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Tinnitus

How Is Tinnitus Treated?

Last modified: 
25/04/2012 - 15:29

Contributing Author: Guy Slowik FRCS

Unfortunately, attempts to identify and treat the underlying disorder causing tinnitus are often unsuccessful. The ability to tolerate tinnitus varies widely from person to person. Some or all of the following techniques may help make tinnitus tolerable.

  1. Using a hearing aid may help to suppress tinnitus.
  2. Relief by playing background music to mask the tinnitus-so-called "white noise."
  3. Using a "tinnitus masker". This is a device worn like a hearing aid that produces pleasant sounds.
  4. For the profoundly deaf, a procedure called a cochlear implant may reduce tinnitus.

What is masking?

Are there medications for tinnitus?

Is surgery effective for tinnitus?

When tinnitus is present in both ears, how is it treated?

Are there effective alternative therapies for tinnitus?

What is masking?

Masking is the use of other sounds to "drown out" or "mask" the annoying noises associated with tinnitus. Unfortunately, some people reject this type of treatment without a trial, assuming that one sound is as bad as another. Fortunately, a simple test is available to obtain a preliminary idea of the value of masking for a particular individual.

The faucet test

In the faucet test, people with tinnitus stand near a sink and turn the water faucet on full force. The reason for this test is that many people with tinnitus notice that they do not hear their tinnitus while standing near running water or while taking a shower.

  • If water sounds mask their tinnitus, it is possible that masking may relieve it.
  • A person can record the water sound that is effective for them and then play it back when they want relief. Another approach, of course, is to invest in a commercial tinnitus masker.

What if the faucet test fails?

If a person can still hear their tinnitus in the presence of water sounds, like the running shower or kitchen faucet, it does not necessarily mean that masking is unsuitable for them. It may mean that their hearing loss is such that masking itself cannot be heard and, therefore, does not drown out the tinnitus.

  • Approximately 90 percent of people with tinnitus have a hearing loss, which most frequently involves high-pitched tones. Most noises associated with tinnitus are within this high-pitched region of tones. In order to mask the tinnitus, it is necessary to use a high-pitched masking noise.
  • When water sounds fail to mask tinnitus, it may be that the person is simply unable to hear that portion of the water sound needed to mask their tinnitus.
  • People who have had their hearing tested and have only a high frequency hearing loss are often told they have normal hearing. Their hearing is, in fact, normal-but only for the low frequencies or up to 2,000 Hz.
  • Hearing experts disagree about the definition of normal hearing. Some experts think that a person needs to hear up through 8,000 Hz or higher in both ears in order to understand speech in the presence of background noise, such as that found in restaurants, social gatherings, offices, etc.
  • If a person has high-frequency hearing loss but otherwise normal hearing, electronic assistance in the form of hearing aids may be required if masking relieves their tinnitus. Clinical studies show that some people can only pass the faucet test while wearing hearing aids.
  • Others who fail the faucet test include individuals whose tinnitus cannot be masked, regardless of the type or intensity of masking. Additionally, in those with complex tinnitus, which is composed of more than one kind of sound, only part of the tinnitus may be masked.

Why does masking work?

Masking is generally successful because the masking sound and the tinnitus sound are vastly different in quality. Tinnitus usually produces a shrill, high-pitched, unpleasant tone. In contrast, water and masking sounds are typically soothing.

  • Most individuals can and usually do "automatically" ignore certain external sounds.
  • These sounds are ignored if they are not too loud or harsh and if they are relatively constant and monotonous.
  • Ignoring the masking sound, which covers up the tinnitus, means that the tinnitus is automatically ignored as well.

Nice To Know:

One benefit of masking is that people experiencing annoying and unpleasant sounds have the opportunity to turn masking sounds on or off. There may be times during the day, such as during a meeting or while helping a child with homework, that personal control of tinnitus symptoms is especially important. At other times, symptoms are not as bothersome and masking is not as important at that moment.

A healthcare specialist typically fits a variety of tinnitus maskers. Then people with tinnitus decide if masking is effective for them. If masking is beneficial, the affected individual and healthcare specialist work together to determine the most effective masker. Ultimately, the person with tinnitus makes the final decision.

When should masking be used?

When masking relieves tinnitus, there is no set schedule to follow for its use. People determine when they need relief and use masking accordingly. For example, some people find that their tinnitus does not bother them except at night. Others require masking during the entire day. A few people wear their maskers 24 hours a day.

  • Some people find that they require masking less as they continue to use it. In these cases, residual inhibition probably plays some role in providing a reduced level of tinnitus.
  • In rare cases, tinnitus becomes permanently suppressed after extensive masking.

Can masking be used during sleep?

Some people with severe tinnitus experience sleep disturbances. In such cases, wearable masking units can be fitted as an in-the-ear unit. This type of unit is more comfortable while sleeping.

  • For those people who do not have wearable tinnitus maskers, FM static may be helpful. "Detuning" a FM radio to pick up only static sound, not a clear station, obtains so-called FM static. This noise is constant in volume and contains all frequencies. The volume may be increased until it just covers the tinnitus, or, if that is too loud, to the maximum comfort level.
  • If hearing loss is significant, FM static masking may not be effective. In such cases, the noise of a fan or air conditioner may mask tinnitus and help to bring on sleep.
  • If all else fails, but the sound of running water or a running faucet does mask the tinnitus, these sounds may be recorded on a high-quality tape recorder and played at any time that relief is desired, such as at bedtime.

Are there medications for tinnitus?

There are varieties of medications that may help to relieve the symptoms of tinnitus. Unfortunately, these drugs rarely provide long-term relief of the condition.

  • Intravenous lidocaine was studied for its effectiveness in tinnitus relief. In one well-controlled study, 85 percent of people obtained partial or total relief of their tinnitus. Unfortunately, the relief was short-lived, lasting about 30 minutes or less. However, the study does suggest that tinnitus may be relieved by certain medications. Research is ongoing to find the appropriate drugs that may provide effective and long-term relief.
  • Another drug that shows promise is alprazolam (Xanax®), which is an anti-anxiety medication. In one study, 76 percent of people treated with this medication found their tinnitus symptoms reduced by at least 40 percent. Moreover, those who found relief with alprazolam also demonstrated a reduction in tinnitus loudness.
  • Some people may be helped by anticonvulsant medication (medications normally used to prevent seizures),or antihistamines (medications used in allergy treatment), or certain medications used for cardiovascular problems.
  • Such studies indicate that, with continued research, better relief and more effective procedures-even cures-may be found.

Is surgery effective for tinnitus?

On rare occasions, surgery may be considered to help relieve severe symptoms of tinnitus. The intensity of tinnitus may be unbearably loud and comparable to the sound intensity of standing near a pneumatic drill. Such cases typically result from inner ear injuries and are frequently associated with profound or even total deafness.

  • If no other forms of treatment are effective, an operation, during which the hearing (auditory) nerve is divided, may be beneficial in about 50 percent of severe cases.
  • Surgical failures occur because the tinnitus may set up a "secondary central focus" within the brain itself. In such cases, the alternate source of the tinnitus, located deep within the brain, cannot be treated with surgery.
  • Surgery for tinnitus requires a high degree of technical skill and is usually only undertaken in major teaching hospitals or university centers with specialized departments.

Nice To Know:

Aspirin or other over-the-counter headache remedies should not be used to treat headaches associated with tinnitus. These drugs may temporarily make the tinnitus worse.

When Tinnitus Is Present In Both Ears, How Is It Treated?

When tinnitus occurs in both ears, it is usually necessary to mask both ears. Only rarely does masking on one side relieve tinnitus on the opposite side.

Nice To Know:

When the noise of tinnitus seems to be coming from inside the center of the head, it may be necessary to arrange the masking sound in a special way. If possible, masking is arranged so that sounds are perceived as coming from the center of the head.

Are There Effective Alternative Therapies For Tinnitus?

In addition to the treatments outlined above, other options are available and worth considering when tinnitus is severe and interferes with daily activities, quality of life, and sleep.

  • Relaxation training therapy teaches the person to learn to relax while experiencing tinnitus symptoms, thereby reducing the effect of that stress.
  • Meditation or yoga may help some people with tinnitus.
  • Biofeedback training may also be helpful. This consists of a series of exercise sessions, in which one learns to control circulation in various parts of the body and relax muscles that control the movement of the head. When a person is able to achieve a good state of relaxation, the tinnitus often subsides.
  • Hypnosis or acupuncture may be tried, although benefit depends on the hypnotist or acupuncturist as well as the confidence the patient has in these methods.
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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.