Rule Out Other Conditions
To treat tinnitus, your doctor may try to identify any underlying condition that may be associated with your symptoms. If tinnitus is due to another health condition, your doctor may be able to take steps that could reduce the noise. Examples include:
- Earwax removal.Removing impacted earwax can decrease tinnitus symptoms.
- Treating a blood vessel condition.Underlying vascular conditions may require medication, surgery or another treatment to address the problem.
- Changing your medication.If a medication you’re taking appears to be the cause of tinnitus, your doctor may recommend stopping or reducing the drug, or switching to a different medication.
Counseling & Sound Therapy
For many people, a combination of counseling and sound therapy can provide tinnitus relief.
- Tinnitus Activities Treatment (TAT): Includes counseling of the whole person, and considers individual differences and needs. TAT utilizes a picture-based approach facilitates engagement of the patient, and provides thorough and structured counseling. The patient is also engaged through the inclusion of homework and activities to demonstrate understanding and facilitate progress. The following four areas are evaluated:
- Sleep: The patient learns about the sleep cycle and how certain habits can affect sleep. Effective strategies to use before and during sleep are taught, and the use of background sounds and relaxation exercises are discussed.
- Hearing: Most people with tinnitus also have an underlying hearing loss. The patient is taught strategies to improve hearing and communication and, when appropriate, the use of hearing aids is considered.
- Emotions: The patient is asked to describe fears and concerns about how tinnitus is affecting his or her life and health. Patients are taught that they can change their reactions to their tinnitus, and that we will help them.
- Concentration: Patients are asked to identify situations when tinnitus interferes with concentration. They practice doing activities that require different levels of attention and, in some situations, use background sounds to help.
- Cognitive behavioral therapy (CBT): This method of counseling has been used for depression, anxiety, post-traumatic stress disorder, and other conditions. It focuses on restructuring the negative reactions toward and regaining control over the condition. In addition to relaxation techniques, it teaches that while you can’t change the tinnitus, you can change your attitude toward it and in this way better manage it.
- Tinnitus Retraining Therapy (TRT): This therapy aims to achieve habituation to your tinnitus. This means you are no longer aware of your tinnitus except when you focus on it, and even when you do notice the tinnitus, it does not bother you. It is combined with low-level, broadband sound generators.
Sound therapy, or acoustic therapy, works by making the perception of the tinnitus less noticeable in relation to background sound that is delivered through the sound therapy device. The devices can be wearable or be placed on a tabletop. Many different sounds are available:
- Noise: Broadband noise is most widely used, most likely because it is easy to ignore. Sounding like radio static, it includes a wide range of frequencies. (Frequency refers to the number of vibrations per second; its perceptual equivalent is pitch.) This is believed to activate a large area of auditory cortex in the brain, possibly making this type of sound more effective.
- Music: Studies have found music to be effective for encouraging relaxation and reducing anxiety. Music can also help distract you from your tinnitus. Most clinicians use mild, moderate-tempo, instrumental music rather than fast-tempo music or music with vocalists, which can feel more stimulating than calming.
- Modulated tones: Amplitude and frequency can be varied, resulting in softly pulsing tones. Some patients find this a more effective, acceptable, and relaxing sound.
- Notched sounds: “Notched” sounds refer to sound with a portion of the spectrum removed, or filtered out. Some approaches remove some frequencies from the frequency of the patient’s particular tinnitus pitch. Other strategies remove frequencies around the patient’s pitch match frequency.
- White noise machines.These devices, which produce simulated environmental sounds such as falling rain or ocean waves, are often an effective treatment for tinnitus. You may want to try a white noise machine with pillow speakers to help you sleep. Fans, humidifiers, dehumidifiers and air conditioners in the bedroom also may help cover the internal noise at night.
- Hearing aids.These can be especially helpful if you have and underlying hearing loss well as tinnitus.
- Masking devices.Worn in the ear and similar to hearing aids, these devices produce a continuous, low-level white noise that suppresses tinnitus symptoms.
- Tinnitus retraining.A wearable device delivers individually programmed tonal music to mask the specific frequencies of the tinnitus you experience. Over time, this technique may accustom you to the tinnitus, thereby helping you not to focus on it. Counseling is often a component of tinnitus retraining.
Some medications have shown to provide relief to tinnitus suffers and may help reduce the severity of symptoms or complications. Learn more about how Hearing Health Foundation’s Hearing Restoration is working toward finding better therapies and cures for hearing loss and tinnitus, here.
Possible medications include:
- Tricyclic antidepressants, such as amitriptyline and nortriptyline, have been used with some success. However, these medications are generally used for only severe tinnitus, as they can cause troublesome side effects, including dry mouth, blurred vision, constipation and heart problems.
- Alprazolam (Niravam, Xanax)may help reduce tinnitus symptoms, but side effects can include drowsiness and nausea. It can also become habit-forming.
There’s little scientific evidence that alternative medicine treatments work for tinnitus. However, some alternative therapies that have been tried for tinnitus include:
- Ginkgo biloba
- Zinc supplements
- B vitamins
Neuromodulation using transcranial magnetic stimulation (TMS) is a painless, noninvasive therapy that has been successful in reducing tinnitus symptoms for some people. Currently, TMS is utilized more commonly in Europe and in some trials in the U.S. It is still to be determined which patients might benefit from such treatments.