Chronic Tinnitus Treatment
Chronic Tinnitus Treatment. Constant noise in the head—called tinnitus—rarely indicates a serious health problem, but it can be frustrating. It can sound like ringing, buzzing, chirping, hissing, or roaring. It may come and go, be constant or pulsatile, in one ear or both ears.
Medical treatments can help make it less bothersome, but there is no cure. Treatments include a physical exam and possibly an audiology test.
There is no cure for tinnitus, but there are some things that can make it less troublesome. The first step is to treat any other conditions that are causing the tinnitus, such as depression, anxiety or insomnia, with medication or psychotherapy. If your tinnitus is caused by noise exposure, hearing aids or other devices that mask sound can make it less noticeable. Some devices can even emit white noise or a soft humming that matches the beat of your heart, which may help you sleep better and concentrate.
If tinnitus is associated with depression, low doses of antidepressants and anxiety medications such as alprazolam can reduce it. Tricyclic antidepressants, such as amitriptyline or nortriptyline, can also improve tinnitus.
Certain drugs can exacerbate tinnitus, including antibiotics and antidepressants, as well as some over-the-counter pain relievers, such as diphenhydramine (Tylenol) and acetaminophen (Tylenol). If your tinnitus is associated with a blood vessel problem or a tumor that might affect your hearing, treating the underlying cause should alleviate the symptoms.
A new approach to tinnitus treatment is called bimodal therapy, which uses two forms of sensory stimulation — sound and touch — to change the brain’s perception of the tinnitus. A wristband sends sound to the ears, while electrodes on your tongue vibrate with electrical pulses. While the therapy has not been formally tested, some patients report improvement. Other therapies include acupuncture, which has been reported to improve tinnitus in some people. Other therapies, such as biofeedback and hypnosis, are being studied. These treatments are often available through mental health clinics or online. The search for a drug-based tinnitus cure is continuing, with several large pharmaceutical companies investing in it.
If your tinnitus is caused by hearing loss, using hearing aids can make it less noticeable. Tinnitus maskers, worn in the ear and similar to hearing aids, emit a low-level white noise that can suppress tinnitus sound. The sound can also provide residual inhibition after it is turned off, making tinnitus less noticeable for short periods. Masking devices are often expensive and not covered by insurance. Other options include white noise machines, fans and even the humming of a ceiling fan or air conditioner.
If the tinnitus is pulsatile (ringing in the ears that changes pitch), or if it is very high-pitched, you may need to consult an otolaryngologist (ear, nose and throat doctor). They can check whether you have a blockage in your ear canal or an injury to the temporomandibular joint in the jaw and can test muscle movement around the neck and head to find whether musculoskeletal factors like clenching the teeth or tension in the muscles of the neck are contributing to the tinnitus.
Cognitive behavioral therapy (CBT) focuses on changing the way you think about your tinnitus, rather than just attempting to quiet it. It can help you learn to relax and focus on other things. It is usually done by a psychologist, and sessions are short-term. It’s not always successful, but it does make tinnitus less bothersome.
There is no medication specifically formulated for tinnitus, and controlled trials haven’t found any supplements or herbs to be more effective than placebos. However, some patients report that acupuncture helps. Others have reported that a change in diet and avoiding irritants such as nicotine, caffeine, sugar and alcohol help. Also, keeping a diary and practicing relaxation techniques can help improve quality of life.
Maskers are audio devices that create a broad-band noise to cover up or mask the tinnitus. They are usually worn behind or in the ear affected by tinnitus. They may be used in conjunction with hearing aids.
The effectiveness of maskers for tinnitus is not well established. In a meta-analysis of four randomized clinical trials, the Cohen’s d for tinnitus intensity ranged from 0.33 to 0.54. A larger sample size and longer-term follow-up is needed for confirmation of the benefits of these devices.
In addition to acoustic maskers, a number of other sound-based techniques have been tried for tinnitus treatment. These include:
Neuromonics Tinnitus Treatment (NTT) uses a combination of counseling and acoustic stimulation to desensitize tinnitus perception. This is achieved by training the limbic system to associate tinnitus with low-level, broad-band noise. This helps to make tinnitus less noticeable, and a patient can eventually become unaware of the presence of tinnitus even when consciously focused on it.
Hyperbaric oxygen therapy is a non-invasive treatment that can provide relief of tinnitus associated with sensorineural hearing loss. However, it does not improve hearing in those with tinnitus that does not accompany a loss of hearing. In one Cochrane review, Bennett et al concluded that HBOT improved tinnitus associated with idiopathic sudden sensorineural hearing loss (ISSHL), but the degree of improvement was insufficient to justify routine use.
Competitive kinesthetic interaction therapy is a form of physiotherapy that purports to activate different groups of muscles in the hand, arm, leg and foot, from the feet up to the face, for a purpose of increasing relaxation and decreasing tension. There is no scientific evidence to support the use of this technique for tinnitus treatment.
Cognitive behavioral therapy
For some patients, the noise from tinnitus becomes so bothersome that professional help is needed. A therapist can help you learn to cope with the noise and make it less intrusive. Various approaches are available, including cognitive behavioral therapy, or CBT, which has been shown to be as effective as medication and sound therapy in clinical trials. CBT aims to help you change the way you perceive and respond to your tinnitus by altering the negative thinking patterns that can worsen it.
Research has shown that these types of psychological therapies reduce tinnitus distress and improve quality of life. They also decrease tinnitus-related anxiety, depression and overall psychiatric symptoms. Improvements from tinnitus-specific therapy are long-lasting.
The type of tinnitus can play a role in how bothersome it is. If the noise is continuous and high-pitched, it may indicate a problem with the auditory system that needs to be addressed by an ear, nose and throat doctor (otolaryngologist). Pulsatile tinnitus often signals a medical problem, such as a blood vessel abnormality or a tumor, and can be treated by an otolaryngologist or a neurosurgeon.
Some tinnitus sufferers report that certain lifestyle changes, such as regular exercise and sleep improvements, can ease the discomfort of their condition. Other options include massage, acupuncture and biofeedback. A specialized approach, called mindfulness-based stress reduction, is being used for pain management, and studies suggest that it could relieve tinnitus as well.
If you’re considering seeing a therapist, your health care provider may be able to refer you. You can also find a therapist online or through a listing service, like Psychology Today or GoodTherapy. There are even apps, such as Tinnitus Rewind and Oto, that can be helpful in reducing the impact of tinnitus on your life.
Chronic Tinnitus Treatment Sound therapy
Sound therapy is a non-invasive, natural, drug-free treatment option that uses carefully considered therapeutic sounds which have been shown to influence physiology, neurology and psychology. It can be used as a stand-alone treatment or as an adjunct to behavioural therapy, as well as other treatments such as massage, acupuncture and exercise.
Constant noise in the head – often described as “ringing in the ears” – rarely indicates a serious health problem, but it can be very annoying. The noise can be a ringing, buzzing, whistling, hissing, chirping, or roaring, and it may seem to come from one or both ears or from outside the head. It can be constant or intermittent, steady or pulsating. It may also change pitch or volume. People with tinnitus often report difficulty working and socializing. There is no known cure, but there are many ways to make it less bothersome.
Some tinnitus patients benefit from using sound-masking devices, which provide external noise that can drown out the internal sound of tinnitus. Others find relief by listening to nature sounds or soothing music. Some studies show that low-frequency sounds – such as those produced by Himalayan singing bowls – lower blood pressure, slow heart rate and promote feelings of calmness (Landry, 2014).
Another strategy is to use the brain’s own natural ability to mask tinnitus with background noise. Some tinnitus sufferers can suppress the ringing by listening to very quiet sounds or by using their own internal “white noise” produced through their vocal cords, which is a common side effect of some medications. Others may find relief through using a cochlear implant. It provides improved hearing communication abilities for people with severe to profound deafness and can mask tinnitus with ambient noise, or even suppress it when electrical stimulation is sent through the auditory nerve (BAST method). People have been using music as a healing or calming tool for centuries. Recent research shows that sounds such as Himalayan singing bowls, flutes and harps can help reduce stress levels by lowering the arousal level of the autonomic nervous system (ANS).
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