope with the life changing implications and complications it brings. However, they are often only prescribed in the most severe of tinnitus cases as they carry some serious side effects that might not make them worth taking for everyone. These include blurred vision, heart problems, dry mouth and constipation.
Cartoon of the middle ear showing muscles that attach to ossicles (ear bones), and ear drum. The stapedius is attached to the stapes (of course -- horseshoe object above), while the tensor tympani is attached to the ear drum. While useful, be aware that there are multiple errors in this illustration from Loyola Medical School. With permission, from: http://www.meddean.luc.edu/lumen/meded/grossanatomy/dissector/mml/images/stap.jpg
Even with all of these associated conditions and causes, some people develop tinnitus for no obvious reason. Most of the time, tinnitus isn’t a sign of a serious health problem, although if it’s loud or doesn’t go away, it can cause fatigue, depression, anxiety, and problems with memory and concentration. For some, tinnitus can be a source of real mental and emotional anguish.
To answer your question about NAC (N-acetyl-L-cysteine), I’ve seen little evidence suggesting that is effective for tinnitus. Instead – though the research is very limited – multiple anecdotal reports describe success with the herb ginkgo biloba. Try taking two tablets of standardized extract of ginkgo three times a day with meals (no more than a total dose of 240 mg a day). Ginkgo may work by increasing blood circulation to the head and neck. Give it at least a two-month trial. You might also explore cranial therapy, a gentle manipulative technique performed by osteopathic physicians. This approach seems to take the pressure or irritation off the auditory nerves. If high blood pressure is responsible for your tinnitus, try to get that under control through diet, exercise, and weight loss or medication if necessary.
If the cause of your tinnitus is excessive earwax, your doctor will clean out your ears by suction with a small curved instrument called a curette, or gently flush it out with warm water. If you have an ear infection, you may be given prescription ear drops containing hydrocortisone to help relieve the itching and an antibiotic to fight the infection.
As with the first exercise, make sure you’re comfortable and unlikely to be disturbed. Now imagine yourself leaving this room. You walk out of the door and follow a path… at the end of the path is another door. You open that door and inside you see a beautiful garden – you can hear birds singing, children playing somewhere in the distance. You feel a cool breeze on your skin and hear the rustle of leaves through the trees. The colours of the leaves, green, gold, red, all dance across a beautiful pond in the middle… as you walk over to the pond, you feel the soft grass under your bare feet… you dip your toes into the calm, clear pond and stop for a moment – just experiencing the beauty of everything around you…
To understand what causes tinnitus, you first need to understand what tinnitus is. Tinnitus is, very simply, unexplainable noises you hear in your head when there is no actual sound present. A person with tinnitus will often hear a whistling, humming, buzzing, whooshing, clicking or ringing in their ears, even when there is nothing in the area that is emitting that particular sound. It may be intermittent or last only a short time or never seem to stop.
Tinnitus can arise anywhere along the auditory pathway, from the outer ear through the middle and inner ear to the brain's auditory cortex, where it's thought to be encoded (in a sense, imprinted). One of the most common causes of tinnitus is damage to the hair cells in the cochlea (see "Auditory pathways and tinnitus"). These cells help transform sound waves into nerve signals. If the auditory pathways or circuits in the brain don't receive the signals they're expecting from the cochlea, the brain in effect "turns up the gain" on those pathways in an effort to detect the signal — in much the same way that you turn up the volume on a car radio when you're trying to find a station's signal. The resulting electrical noise takes the form of tinnitus — a sound that is high-pitched if hearing loss is in the high-frequency range and low-pitched if it's in the low-frequency range. This kind of tinnitus resembles phantom limb pain in an amputee — the brain is producing abnormal nerve signals to compensate for missing input.
The degree of loudness or annoyance caused by tinnitus varies greatly from one individual to another. Loudness and annoyance do not always covary. An individual with loud tinnitus may not be troubled, while an individual with soft tinnitus may be debilitated. Most individuals with subjective tinnitus have hearing loss that shows up in a standard clinical audiogram. Tinnitus can sometimes worsen or sometimes improve over time.

Dr. Julie Prutsman’s team of audiologists offer a higher standard of expertise. She has been deeply involved with tinnitus for more than 15 years, long before effective treatments had been developed beyond hearing aids and maskers. Dr. Julie also studied under one of the industry’s most respected and leading medical experts, Dr. Pawel Jastreboff, and she has personally trained each and every one of her doctors.
 Sound therapy can be effective in treating tinnitus because it may make the tinnitus less noticeable or mask the tinnitus or fade tinnitus. Hearing aids are included as a critical component of a sound therapy program. Modern hearing aids come with a special tinnitus managing sounds along with digital amplification. They are much evolved over the older technology. Different products work in different ways, although most hearing aids can alleviate tinnitus, certain hearing aids have built-in technology specifically for tinnitus relief. At amplifon, we have a clearly defined way to measure and quantify chronic tinnitus. As per the severity of the problem, an appropriate combination of treatment methods is selected to deal with your tinnitus. Amplifon audiologists are specially trained in counselling procedures as well which is another critical element of sound therapy. Consult your Amplifon audiologist to find more details about what suits you to deal with your tinnitus problem.
Don't give up on things unless you are sure they are having some effect, especially if it's something you enjoy; or you could end up feeling miserable and deprived for no reason. Do not give up several things at once, or you will not know which one was affecting your tinnitus. If you decide to limit these things and fancy the occasional treat, maybe try using the other strategies (such as relaxation) for those times when your tinnitus is a bit louder. For more details, see our information on Food, drink and tinnitus.
For many, tinnitus symptoms come on gradually and eventually go away as the brain and ears adjust. However, for others tinnitus can last for years and cause various complications. A high percentage of people with tinnitus that’s persistent and untreatable go on to also develop anxiety or depression as a result. What types of things can you do to deal with and lower tinnitus symptoms? Tinnitus treatment includes avoiding excessively loud sources of noise pollution, using certain hearing aids, preventing ear infections and avoiding drug use.
Some tinnitus sufferers have experienced relief through hearing aids, but studies indicate that such benefits are limited to those with low-frequency tinnitus.8 For those with a tinnitus pitch above 5–6 kHz or those with a hissing or buzzing tinnitus, the benefits of hearing aids are more limited or even nonexistent. This makes sense from a neuroscience point of view, as the hearing aid will typically not be making up for hearing loss at frequencies above 6–8 kHz; this prevents any possible effects on tinnitus types that are caused by changes to higher frequency regions in the auditory system. While hearing aids are essential to improving the lives of the hearing impaired, they are not typically the best option for tinnitus; especially when used alone.
MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.

Patients with head or neck injury may have particularly loud and disturbing tinnitus (Folmer and Griest, 2003). Tinnitus due to neck injury is the most common type of "somatic tinnitus". Somatic tinnitus means that the tinnitus is coming from something other than the inner ear. Tinnitus from a clear cut inner ear disorder frequently changes loudness or pitch when one simply touches the area around the ear. This is thought to be due to somatic modulation of tinnitus. We have encountered patients who have excellent responses to cervical epidural steroids, and in persons who have both severe tinnitus and significant cervical nerve root compression, we think this is worth trying as treatment.


When we hear, sound waves travel through the ear into the cochlea, our hearing organ in the inner ear. The cochlea is lined with thousands of tiny sound-sensing cells called hair cells. These hair cells change the sound waves into electrical signals. The hearing nerve then sends these electrical signals to the hearing part of the brain, which analyses them and recognises them as sound.
Tinnitus affects every layer of society, and there has been increasing support for awareness. Recently, musicians who are affected by tinnitus have come together to create awareness for the disorder. Artists including Chris Martin of Coldplay and Black Eyed Peas have created a compilation album to help raise funds towards finding a cure for tinnitus. In the United States, the Department of Defense has invested millions of dollars into investigations of tinnitus sound therapies. In addition, the American Tinnitus Association makes efforts to lobby the US government to provide support for tinnitus sufferers.
In addition to treating associated problems (such as depression or insomnia), there are several strategies that can help make tinnitus less bothersome. No single approach works for everyone, and you may need to try various combinations of techniques before you find what works for you. If you have age-related hearing loss, a hearing aid can often make tinnitus less noticeable by amplifying outside sounds.
There is no cure for tinnitus. However, it can be temporary or persistant, mild or severe, gradual or instant. The goal of treatment is to help you manage your perception of the sound in your head. There are many treatments available that can help reduce the perceived intensity of tinnitus, as well as its omnipresence. Tinnitus remedies may not be able to stop the perceived sound, but they can improve your quality of life.
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