In this guide, we’ll cover all the information you need to know about treatments for tinnitus in 2020.
Tinnitus is defined as the perception of sound without a corresponding sound present outside the body. Put another way, you can hear a sound, or sounds, when that sound does not exist in the world outside you. Most people hear a high-pitched ringing, humming, whooshing or buzzing, though tinnitus can have many types of sounds. It may be heard in one or both ears and be present all or only some of the time.
It is important to clarify here that tinnitus is a symptom, and not a disease. Put more simply, it is a consequence of something that isn’t working correctly in the part of your body responsible for hearing and making sense of sound. Sometimes this problem is something that can be resolved by a doctor, and sometimes the problem might be something that is not fully understood.
There is no permanent cure for tinnitus. This is largely because there are many different potential causes, and we do not fully understand the underlying reasons why some people experience tinnitus. However, there are a number of treatments and remedies available that can be used to help, or relieve, the severity of the individual experience. In particular, many of the therapies available can be successful in reducing the “perceived loudness”.
In this article we’re going to go through the treatments currently available for tinnitus. We’ll look at the science behind these, and whether they’ve been proven to work.
In order to understand which treatments might be successful for your tinnitus, it is important to first establish whether there are any contributing factors which may be making your tinnitus worse and that could be resolved. If you are experiencing symptoms the first step would be to see your doctor. They will ask you more about your health in general, examine your ears, and may arrange some tests to investigate whether there might be a clinical condition which could result in tinnitus, or something else making the tinnitus seem worse.
Here are some of the factors that could be causing tinnitus that your doctor might want to exclude:
Damage to hearing is the most common cause of tinnitus, and the conditions often go hand in hand. Hearing loss itself can have several causes, but the one that puts you at the highest risk of tinnitus is prolonged exposure to loud noise. This often is more common in people with high risk jobs (such as musicians or construction workers) but can also be a result of just listening to music too loudly on a regular basis.
The best current theory for why this causes tinnitus is that the damage reduces the amount of sound getting to the brain. The brain then tries to get more information from the ear and that this extra sensitivity results in tinnitus.
Interestingly, we have a better understanding of some of the rarer types of tinnitus. For example, pulsatile tinnitus can be caused by turbulent blood flow, often in the neck or in the bone behind your ear. Other unusual types include clicking tinnitus due to spasms of the tiny muscles inside your head.
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:
Cognitive behavioural therapy (CBT) is a type of talking therapy that can be targeted towards tinnitus. It aims to help you understand your thoughts about your tinnitus, and how these thoughts are related to certain behaviours which might improve or worsen your symptoms. You will work with a therapist to identify and change patterns of thinking which might make your tinnitus worse.
For example, tinnitus might make it difficult for you to concentrate on a certain task. This might then frustrate you and make you more stressed about your tinnitus. The increased stress then makes your tinnitus worse, which in turn worsens the stress. This is an excellent example of the type of thought cycle that CBT aims to interrupt.
CBT is usually delivered by a therapist over a series of sessions ranging from 6 to 24 weeks long. Your therapist will work with you to find the right therapy for your lifestyle and experience of tinnitus. There have been numerous scientific studies demonstrating its effectiveness and as such it forms a foundation for many treatments.
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.
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.
Tinnitus retraining therapy (TRT) focuses on the idea that you can learn to better cope with and habituate to your tinnitus on both a conscious and subconscious level. It combines some of the techniques also used in CBT, mindfulness and relaxation with use of a noise generating device to distract your attention from the noise of the tinnitus.
The quality of scientific evidence to support the use of TRT is limited, but the general consensus amongst tinnitus therapists is that TRT is useful. The literature describes no negative side effects and further research has been recommended to better understand its effectiveness.
Sound therapy describes the use of a competing sound in an agreed 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.
Hearing aids are used to treat tinnitus, and many of them will have a special tinnitus noise therapy programme. They are classified as a type of sound therapy because they amplify ordinary everyday sounds that might distract you from the sound of the tinnitus. The advantage with hearing aids is that they are used almost all the time (except when you’re sleeping). Hearing aids are often the first stage in any tinnitus treatment plan, as most people with tinnitus also have some level of hearing loss.
Sound therapies (and masking in particular) do seem to help many people with tinnitus, although the scientific evidence is not yet conclusive.
Although we’ve described the most commonly used treatments for tinnitus, this is by no means a comprehensive list. The treatments we’ve discussed are available in specialist hearing therapy, tinnitus and audiology clinics and have been assessed in scientific papers. But which treatment is the most effective?
Tinnitus is a very individual condition and one of the key aspects of its management is understanding what works best for you. Many treatments will work for some but not for others. There is no one single most effective treatment, and you may need to try one or more of the therapies before you find something that helps you cope better
It is not something that can be cured overnight, but with the right support, intervention and the right mindset, tinnitus can be successfully managed.
We believe that anyone with tinnitus should have access to the necessary tools required to manage their condition. At the moment, that is not the case. Many of the treatments described in this article are not widely available, and in certain cases only available privately. That’s why we’re building Oto.
Oto is a mobile app that allows anyone with tinnitus or hearing loss to track their hearing health and access digital treatments. We’re building the most effective therapies right into the app, meaning that they’ll be available for use at a time and place of your choosing.
We'd love for you to try the pre-release version of Oto. We're currently testing an early prototype of the app with access to the introductory tinnitus therapy module. Click the relevant link below if you'd like to try this for free.