If you’re struggling with tinnitus and experience anxiety or depression relating to your condition, cognitive behavioural therapy is a form of counselling that helps you to cope and readjust your negative feelings. Tinnitus retraining therapy (TRT) can also be used in conjunction with CBT, harnessing the body's natural ability to tune out sounds and make it part of your subconscious mind rather than at the forefront.
Many people find that tinnitus causes frustration, stress, and even anger. And unfortunately, your exasperation and anxiety can seem to amplify the issue. Learning how to thoroughly relax can help you manage your tinnitus. Deep breathing, meditation, yoga, or music therapy may help in combination with sound therapy. You could also explore relaxing hobbies like gardening, painting, swimming, photography, knitting, reading, cooking, or other physical activities (walking, biking, etc.).
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.
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A large, 2014 study of almost 14,000 people found obstructive sleep apnea was linked to significantly higher rates of hearing impairment and hearing loss. Scientists think one reason for this is changes to blood flow to the ear that result in inflammation. (We know that sleep apnea causes changes to circulation and weakens blood flow to some areas of the body, including the brain.) A related factor? People with sleep apnea are at greater risk for high blood pressure, and high blood pressure can exacerbate hearing loss, according to research.
Meniere’s disease isn’t directly connected to tinnitus, but people with Meniere’s often experience it, at least temporarily. Meniere's disease is an inner ear disease that typically only affects one ear. This disease can cause pressure or pain in the ear, severe cases of dizziness or vertigo and a ringing or roaring tinnitus. While Meniere’s isn’t fully understood, it appears that several relief options for tinnitus can also help with this disease. Patients are often advised to reduce stress and lower their consumption of caffeine and sodium.
Acoustic neuroma: This is a rare subjective cause of tinnitus, and includes a certain type of brain tumor known as an acoustic neuroma. The tumors grow on the nerve that supplies hearing and can cause tinnitus. This type of the condition usually are only noticed in one ear, unlike the more common sort caused by hearing loss usually seen in both ears. Causes of objective tinnitus are usually easier to find.
No two patients and no two tinnitus cases are alike. As such, the “best” treatment option is often contingent on an array of factors unique to each patient. Moreover, successful management of tinnitus may require overlapping layers of treatment. ATA recommends that patients work with their healthcare provider(s) to identify and implement the treatment strategy that is best suited to their particular needs.
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.
Acoustic neural stimulation is a relatively new technique for people whose tinnitus is very loud or won’t go away. It uses a palm-sized device and headphones to deliver a broadband acoustic signal embedded in music. The treatment helps stimulate change in the neural circuits in the brain, which eventually desensitizes you to the tinnitus. The device has been shown to be effective in reducing or eliminating tinnitus in a significant number of study volunteers.
Vertigo is the sensation of spinning or rocking, even when someone is at rest. Vertigo may be caused by a problem in the brain or spinal cord or a problem within in the inner ear. Head injuries, certain medications, and female gender are associated with a higher risk of vertigo. Medical history, a physical exam, and sometimes an MRI or CT scan are required to diagnose vertigo. The treatment of vertigo may include:
Exposure to loud noise: Loud noise exposure is a very common cause of tinnitus today, and it often damages hearing as well. Unfortunately, many people are unconcerned about the harmful effects of excessively loud noise from firearms, high intensity music, or other sources. Twenty-six million American adults have suffered noise-induced hearing loss, according to the NIDCD.
Many drugs have been studied for treating tinnitus. For some, treatment with low doses of anti-anxiety drugs -- such as Valium or antidepressants such as Elavil -- help reduce tinnitus. The use of a steroid placed into the middle ear along with an anti-anxiety medicine called alprazolam has been shown to be effective for some people. Some small studies have shown that a hormone called misoprostol may be helpful in some cases.
But one of the awesome powers of the human brain is its adaptability. “It can learn and reorganize itself every time you practice something new,” Kilgard says. His research, including a study published in February 2014 in the journal Neuromodulation, has shown this adaptability may be key to helping the brain “turn down” the hyperactivity that can lead to tinnitus, he says. (4)
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.