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Coping with Tinnitus

Mostafa Abdi - Sunday, October 31, 2010

For the millions of tinnitus sufferers in the world, the reality is that the cures available are possibly not really cures or are either experimental, only work part of the time or are simply too dangerous to be considered most of the time.  Especially for suffers of subjective tinnitus, where there is nothing physically wrong with the ear, turning off tinnitus is almost impossible.  Instead, the best way to deal with tinnitus is to work on coping with it and tricking the brain into ignoring the sounds, even if they started out as a roar. 

 

Using Music to Quell the Noise

 

Different music therapy approaches are used to help tinnitus sufferers learn to cope or simply help mask the tinnitus so they can function.  The approaches vary from simply having music or background noise going all the time to help the person not hear the tinnitus related noises to white noise generators that work more specifically to help mask the problem. 

 

On top of this, there is a very specialized version of music therapy called notch therapy that helps tinnitus suffers by getting their brain to turn off the specific frequency the tinnitus is on.  For this therapy, a patient will bring a specially trained audiologist some of their favorite songs that they listen to on a regular basis as well as hearing test results showing which frequency or frequencies are causing the problem.   The audiologist takes the music the patient gave them and strips out the frequencies that they hear due to tinnitus and the patient is given a CD of the modified music.  Listening to this helps the brain calm the over stimulated nerves causing the tinnitus and helps the brain sort out what frequencies are actually being heard. 

 

Other Technologies to help Coping

 

There are a couple other ways that people can get help coping with technology.  There have been many success stories of hearing aids actually helping with tinnitus.  If the rest of the frequency band is being properly represented, the nerves causing the tinnitus often times settle down.  In fact, some hearing aids can actually do notch therapy as well now, doubling the value of the hearing aid as a part of coping with tinnitus.  There have been other attempts to help eliminate the tinnitus including acoustic stimulation and there has even been success in coping with tinnitus by seeking psychological therapy, especially using cognitive behavioral therapy’s theories of psychotherapy.


Treatment and Cures for Tinnitus

Mostafa Abdi - Wednesday, October 06, 2010

For those suffering from tinnitus, many will never truly get relief from their symptoms due to the type of tinnitus they have.  However, there are some tried and true ways of getting rid of tinnitus for those having the issue because of physical problems of the ear, rather than nerve damage of some sort.  Some of these methods do show promise for the latter type of tinnitus as well but most of the treatment and cures are for objective tinnitus sufferers or tinnitus where a doctor can identify a physical problem of some sort. 

 

For some, the best solution to their tinnitus problem will be surgical.  For those with a physical problem of the ear, including leaking of fluid from the inner to middle ear or a small hole in the ear drum and other common and less than common ear design issues, surgery can provide a quick, safe and most importantly permanent fix for objective tinnitus. 

 

For others, the solution to their tinnitus can be something as simple as a course of antibiotics to clear up an inner or middle ear infection or even just a thorough cleaning of the ears.  Lingering infections and fluid buildup can actually cause a plaque to form inside the ear and in extreme cases a surgical removal of that may be needed.  However, in most cases antibiotics and possibly a decongestant can be used to remove the inflammation and fluid from inside the ear.  For wax buildup, it too can get so dense that it is almost a plaque in the outer ear.  Regular hygiene can prevent the buildup in the first place but if left unchecked will require a doctor to safely scrape the ear canal and remove wax buildup inside. 

 

For subjective tinnitus sufferers, proper medical based treatment methods can include small changes in medications a patient is taking to try to eliminate any medications that have tinnitus as a known side effect to changing the patient’s diet to try to see if there is a nutrient deficiency causing the problem.  There are some medications that can help with tinnitus but the most common treatments focus more on eliminating things rather than adding things.  For example, before giving small doses of anti-psychotics which are known to work to help treat tinnitus, a doctor is going to try having the patient adjust their diet, supplement with key nutrients and avoid common things like caffeine, salt and nicotine first. 


What is tinnitus part 2

Mostafa Abdi - Sunday, September 19, 2010

What Is Tinnitus?

 

Tinnitus, while considered by many a disease is actually a symptom with many causes.  Tinnitus can vary but all Tinnitus suffers will hear some sort of sound when there is none there to hear.  The experience of tinnitus varies from individual to individual with some people experiencing only mild noises that are easily ignored to others who can hardly cope both because of the sound and because of the volume.  For all who experience tinnitus though, it can be a distraction even when mild. 

 

Causes of Tinnitus

 

The single biggest cause of tinnitus is due to hearing damage. High sound pressure volumes cause a person’s ears to stop responding as well to sounds and the resulting damage also causes the nerves to produce sounds that are not there.  High sound pressures can come from anything from a jet engine to loud music to gun shots and more.  Any sound that comes in higher than 90 decibels can cause hearing damage.  The higher the decibels, the faster and more dramatic the hearing loss is.  Each individual is different in how they might experience tinnitus from hearing damage though.  Some may have some short term humming while others may experience constant noise for weeks, months or for the rest of their lives from even one event. 

 

The second most common cause of tinnitus is from a physical problem with the ear.  For some experiencing symptoms for this reason the problem can be as simple as wax buildup in the ear.  The process is not completely understood but the wax sitting against the eardrum can irritate the nerves nearby causing the perception of sound.  Other people will report tinnitus as part of having an ear infection as well.  Both middle and inner ear infections can irritate and even potentially damage the nerves responsible for hearing causing the hearing of sound when none is there.  For a small percentage of tinnitus suffers there are a couple conditions where the eardrum is not completely sealed or there is some other tiny flaw in the ear that causes the tinnitus symptoms. 

 

The final most common cause of tinnitus is as a side effect from medication.  There are many medications where tinnitus symptoms are a known side effect of the medication.  In fact, it is a very common side effect, with medications as common as aspirin, some antibiotics and commonly taken anti-malaria drugs all having tinnitus listed as a known side effect. 


What is Tinnitus part 1?

Mostafa Abdi - Wednesday, July 28, 2010

Tinnitus is not a disease but actually a symptom that can have many different causes.  The symptom which is tinnitus is hearing sound when there is no external source for the sound.  The actual sound can be difficult to categorize and specific sounds do not necessarily point to a cause.  On top of this, because there is no external stimulation, testing to verify tinnitus is virtually impossible.  The only thing that can be done is categorize how bad the sound is based on how much it affects the person and their daily life. 

What Causes Tinnitus

Most cases of Tinnitus are subjective tinnitus, where there is no clinical test for the symptoms.  The causes of this type of tinnitus vary but the most common is noise-induced hearing loss.  For example, virtually everyone will have ringing in their ears for a few days after a loud concert.  Another common cause is actually impacted earwax in the ear canals.  Ear infections and middle effusion can also cause Tinnitus. 

Another common cause of tinnitus is the aging process.  Aging causes hearing loss and hearing loss can sometimes lead to tinnitus.  Tinnitus is also a common symptom of lead and mercury poisoning but can also be caused by a number of medications, including aspirin, some antibiotics, some diuretics, anti-depressants, quinine and other medications as well. 

The final cause of tinnitus is those that cause the much more rare objective tinnitus.  In these cases, a doctor can actually hear sound coming from the ears of the patient.  This type of tinnitus can be caused by altered blood flow around the ear that causes the person to be able to hear their pulse or blood flowing.  Occasionally, this type of tinnitus can be the symptom that leads to diagnosis of serious and dangerous conditions such as aneurysm and dissection of the carotid artery or vasculitis. 

What Does Tinnitus Sound Like?

Tinnitus sounds different from everyone, even if two people have the same cause of their tinnitus.  It can happen in just one ear or both and is most commonly described as a ringing noise.  However, it can sound like a buzz, hum, whistle, click, crickets, music and many more different sounds.  The sound can be constant or can be one that just pops up then goes away later.  Certain tinnitus suffers find they can set it off by moving part of their body, typically their head, tongue, jaw or eyes.  The intensity can vary from only noticeable in quiet surroundings to a howl that cannot be ignored. 


iPods and Tinnitus

Mostafa Abdi - Wednesday, July 21, 2010

Ironically, the iPod is both a cause of tinnitus and potentially a way to help alleviate tinnitus sufferer’s symptoms.  For the average person with an iPod though, it is far more likely to be a cause than a way to alleviate the symptoms.  Some of the treatments that utilize an iPod to treat tinnitus are utilizing the most advanced research to help alleviate tinnitus symptoms. 

iPod’s Roles in Causing Tinnitus

The iPod and many other MP3 players cause tinnitus in two different ways.  First of all, they produce output that is the equivalent to a jet engine.  While not the blanket roar of the jet, the music piped through a set of headphones can easily hit decibel levels that can cause permanent hearing damage.  Hearing damage is the single most likely cause of tinnitus symptoms and iPods and MP3 players lack even basic protection to keep the output from exceeding the threshold for permanent hearing damage. 

The second and less talked about way that an iPod can potentially cause tinnitus is through infection.  The person who wears the ear bud style headphones, especially the most modern renditions that boast noise blocking silicone rubber ear pieces, can cause infection if left in for too long.  Bacteria love dark, moist environments and an ear sealed up with a silicon ear bud is a great environment for bacteria growth.  The bacteria begin taking hold and a middle or outer ear infection settles in which can cause tinnitus as well.  Most of the time, treating the infection will make the tinnitus go away; however, the root cause is often ignored. 

In both cases, using speakers for an iPod or MP3 player rather than earphones as much as possible will reduce or eliminate both of these potential iPod related tinnitus causes.  However, for many, earphones are the only option.  In this case, being sure to keep the volume as low as possible and using open ear headphones rather than ear buds will help in both preventing hearing loss as well as inhibiting infection potentials. 

iPods to Treat Tinnitus

The most common treatment for most tinnitus is to produce white noise or play music which masks the tinnitus sounds for the person suffering.  This allows them to function during the day and fall asleep without being distracted by the tinnitus noises.  An iPod can either play white noise MP3’s or there are programs that are designed to produce more random white noise rather than looping an MP3 of the same white noise.  

On top of this, there are special treatments that utilize an iPod to play specially modified songs that have tinnitus frequencies blocked.  This helps the brain turn off the sensitivity to those frequencies making the symptoms less or go away completely. 


Future Developments for Tinnitus Cures

Mostafa Abdi - Saturday, July 17, 2010

While not typically debilitating, many people suffer from the effects of tinnitus.  For some of them, tinnitus makes falling asleep more difficult or at times causes their work to suffer when they have a period where the tinnitus is loud.  Because tinnitus affects so many people, it is very well researched and methods for alleviating tinnitus symptoms have come a long way in the past few years.  Going forward, there is research into many different ways of getting rid of tinnitus and some of these will soon be available to the general public. 

Basics of Tinnitus

Tinnitus is actually a symptom, not an actual disease.  It has many causes, from hearing loss to impacted ear wax to being a symptom of heavy metal poisoning to being a side effect of many different types of medication.  However, the single most common cause of tinnitus is hearing loss and most attempts to help correct tinnitus sufferers focus on this cause and the resulting tinnitus. 

Newest Treatment Options

Two of the newest treatment options available are tinnitus retraining therapy and additive destimulation therapy.  Tinnitus retraining therapy is a two pronged approach to dealing with tinnitus.  The first part is through the use of a sound generator to help alleviate the distraction of tinnitus.  The second part of this therapy is specialized counseling which helps retrain the brain and ear of the tinnitus sufferer to either make the sound less noticeable or to teach the person how to ignore it. 

Additive destimulation therapy is the latest and greatest though and uses a far more technological approach to helping with tinnitus.  In this therapy, the audiologist identifies the frequency or frequencies that the tinnitus sufferer hears and then modifies songs that the sufferer likes to listen to take out those frequencies.  By removing these frequencies, the brain becomes less sensitive to them and over time, hearing the tinnitus frequencies is no longer an issue because they can be more easily ignored. 

The Next Round

On the horizon are techniques that utilize electricity to achieve tinnitus relief.  The auditory nerve is the target of one such treatment, called nerve stimulation.  In this procedure, an electrode is attached to the auditory nerve and helps reset the receptors in the brain.  Because it is fairly drastic and experimental, it is reserved for only the most severe tinnitus sufferers. 

The last procedure is called repetitive transcranial magnetic stimulation.  It involves using magnets to stimulate specific spots in the brain.  In research trials it shows promise in turning off tinnitus with very few side effects and should be approved for bigger trials soon.


Current Treatment Options for Tinnitus

Mostafa Abdi - Tuesday, July 13, 2010

For the tinnitus sufferer, making the tinnitus go away or even just lessening it from severe to mild is important for them to be able to have productive days and restful nights.  One of the most common complaints of the tinnitus sufferer is that they have difficulty falling asleep because of the sounds.  Treating tinnitus is often a two pronged approach.  While working to treat the symptom, which is tinnitus, the sufferer and their medical professional should be looking to assess what is causing the tinnitus. 

Treating the Symptom of Tinnitus

Common treatments for subjective tinnitus work to alleviate symptoms.  For many tinnitus sufferers who have trouble falling asleep, the most common method of treatment is to create white noise in the room.  This white noise can be a fan or a specifically designed white noise generator that sits beside the bed.  More recent white noise generators work with iPods and other MP3 players to provide music or constant white noise such as wind or wave sounds.  More advanced auditory stimulation includes music therapy and notched music therapy where the tinnitus frequencies are taken out of the patient’s favorite music.  This causes the brain to stop being stimulated on those frequencies making the tinnitus more tolerable. 

Other common methods of treating tinnitus include reducing or eliminating stimulants and salt.  Caffeine and nicotine reduction can help some tinnitus sufferers, however, in some it can make it worse so it is something to evaluate.  Alcohol consumption, likewise, can cause tinnitus to get better or worse and can be used, in moderation, if it helps.  Zinc supplements, as well as herbal formulas with zinc have been shown to help some sufferers of tinnitus as well because a zinc deficiency can actually be a cause of tinnitus symptoms.  Certain medications can be used, including anticonvulsants, tricyclics and benzodiazepines, however, the side effects of these medications can be more detrimental than the tinnitus itself. 

Treating Tinnitus Causes

For some, especially those with objective Tinnitus, there are treatments that actually work to fix the cause of the problem.  One of the most common is impacted ear wax.  A quick visit to a general practitioner or ENT can remove impacted earwax and provide immediate relief should this be the cause.  There are other surgical procedures available to objective tinnitus sufferers depending on the cause.  For some cases, a quick Botox injection can take care of the problem and for others a detailed surgery where the cochlea is shielded by a Teflon implant is needed.  


Cognitive Behavioural Therapy for Tinnitus

Mostafa Abdi - Tuesday, December 01, 2009

Cognitive Behavioral Therapy (CBT) is a widely-practised psychological treatment designed to restructure the thoughts and behavior of patients who have lifestyle and emotional difficulties. Patients are asked to question their outlook on their life, and to restructure negative associations they make towards themselves, their environment or a particular ailment from which they suffer.

A large body of evidence shows that CBT is effective in anxiety and depression management. As well as the obvious benefits this produces for tinnitus sufferers, CBT can also be successful in altering the negative feelings that are evoked by someone’s tinnitus. This form of ‘cognitive restructuring’ can reduce heightened awareness of tinnitus, which in turn paves the way towards habituation.

CBT does not consist of only one form of treatment, but includes behavioral modification, environmental and situation change, relaxation, hypnotherapy and thought-controlling exercises [[i]].

A Swedish report in 2004 demonstrated that CBT delivered via emails from therapist to patient resulted in clinically significant reduction of distress as measured for 27.4% of patients.  A three-month follow-up demonstrated that the improvements had been maintained, but there was a high drop-out rate of 30% from the treatment. Although this is a cost-effective and labor-saving form of CBT, the majority did not benefit. CBT may be best administered one-to-one or in a group setting [[ii]].

A study which reviewed a large amount of clinical data on CBT, showed that there was no significant reduction in subjective tinnitus loudness or associated depression. But they did conclude that CBT significantly improved quality of life which led to positive management of tinnitus.     

Overall, although CBT may not be conclusively proven to reduce tinnitus intensity, it is generally considered as an effective means of managing the distress provoked by tinnitus. It is also believed that CBT facilitates acceptance and alleviation of negative thoughts towards the tinnitus, which improves quality of life by reducing associated fear, anxiety and depression [[iii]].



[i] Shulman AGoldstein B. Subjective idiopathic tinnitus and palliative care: a plan for diagnosis and treatment. Otolaryngol Clin North Am. 2009 Feb;42(1):15-37, vii

[ii] Kaldo V et al. Internet versus group cognitive-behavioral treatment of distress associated with tinnitus: a randomized controlled trial.  Behav Ther. 2008 Dec;39(4):348-59. Epub 2008 Apr 20.

[iii] Hesser H et al. Clients' in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress.  Behav Res Ther. 2009 Jun;47(6):523-8. Epub 2009 Feb 10


Tinnitus Vitamin: do they work?

Mostafa Abdi - Sunday, November 29, 2009

Vitamins A, C and E

Noise-induced acoustic trauma is closely associated with free radical formation and reduced cochlear blood flow 7-10 days after noise exposure.

Animal trials have found that NIHL was preventable when the anti-oxidants Vitamin A, C and E were used with magnesium 1 hour before damaging noise exposure. Interestingly, vitamins or magnesium alone were not able to prevent NIHL or sensory cell death, but together they had a combined synergistic effect. These are encouraging results and it would be interesting to see how they translate to human NIHL trials [[i]].

Other vitamins for tinnitus

  • ZInc
  • Magnesium
  • B12

Companies supplying Tinnitus Vitamins

  • Arches
  • T-gone


[i] Le Prell CG et al. Free radical scavengers vitamins A, C, and E plus magnesium reduce noise trauma.  Free Radic Biol Med. 2007 May 1;42(9):1454-63. Epub 2007 Feb 20


Treatment Reviews for TInnitus: Hynotherapy

Mostafa Abdi - Friday, November 27, 2009

Clinical hypnotherapy is a common form of therapy for many emotional disorders including phobias, compulsions, unwanted habits, lack of self-confidence, or even physical conditions like irritable bowel syndrome and arthritis.

Hypnosis places the patient into a trance-like state which falls somewhere between wakefulness and sleep. It taps into the subconscious which hypnotherapists and psychologists claim is a source of many of our problems. Following the hypnotherapist’s communication with this section of the patient’s mind, it is believed that the patient can ‘unlearn’ conditioned habits which manifest in the real world as emotional or physical disorders.

As well as being a symptom of a physical condition like hearing loss, tinnitus is also deeply connected with the emotional and stress-causing centers of the brain. It seems logical to contend that if you can reduce the subconscious fear and anxiety caused by tinnitus using hypnotherapy, you can reduce the awareness of tinnitus and thus improve quality of life.

Hypnotherapists commonly quote a 70% success rate in promotional brochures, but although hypnotherapy has been used for tinnitus management for nearly 30 years, few studies have been conducted into its clinical efficacy.

A study in 2007 concluded that 5 to 10 sessions of Ericksonian hypnotherapy resulted in significant improvements in tinnitus for 35 patients with mild to severe tinnitus. These patients were also taught self-hypnosis so that they could continue therapy without a hypnotherapist[[i]].

These results have been vindicated by a larger study with 393 tinnitus sufferers who were also given Ericksonian hypnotherapy for 28 days. 88% of patients with chronic tinnitus showed improvement immediately after the sessions and 6 to 12 months after the therapy, indicating long-lasting results [[ii]].

Although both reports show a reduction in tinnitus, there were no control groups, so despite good statistics it cannot be determined whether the results are attributable to the therapeutic effects of hypnosis, or simply the counseling effect of talking to someone about their tinnitus. Indeed, a study has shown there was no difference in tinnitus reduction between patients who had three sessions of hypnotherapy compared to a single counseling session, indicating no real benefit [[iii]].

Also not all hypnotherapy is the same, ranging from traditional suggestive hypnosis to Ericksonian hypnotherapy to neuro-linguistic programming. These techniques will probably yield different results for different patients, and there is currently not enough research to ascertain which is most effective for tinnitus.

Some hypnotherapy regimes rely on self-hypnosis, which may not be a good option for everyone, particularly for the extremely elderly [[iv]]. Finally, the effectiveness of any psychological treatment will depend heavily on the person administering it, so it is worth assessing the reputation of local hypnotherapists before considering this treatment.



[i] Maudoux A et al. Ericksonian hypnosis in tinnitus therapy.  B-ENT. 2007;3 Suppl 7:75-7

[ii] Ross UH et al. Ericksonian hypnosis in tinnitus therapy: effects of a 28-day inpatient multimodal treatment concept measured by Tinnitus-Questionnaire and Health Survey SF-36. Eur Arch Otorhinolaryngol. 2007 May;264(5):483-8. Epub 2007 

[iii] Mason JD et al.  Client centred hypnotherapy in the management of tinnitus--is it better than counselling? J Laryngol Otol. 1996 Feb;110(2):117-20

[iv] Attias et al.  J Audiology.  Comparison between self-hypnosis, masking and attentiveness for alleviation of chronic tinnitus. 1993 May-Jun;32(3):205-12