Tinnitus

What is Tinnitus?

Tinnitus is “the perception of sound that is generated in the head”.  Many people know tinnitus as the ringing or buzzing sound associated with coming out of a loud concert or other very noisy environments.  Tinnitus may also sound like crickets, high tension wires, jet engine noise, whooshing, humming, or even music.  It can be heard as coming from one or both ears or from within the head.

What Are the Causes Of Tinnitus?

For most people, tinnitus is a phantom perception produced by background activity within the brain’s hearing pathways.  Only the person with tinnitus can hear the sound (“subjective tinnitus”).  Occasionally, the tinnitus comes from a “real” sound produced by blood flow, contraction of small muscles in the head or a ringing produced by tiny hair cells in the inner ear.  In some cases, this kind of tinnitus can be heard or measured by a trained observer (“objective tinnitus”).  This type of tinnitus is relatively rare.

Tinnitus is commonly associated with noise exposure, hearing loss, ear disease or dysfunction, head/neck injury or insult, certain medications, even stress.

What Can I Do To Manage My Tinnitus?

There are many steps you can take to manage tinnitus. Here are a few suggestions to get you started.

Educate Yourself

Getting accurate and helpful information about tinnitus is an important part of learning how to manage tinnitus. Your audiologist can provide you with preliminary information on tinnitus and its management. However, you may have more questions than your audiologist is able to answer in a short visit. Ask your audiologist if they can recommend reading materials on tinnitus, a local support group or a clinic that specializes in tinnitus care.

Below are some suggestions on where to look for in-depth and accurate information on tinnitus.

On the internet:

A word of caution – be careful about what you choose to read on the internet. Some internet sites may leave you feeling worse about tinnitus by presenting tinnitus as a dreadful and unmanageable experience. Other sites will offer you a “cure” or remedy for tinnitus that has not been proven effective through proper research (although it may prove to empty your wallet).

Books

Tinnitus self-help books written by professionals that specialize in tinnitus and its management can be very helpful in getting started on tinnitus management. Three excellent self-help books are:

  • Tinnitus Treatment Toolbox by J. Mayes
  • Learning to Live with Tinnitus and Hyperacusis by L. McKenna, D. Baguley, & D. McFerran
  • How to Manage Your Tinnitus: A Step-by-step Workbook by J.A. Henry, T.L. Zaugg, P.J. Myers & C.J. Kendall

All three books are available through on-line book sellers and some local libraries.

Have Your Hearing Tested

The majority of people with tinnitus have some degree of hearing loss. Having a hearing test at a hearing clinic is a good first step for anyone with troubling tinnitus, even if hearing loss isn’t recognized as a problem. Addressing even minimal hearing loss can help reduce tinnitus awareness.

Where Are Hearing Tests Done?

You can arrange for a hearing test through a private hearing clinic. Many private hearing clinics have an audiologist on staff. All Canadian- and US-trained audiologists have some training in tinnitus assessment and care. Click here for a list of Canadian audiologists who specialized interest in tinnitus care.

Hearing tests are also done through some public hospitals and health units. Hearing tests for adults within the public healthcare system typically require a referral from a medical doctor.

Avoid Silence

Being in a very quiet room will make most people notice tinnitus more than being in a noisy room. Finding ways to enrich your sound environment won’t get rid of tinnitus but it may help to make tinnitus less noticeable. Tabletop sound generating devices or sound generating apps on a smart phone can make you less aware of tinnitus, especially at night when our homes are quiet and our minds less occupied.

Another effective way to avoid silence is to use hearing instruments. Several models of hearing instruments can be programmed with a sound generator. The sound generator is programmed to play white or shaped noise, patterned tones or even pleasant environmental sounds like ocean waves. Many people find that wearing these instruments throughout the day reduces tinnitus awareness and helps them to relax. Your audiologist can help you decide the best way to use sound to manage tinnitus.

A few hearing clinics specialize in fitting instruments for tinnitus and carry a full range of devices designed for tinnitus care. If you are unsure, ask your audiologist about their experience with tinnitus management and what products they do and don’t provide.

You have a minimum 30-day trial period for hearing instruments. Ensure that you are fully satisfied with the product and service that you receive before you commit to payment. You should find the instruments comfortable enough to wear all day.

Get a Good Night’s Sleep

About half of people with tinnitus report difficulty falling asleep or getting back to sleep. In addition to avoiding silence throughout the night, make sure that you employ good sleep habits.

Here are some ways to improve your “sleep hygiene”:

  • Avoid screen time 2 hours before bed
  • Have a consistent and relaxing bedtime routine
  • Go to bed only when sleepy
  • Get up at the same time every day
  • Avoid naps
  • Avoid clock-watching
  • Keep your computer and TV out of the bedroom
  • Keep your room dark and the temperature at about 18 degrees Celsius
  • Exercise regularly and not too late in the evening (about 2 hours prior to bedtime)
  • Limit use of caffeine, alcohol and nicotine, all of which can disrupt sleep patterns
  • Let go of the fear of not sleeping

Reduce Stress

Stress tends to increase tinnitus. Minimize stress in your life where possible and learn how to improve how you react to stressful events. Relaxation is a skill many of us are not very good at. You can improve your ability to relax with daily practice of relaxation exercises such as deep breathing or progressive muscle relaxation. Mindfulness meditation can also help you learn to react less to tinnitus and other experiences.

Some people can teach themselves these relaxation and mindfulness-based stress reduction through reading books and listening to audio recordings. Others prefer to learn these techniques with an experienced professional.

Protect Your Hearing

Exposure to loud sound can cause tinnitus to emerge or worsen. Protecting your ears from hazardous levels of noise is essential to prevent noise-induced hearing loss and onset or aggravation of tinnitus. This means turning sound down to a safe level when possible and wearing appropriate hearing protection when you can’t. This applies at work, play and home.

It is also important not to overprotect your ears. People with decreased sound tolerance [link here] often overuse hearing protection. This can worsen sound intolerance. It can also result in the wearer not hearing important warning signals.

Your audiologist can provide you with information on when and how to use hearing protection appropriately.

Medications

There are no medications that have been shown to safely and consistently eliminate tinnitus. Some physicians may prescribe anti-depressants or sleep aids to manage the effects of tinnitus.

Certain medications or combination of medications may trigger or exacerbate tinnitus. These include medications known to be toxic to the hearing system (ototoxic drugs) such as aminoglycocide antibiotics, vancomycin and certain chemotherapy agents. Pain medications such as non-steroidal anti-inflammatory drugs (e.g. ibuprofen, aspirin, naproxen), loop diuretics and quinine (used to treat malaria and leg cramps) may also trigger or exacerbate tinnitus. If you are concerned about a drug that you are or will be taking, discuss your concerns with your prescribing physician or pharmacist.

It is important to tell your physician if you experience tinnitus onset or changes while taking a medication. You and your doctor can discuss if a change in dosage or medication is advisable.

Diet and Supplements

Diet modifications and use of supplements such as vitamin B, magnesium and zinc have not been shown to be consistently effective in eliminating tinnitus.

Some people are concerned that certain food items such as coffee will worsen tinnitus. This is not usually the case. Taking a two-week break from a certain food or beverage that you believe might be contributing to tinnitus, followed by a reintroduction of the food or drink, might tell you if the food or drink is linked to tinnitus. Keep in mind that sudden withdrawal from caffeine can have its own side effects such as headache and fatigue.

Tinnitus treatment options

There are a few structured therapies designed to help manage tinnitus.

Cognitive behavioural therapy

Cognitive behavioural therapy, or CBT, teaches us to identify and change negative automatic thinking that contributes to unpleasant feelings and reactions. If the first thought that comes into our heads whenever we hear tinnitus is negative (“I can’t hear because of tinnitus” or “I will never be able to relax because of tinnitus”), then we are likely to feel negatively toward the tinnitus. By changing how we think about tinnitus, we change how it makes us feel. CBT has been shown to be very effective in reducing tinnitus distress.

CBT is typically taught by psychologists or clinical counsellors trained in CBT techniques. CBT is not a service typically offered by audiologists but it may be available through a counsellor or psychologist in your community. CBT is also a component of Progressive Tinnitus Management, discussed below.

Tinnitus Retraining Therapy

Tinnitus Retraining Therapy (TRT) is protocol for tinnitus management that includes sound therapy and educational counselling. Participants in a TRT program receive individualized counselling on tinnitus and instructions on how to use sound to lessen tinnitus awareness. In theory, the combination of counselling and sound therapy help to retrain the brain’s neural networks responsible for tinnitus detection. The goal of TRT is to decrease awareness of tinnitus as well as the reaction to tinnitus (tinnitus habituation). Audiologists take a TRT training course to become qualified as a TRT provider.

TRT is recognized by Veterans Affairs Canada and WorksafeBC. Claimants with a recognized tinnitus claim can request coverage for TRT from these organizations.

Mindfulness Meditation

Mindfulness meditation aims to teach individuals bring their conscious attention to the here-and-now, rather than dwelling in the past or guessing about what might happen in the future. The principle behind mindfulness meditation is that all we have is the present, and that the present moment is where we have the ability to change how we respond to what is happening within and outside of ourselves. We can eliminate or reduce suffering by learning to experience our thoughts, feelings, and perceptions – including tinnitus – without judgment or reaction.

Mindfulness-based stress reduction, or MBSR, is a group program that focuses on developing mindful awareness. Typically the course is structured over 8 weeks in groups between 10 and 40 people. MBSR has been used to improve the well-being of people with chronic health conditions as well as people who are generally healthy. Research funded by the British Tinnitus Association is examining the effectiveness of MBSR for tinnitus management, and there is at least one online MBSR course for tinnitus management that has been piloted and shown to have positive results.

Progressive Tinnitus Management

Progressive Tinnitus Management, or PTM, is a “stepped care” approach. PTM recognizes that not all individuals with tinnitus need the same level of care to learn to manage reactions to tinnitus. Some patients require only a hearing evaluation and possibly hearing aids. Those patients who require more care are offered Skills Education, which is provided by both an audiologist and a psychologist. The audiologist teaches strategies for using sound, while the psychologist teaches coping strategies that are based on CBT. Patients requiring even more care receive an in-depth evaluation by an audiologist and a psychologist, and one-on-one counselling sessions as needed.

This web page is an initiative of the Canadian Academy of Audiology (CAA). Note that inclusion of a therapy program on this web site does not constitute CAA’s endorsement of a particular approach or protocol for tinnitus and hyperacusis management.
For information on guidelines for clinical practice in tinnitus, including a plain language summary, please visit the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) web site.

AAO-HNS Clinical Guidelines for Tinnitus (plain language)

 

 

Where can I find more information?

 

Professional Resources

Professional Resources

 

Educational Opportunities

Tinnitus Care Providers

All Canadian and US trained audiologists have some training in tinnitus assessment and care. Click here for a list of Canadian audiologists who specialized interest in tinnitus care.

Tinnitus care provider list is an initiative of the Canadian Academy of Audiology (CAA).  If you are an audiologist with specialized training in tinnitus and working in Canada, please consider adding your name to this list by contacting CAA .

Canadian Academy of Audiology
Email: contact@canadianaudiology.ca
Web site:  www.canadianaudiology.ca
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The Canadian Academy of Audiology does not endorse any specific clinician, clinic, nor tinnitus management approach.