Tinnitus Treatments: The Oto Health Guide 2020

Fatema Dawoodbhoy
Intern at Oto Health | 5th Year Medical Student
October 5, 2020

Ever wondered what tinnitus treatments are available? Or what is out there to make it more manageable? Which tinnitus treatments actually work?

Welcome back to the Oto Health guide to tinnitus series. Previously, we dug deeper into the various causes of tinnitus. Now you know about the different causes, it is time to learn about the tinnitus treatments currently available.


Overview

The type of treatment you are offered often depends on the cause, and the doctor or audiologist’s professional opinion. There are also numerous self-help methods that can provide some relief to the symptoms. Ultimately there is no cure for tinnitus, but there are treatments that can help. In many cases, you might need to try several or use a combination of treatments to get the optimal benefit. It is crucial to say that none of the available treatments provide a quick fix and it can take time to help show improvements. However, the most important thing is that finding a combination that works for you can help you to cope and reduce the impact on your life.

There is a lot of uncertainty surrounding the effectiveness of some of the treatment available. In this guide, I will go through the scientific research behind these treatments, and which ones have been shown to work. It is important to understand that some treatments have been tried but are not recommended as viable treatment forms.


Health conditions

If you read our last guide, you’ll know that tinnitus is not a disease in itself, but a symptom of an underlying condition such as Meniere’s disease or Eustachian tube dysfunction. In order for your doctor to decide which treatment is most appropriate, they will have to first establish whether there is a reversible cause. This is because the treatments can differ depending on the diagnosis. If there is a reversible medical condition that is causing the tinnitus, usually treating the underlying cause can help reduce or stop it. Let’s start with some simple treatments for underlying health conditions.



A perforated ear drum can contribute to tinnitus
A perforated ear drum can contribute to tinnitus.

 

Ear wax

Ear wax actually has a lot of protective features for our ears, but only in the right amounts. If there is too much ear wax present, it can occlude the ear canal and often results in tinnitus. Your doctor can remove some of the impacted ear wax at the appointment. In many cases, this can get rid of the tinnitus all together, or reduces its intensity. Unfortunately for some people, because they have a chronic build-up of ear wax, recurrent appointments to the doctors will be needed to help relieve the tinnitus.

Medications

Some medications have been known to cause or worsen tinnitus - we discussed these in our last post here.

If your doctor has found one of these medications to be the underlying reason for your tinnitus, they will most likely reduce or completely stop the medication. Hopefully, the reduction in severity of tinnitus should follow.

Blood vessel conditions

Blood vessel conditions are rarer causes and usually present as pulsatile tinnitus. The most common blood vessel disorders are atherosclerosis (high cholesterol) and high blood pressure. For this underlying cause, there are several treatments available to manage the condition such as medication or surgery. Again, once the underlying blood vessel condition is managed or fully treated, there should be an improvement in the tinnitus.


Psychological Tinnitus Treatments  

If the cause behind your tinnitus is unknown or irreversible, your doctor might refer you for talking therapies, or psychological therapy as we often call it. Tinnitus counselling is a therapy involving a multi-professional approach. You will work with healthcare professionals such as hearing therapists, audiologists or doctors to get a better understanding and grasp of your tinnitus. Learning more about the condition will play a key role in learning how to cope with it and manage it better on a day to day basis. If you know what you are dealing with when it comes to tinnitus, the more control you have over it.

Psychological therapy forms the mainstay of tinnitus treatments
Psychological therapy forms the mainstay of tinnitus treatments

Cognitive-behavioural therapy

Cognitive-behavioural therapy (or CBT for short), is a therapy commonly used in the treatment of several other conditions such as anxiety. It works on the premise that your thoughts affect the way you behave. CBT will help retrain your thinking process and thus change your behaviour and how you act. This technique has been proven to show success when applied to tinnitus. Altering your thought process and the thoughts you associate with tinnitus can reduce your anxiety about it, and allows you to accept the noises you hear. With time, the impact of tinnitus on your life should be reduced.

In the numerous scientific studies undertaken CBT has been shown to be the most effective treatment for management of tinnitus, and is recommended for use in the NHS.


Mindfulness Therapy

Mindfulness therapy for tinnitus incorporates traditional meditation techniques and applies these in a therapeutic approach to help you cope better with your symptoms. Mindfulness teaches people to practice relaxation techniques before focusing on the tinnitus aspect of the therapy. During a session you will be prompted to focus on how different aspects of your senses feel in that moment. For example,  feeling the sensation of the seat against your back,  focusing  on the movement of your chest as you become aware of how you are breathing.

Mindfulness therapy is often used as a tinnitus treatment
Mindfulness therapy is often used as a tinnitus treatment

The aim of mindfulness therapy is not to “get rid of” the tinnitus, rather to make the sensation of it less intrusive to your life. This is a gradual process, and once you are more comfortable with the techniques of meditation the therapy can then begin to focus on the tinnitus and how it feels. This can initially cause anxiety for some, but eventually you will start to feel that the tinnitus is less of a problem.

Initial scientific studies looking into mindfulness therapies have shown promise. Although there have been no large scientific trials, mindfulness therapy is often recommended based on this early evidence.

Other therapies

Sound therapy

Sound therapy describes the use of a competing sound in a programme to habituate you to your tinnitus, so to reduce the perceived intensity. The therapy can be delivered in several different ways, but the most common of these uses “masking”.  A sound in a similar pitch to your tinnitus, or a white noise sound is programmed into a device which you listen to for a regularly fixed period of time. Another type of Sound Therapy involves listening to a relaxing or distracting pleasant sound, which can cover up or ‘mask’ your tinnitus.

Sound therapy is provided using either a dedicated device or an application on a smartphone. The main problem with these is that they are normally only effective during use meaning no relief is provided when the device is not available. Sound therapy can also be provided on a smartphone.

Tinnitus retraining therapy

Tinnitus retraining therapy (or TRT for short) is a combination of long-term counselling and intensive sound therapy. It intends to retrain your brain and the way it responds to tinnitus. The idea is that this re-training will help you start to tune out the sound you hear associated with tinnitus and slowly you will start to notice it less. This therapy is a highly specific and needs to be performed by a trained specialist.

The scientific research undertaken has not been conclusive, and it is not clear how beneficial this type of therapy is. Therefore it is not routinely offered on the NHS.

Self-help

Tinnitus and stress are closely linked. Although we don’t fully understand the underlying reason behind what causes us to hear tinnitus, we do know that stress can make it worse. This is because stress triggers the “fight or flight” response, which we know also affects tinnitus. Therefore, reducing and finding ways to cope with stress can be helpful.

Here are some lifestyle changes that have been shown to reduce stress:

  • Regular exercise – this improves overall mental well-being and can be used as an excellent coping strategy for stress. It will also serve as a distraction for your tinnitus.
  • Keeping active – staying busy with other tasks and hobbies will not only help to reduce stress but can help to distract your mind from tinnitus.
  • Healthy diet – eating healthily is very important to manage the stress of our daily lives.
  • Smoking – there is a common misconception that tobacco can help you to relax. However, the opposite has in fact shown to be true, with nicotine worsening stress overall.
  • Personal contact – Tinnitus and hearing loss can be hugely isolating. Talking about how you feel to your friends and loved ones will help you to process your emotions.
There are many of free resources to help you cope with your tinnitus

The British Tinnitus Association has a webpage showing all the tinnitus support groups available, giving you the opportunity to meet and get inspired by other people with tinnitus.

Sleep Hygeine

Getting a good nights sleep can really benefit your tinnitus
Getting a good nights sleep can really benefit your tinnitus

You might think that this refers to brushing and flossing before bed but it actually refers to your sleep cycle. In many people, tinnitus can affect sleep and thus have a spill-over effect on your daily activities. Sleep hygiene measures can involve:

  • Keeping a rigid sleep schedule by going to bed and waking up at the same time each day
  • Restricting any form of caffeine or alcohol a few hours before bed
  • Reducing screen time for an hour before bed
  • Keep your bedroom for sleeping only! Avoiding using this space for work or other activities if possible

All these measures can train your body to get a good nights rest.

Tinnitus treatments that don't work!

Medications

A number of drugs have been researched for use in the treatment of tinnitus, but studies have found none of these to be beneficial. These are therefore not recommended for use.

Herbal Remedies

There are claims regularly made online about certain herbal remedies that can be used to treat tinnitus. Although the majority of these are harmless, none have been found to be effective .

There are large number of treatments available online, and if you look through the tinnitus forums you will regularly see people discussing various new treatments and techniques. Although many of these are harmless, some are expensive and have the potential to be dangerous. We recommend being very careful if you see a new treatment claimed to be beneficial in tinnitus. If you have any doubt, there is an excellent resource provided by the British Tinnitus Association that assesses both the effectiveness and safety of the majority of treatments available.

You can access this list here.

What tinnitus treatments does Oto include?

Oto brings together all the known effective therapies in tinnitus management into a progressive programme of cognitive behavioural therapy (CBT), targeted mindfulness, relaxation therapy and education. Work through Oto’s therapy modules whilst filling in a hearing health log to see how your tinnitus improves over time. Oto harnesses the power of artificial intelligence to give you in-depth insight into your tinnitus and hearing health in general, with quick and simple tracking.

Oto allows you to access tinnitus therapy from the comfort of your own home, for a fraction of the cost of private therapy. No more long waiting lists, no more driving to appointments.


Want to try Oto?

We’re currently testing the pre-release version of Oto. If you’d like to test this for free, please use the following download link:


NB. To download Oto on iOS, you’ll need to first download Apple’s TestFlight app. This will allow you to join our testing programme.

References

1.NHS Inform. Hearing loss. [Online] www.nhsinform.scot. Available from: https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/hearing-loss#treating-hearing-loss [Accessed: 29th September 2020]

2.NHS Choices. Tinnitus. [Online] NHS. Available from: https://www.nhs.uk/conditions/tinnitus/

3.NHS Inform. Tinnitus symptoms and treatments. [Online] www.nhsinform.scot. Available from: https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/tinnitus#treating-tinnitus [Accessed: 29th September 2020]

4.Mayo Clinic. Tinnitus - Diagnosis and treatment - Mayo Clinic. [Online] Mayoclinic.org. Available from: https://www.mayoclinic.org/diseases-conditions/tinnitus/diagnosis-treatment/drc-20350162

5.British Tinnitus Association. Self help for tinnitus. [Online] British Tinnitus Association. Available from: https://www.tinnitus.org.uk/self-help [Accessed: 29th September 2020]

6.British Tinnitus Association. Tinnitus Support Groups. [Online] British Tinnitus Association. Available from: https://www.tinnitus.org.uk/find-a-support-group [Accessed: 29th September 2020]

7.Oto Health. What causes tinnitus? The Oto Health Guide 2020. [Online] www.otohealth.ai. Available from: https://www.otohealth.ai/post/what-causes-tinnitus-the-oto-health-guide

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