TINNITUS: WHAT TO DO ABOUT THAT MADDENING RINGING IN YOUR EARS
Tinnitus is sound in the head with no external source. When it lasts more than six months, it’s known as chronic tinnitus. I’ve had it for years—in fact for so long that I can’t remember when I first developed it. Tinnitus is especially common in folks over age 55 and is strongly associated with hearing loss.
Over time I’ve “habituated” myself to the buzzing in my ears and hardly ever notice it anymore. I’ll speak about that later in this post. But first here is more information on tinnitus with excerpts from the October 23, 2018 Harvard University updated article Tinnitus: Ringing in the ears and what to do about it:
For many, tinnitus is a ringing sound, while for others, it’s whistling, buzzing, chirping, hissing, humming, roaring, or even shrieking. The sound may seem to come from one ear or both, from inside the head, or from a distance. It may be constant or intermittent, steady or pulsating.
Almost everyone has had tinnitus for a short time after being exposed to extremely loud noise. For example, attending a loud concert can trigger short-lived tinnitus. Some medications (especially aspirin and other nonsteroidal anti-inflammatory drugs taken in high doses) can cause tinnitus that goes away when the drug is discontinued. As many as 50 to 60 million people in the United States suffer from this condition. Many people worry that tinnitus is a sign that they are going deaf or have another serious medical problem, but it rarely is.
Most tinnitus is subjective, meaning that only you can hear the noise. But sometimes it’s objective, meaning that someone else can hear it, too. This is more likely to happen in older people, because blood flow tends to be more turbulent in arteries whose walls have stiffened with age.
The course of chronic tinnitus is unpredictable. Sometimes the symptoms remain the same, and sometimes they get worse. In about 10% of cases, the condition interferes with everyday life so much that professional help is needed.
While there’s no cure for chronic tinnitus, it often becomes less noticeable and more manageable over time. You can help ease the symptoms by educating yourself about the condition — for example, understanding that it’s not dangerous. There are also several ways to help tune out the noise and minimize its impact.
What’s going on?
Most people who seek medical help for tinnitus experience it as subjective, constant sound like constant ringing in the ears or a buzzing sound in the ear, and most have some degree of hearing loss. Things that cause hearing loss (and tinnitus) include loud noise, medications that damage the nerves in the ear (ototoxic drugs), impacted earwax, middle ear problems (such as infections and vascular tumors), and aging. Tinnitus can also be a symptom of Meniere’s disease, a disorder of the balance mechanism in the inner ear.
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. 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.
Evaluate and treat underlying problems
If you develop tinnitus, it’s important to see your clinician. She or he will take a medical history, give you a physical examination, and do a series of tests to try to find the source of the problem. She or he will also ask you to describe the noise you’re hearing (including its pitch and sound quality, and whether it’s constant or periodic, steady or pulsatile) and the times and places in which you hear it. Your clinician will review your medical history, your current and past exposure to noise, and any medications or supplements you’re taking. Tinnitus can be a side effect of many medications, especially when taken at higher doses. Musculoskeletal factors — jaw clenching, tooth grinding, prior injury, or muscle tension in the neck — sometimes make tinnitus more noticeable.
Tinnitus that’s continuous, steady, and high-pitched (the most common type) generally indicates a problem in the auditory system and requires hearing tests conducted by an audiologist.
Your general health can affect the severity and impact of tinnitus, so this is also a good time to take stock of your diet, physical activity, sleep, and stress level — and take steps to improve them. You may also be able to reduce the impact of tinnitus by treating depression, anxiety, insomnia, and pain with medications or psychotherapy.
If you’re often exposed to loud noises at work or at home, it’s important to reduce the risk of hearing loss (or further hearing loss) by using protectors such as earplugs or earmuff-like or custom-fitted devices.
Managing tinnitus
In addition to treating associated problems (such as depression or insomnia), there are several strategies that can help make it 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 FDA-approved drug treatment for tinnitus, and controlled trials have not found any drug, supplement, or herb to be any more effective than a placebo. That includes ginkgo biloba, which is sometimes promoted for this purpose. Some patients believe that acupuncture helps, but it too has been found to be no better than a placebo.
The most effective approaches are behavioral strategies and sound-generating devices, often used in combination. They include:
Cognitive behavioral therapy (CBT). CBT uses techniques such as cognitive restructuring and relaxation to change the way patients think about and respond to tinnitus. Patients usually keep a diary and perform “homework” to help build their coping skills. Therapy is generally short-term — for example, weekly sessions for two to six months. A review of six studies found that after CBT, the sound was no less loud, but it was significantly less bothersome, and patients’ quality of life improved.
Tinnitus retraining therapy (TRT). This technique is based on the assumption that tinnitus results from abnormal neuronal activity. The aim is to habituate the auditory system to the tinnitus signals, making them less noticeable or less bothersome. A device is inserted in the ear to generate low-level noise and environmental sounds that match the pitch, volume, and quality of the patient’s tinnitus. Depending on the severity of the symptoms, treatment may last one to two years.
I personally think that “habituation” is the best way to control tinnitus. Here are excerpts from the rewiringtinnitus.com blog titled Tinnitus: How Long Does it Take to habituate?
Habituation
For many tinnitus sufferers, habituation occurs naturally over time, but this is not the case for everyone. Regardless of what strategy you decide to use, it’s important to understand that habituation doesn’t happen all at once.
Spikes and fluctuations can and will still occur throughout the entire process. So rather than constantly assessing how loud it is, it’s better to think of progress in terms of improving quality of life. If you are more productive at work, more relaxed at home, sleeping better, and doing more the things that you enjoy – that’s what really matters. If the overall trend is showing an increasing quality of life, you know you’re on the right track.
4 Levels of Habituation:
Level 1: A person who reaches this point can still hear the sound of their tinnitus but it stops affecting them so much emotionally. Anxiety levels go down, the sound becomes less intrusive, and is more easily tolerated as they go about their day. Quality of life improves significantly, but spikes are still challenging. Relief is not constant at this point.
Level 2: Tinnitus is much less bothersome, and the brain can tune it out most of the time. The sound is still there, but it seems much quieter, and as a result, it’s much easier to tolerate. At this point, a person can expect to have far more good days than bad days. And while spikes still occur, they are not as problematic.
Level 3: At this point, your tinnitus stops bothering you entirely. Your brain will effectively tune out the sound automatically, more or less all of the time. And when you do hear it, it won’t bother you at all. If you experience a spike at this point, it’s easily managed.
Level 4: Tinnitus appears to be gone. The brain effectively filters the sound out of existence. This is as close to a cure as you can possibly achieve. People report this anecdotally, however it’s very uncommon.
How long will it take to find relief?
It depends on how much relief you’re looking for. Countless people achieve the first level of habituation in as little as 2-4 weeks. And for most people, this equates to a massive improvement in quality of life.
In more severe cases, it takes much more time, with the person working hard every single day to make the change. The bottom line is that it takes time and commitment to make these changes and new associations in your brain. Most approaches require a daily practice to work, and without discipline, they won’t work at all.
But it’s possible, and with the right approach, it’s most likely easier than you thought, at least to reach the first levels of habituation.
Happy New Year! Here’s to you having a healthy & fit 2019!