Tinnitus Management

At Marin Hearing Center, we specialize in the evaluation and treatment of tinnitus. We are here to provide resources to minimize the effects of tinnitus on your life in order to enhance your quality of life.

What is tinnitus?

Tinnitus is the perception of sound in the ear(s) or head, most commonly perceived as ringing, humming, or buzzing in the ears, without an external source. It can be heard in one or both ears or just “in the head.” It is real, neural activity in your brain. Tinnitus is a symptom, rather than a disease entity in itself. Approximately 50 million people are affected by tinnitus in the U.S., and 30 million adults experience persistent tinnitus. Tinnitus can also affect children. Tinnitus is severe enough for 12 million people that it will impact daily life.

Causes

Although there are many causes of tinnitus, the cause is often not known. Tinnitus can be generated from something as simple as earwax pushing against the eardrum, to something as potentially serious as a growth on the hearing nerve. It can even be related to non-auditory factors such as neck or jaw problems.The most common causes are inner ear damage from noise exposure that damages the delicate sensory cells of the inner ear, medications that are harmful to the inner ear, infections, the normal degenerative aging process, and head injury. In rare situations, tinnitus originates in the middle ear (the cavity behind the eardrum) and can be heard by an examiner. In these cases, the “objective” tinnitus may be the result of middle-ear muscle twitching or abnormal blood flow, and may be perceived as “throbbing” or “pulsing.” This type of tinnitus warrants a visit to an ear specialist, for possible surgical/medical intervention. Activities such as smoking, drinking alcohol or caffeine, and taking excessive amounts of aspirin or non-steroidal anti-inflammatories may worsen tinnitus. Most people with tinnitus also have hearing loss, so it is important to have your hearing checked if you are experiencing tinnitus. In fact, 90% of the members of the American Tinnitus Association who are affected by tinnitus also report hearing loss.

Effects of tinnitus on life activities

The presence of tinnitus can affect sleep, concentration, and stress. 20% of tinnitus sufferers report that their tinnitus affects their sleep, and 26% report that they have difficulty focusing on a task. Despite these statistics, there are things you can do to facilitate your sleep, reduce stress, and improve your concentration.

Tinnitus treatment

In most cases tinnitus cannot be cured, but it can be managed to reduce aggravating factors and reduce your awareness of it. If the tinnitus is potentially caused by something that is medically or surgically treatable, we will provide you with recommendations and options to treat the underlying cause.

Counseling

Counseling approaches include basic information about hearing loss and tinnitus, and may also include collaborative activities to assist in coping, thinking, accepting, and reacting to tinnitus in different ways. Counseling typically focuses on a person’s thoughts and emotions, hearing, stressors, concentration, and sleep. Many individuals experience relief from their tinnitus following education and counseling.

At Marin Hearing Center, we specialize in tinnitus consultation in order to provide you with the education and background information you need and activities to assist you with your tinnitus.

Stress reduction

Stress makes it harder to cope with tinnitus. Relaxation exercises 15 minutes a day can help you to relax and reduce stress. These exercises may include progressive muscle relaxation, deep breathing, and guided imagery.

At Marin Hearing Center, we can assist you with setting up a stress reduction program using relaxation exercises.

Sound therapy

The presence of background noise reduces the prominence of tinnitus for many patents. The background noise may be in the form of environmental noise (e.g., fan, heater, air conditioning, raindrops, music, and other sound generators) or wearable devices (e.g., hearing aids, hearing aids with sound generators, and other wearable sound devices). Most people with tinnitus also have hearing loss. 28% of hearing aid users report significant reduction in their tinnitus when using hearing aids and 2/3 of hearing aid users experience tinnitus relief most or all of the time. Most hearing aid manufacturers now incorporate sound therapy into at least some of their hearing aids, typically in the form of a broadband or “white” noise or narrower bands of noise. A highly original hearing aid feature known as “Zen,” which utilizes semi-random tones, has been shown in research to be a promising tool for tinnitus relief and is available in Widex instruments.

At Marin Hearing Center, we are well-informed about hearing aids and the various available sound therapy treatments. We will assist you, if needed, in finding one or more that may be appropriate for you.

Facilitating sleep

Many tinnitus sufferers report that their tinnitus interferes with their sleep. There are a number of things you can do to nurture your sleep experience. These may include the following:

• Do not eat large meals prior to sleeping
• Maintain a standard bedtime and set your alarm for the same time every day.
• Avoid alcohol & caffeine an hour or two before bedtime.
• Walk or exercise 10 min/day, but not right before bedtime.
• Don’t take a late afternoon or early evening nap. If you find yourself very tired kin the afternoon, take a brisk walk instead of a nap.
• Reduce bright light and distractions from the bedroom (such as TV); close your curtains or drapes and keep your bedroom dark enough to sleep.
• Don’t watch TV, eat, or read in bed.
• Go to bed only when you are tired.
• Sleep on your back or side; try to avoid sleeping on your stomach.
• Have a set pre-bedtime routine. When you go to bed, take a deep breath and relax with pleasant thoughts.
• Use sound therapy when trying to get to sleep (e.g., music, steady-state nose, relaxation sounds).

Concentration

For some, tinnitus may be distracting to their activities of daily living, such as reading a book or newspaper or concentrating on their work. There are a number of opportunities to improve your concentration habits, including the following:

• Separate long, complex task into shorter ones
• Take frequent breaks during tasks
• Eliminate distractions
• Use sound therapy to make it easier to concentrate on tasks

Use of medications

• Despite many advertising claims, no medication or herbal supplement has been shown in well-designed studies to cure tinnitus.
• Some medications can cause tinnitus, and stopping or changing that medication may eliminate the tinnitus. You should, of course, check with your prescribing professional before stopping any medication.
• The interaction of taking two or more medications can cause tinnitus.
• Some medications are used to treat reactions to tinnitus, such as anxiety & depression, or to facilitate sleep. These medications may be helpful, even though they are not directly treating the tinnitus.
• Some tinnitus sufferers may be deficient in dietary nutrients, but well-designed studies to date have not been replicated, and an excess of some supplements can be harmful.

Surgery

Very rare causes of tinnitus may be treated surgically. This typically affects only one ear, and a thorough medical work-up is necessary. Surgery to sever the auditory nerve is not a recommended treatment for tinnitus, as hearing in that ear will be lost and tinnitus is likely to still be present. This speaks to the “central” nature of tinnitus in the brain, rather than in the ear itself.

Alternative Treatments

Hundreds of treatments for tinnitus have been publicized and have been marketed aggressively. Caution is warranted in evaluating such claims, and you are advised to consult with your hearing healthcare professional. Viable treatments typically need to have:

• A controlled condition
• A good measurement tool
• Be studied by a group that does not have an interest in a positive outcome (such as a financial interest)
• Be replicated by at least one other research group

New directions

Research studies of tinnitus are ongoing. Some of the interesting directions involve electrical stimulation of the inner ear (cochlea), electrical stimulation of the brain, and magnetic stimulation of the brain. The American Tinnitus Association is a good source for information regarding tinnitus research, as are many universities.

What you can do to help with your tinnitus

• Accept that there may be no cure for your tinnitus at the present time.
• Accept that there are many things you can do to manage or alleviate the impact tinnitus has on your life.
• Improve your overall well-being; e.g.; relaxation, healthful foods, exercise, treatment for depression and anxiety, counseling, and modification of your reactions to tinnitus.
• If you have a hearing loss and tinnitus, Marin Hearing Center can assist you in determining how hearing aids might help you.

Conclusion

There is good reason to be hopeful that you can reduce tinnitus-related problems, in view of the variety of counseling and sound therapy options that are available, the pursuit of new approaches by device and pharmaceutical companies, the development of animal models to link neural activity and tinnitus behavior, and the increase in tinnitus-related research funding. At Marin Hearing Center, we can guide you through the process of better understanding your tinnitus and reducing your tinnitus-related problems.

References and Self-help:
Davis, P. (1995). Living with tinnitus. Rushcutters Bay, N.S.W.: Gore & Osment.
Hallam, R.S. (1989). Living with tinnitus: Dealing with the ringing in your ears. Wellingborough, Northhamptonshire, Torsons.
Henry, J.L., & Wilson, P.H. (2002). Tinnitus: A self-management guide for the ringing in your ears. Boston: Allyn & Bacon.
Tyler, R.S .(2011). Your guide to tinnitus (ringing in the ears). Better Hearing Institute. www.betterhearing.org.
Tyler, R.S. (2008). The consumer handbook on tinnitus. Sedona: Auricle Ink Publishers.
WidexUSA (2012). The many faces of tinnitus.
American Tinnitus Association: www.ata.org