Tinnitus (pronounced “TINN-ih-tus” by most physicians, although others pronounce it “ti-NIGHT-us”) is the “perception of sound when no actual external noise is present.”[1] These sounds are most often perceived as ringing, but can be heard as buzzing, roaring, whooshing, swishing, clicking or hissing sounds.[2], [3] Millions of people around the world experience tinnitus. In the US, over 45 million people, or about 15% of the population, have symptoms of tinnitus, while over 2 million people have extreme tinnitus.[4] Tinnitus can be a symptom of a more serious disorder, including ear injury or hearing loss (sensorineural and age-related). It can be an extremely debilitating condition. [5] Treating tinnitus naturally involves diagnosing the condition, trying auditory therapy and being open to other methods.
Method 1 - Diagnosing Tinnitus
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→ Understand what tinnitus is. Tinnitus can range from very loud to very soft sounds, can be loud enough to interfere with normal hearing and be heard in one or both ears. You may hear ringing, buzzing, roaring, clicking or hissing sounds., There are essentially two types of tinnitus: subjective and objective tinnitus.
→ Subjective tinnitus is the most common form of tinnitus. It can be caused by structural ear problems (in the outer, middle and inner ear) or by problems with the auditory nerve pathways leading from the inner ear to the brain. In subjective tinnitus, you are the only person hearing the sound.
→ Objective tinnitus is much rarer, but can be perceived by a physician during an examination. This can be caused by vascular problems, muscle contractions or conditions related to the inner ear bone.
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→ Determine your risk factors for tinnitus. Tinnitus tends to affect men more often than women. Older people tend to experience tinnitus more than young people. Some of the key risk factors for tinnitus include:
→ Age (the peak age of first experiencing tinnitus is between 60 and 69 years)
→ Gender
→ Military service (exposure to loud explosions, gunfire, loud machinery)
→ Employment in a loud workplace environment
→ Listening to loud music
→ Those exposed to any loud noise, either through work or through leisure activities
→ A history of depression, anxiety and/or obsessive-compulsive disorder.
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→ Take the Tinnitus Handicap Inventory questionnaire. The Tinnitus Handicap Inventory, a questionnaire from the American Tinnitus Association may be a good place to start. This questionnaire asks you to assess your level of auditory problems so that you can determine the extent to which tinnitus affects you. This can be a good first step in figuring out how to treat your tinnitus.
Method 2 - Talking With Your Doctor
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→ Get a diagnostic test from your doctor. The doctor will likely physically examine your ears with an otoscope (a lighted instrument for inspecting ears). You may also undergo a hearing test, potentially some imaging tests such as an MRI or a CT scan. In some cases, more extensive tests may be necessary. In general, these tests are not invasive or painful, but may cause some discomfort.
→ You may experience changes in the bones of the inner ear that can be genetically based. The inner ear includes three very small bones: the malleus, the incus and the stapes. These three bones are connected to each other and to the eardrum (tympanic membrane). They are also connected to the structures that translate sound vibrations into nerve impulses that we perceive as sound. If these bones are not able to move freely because of otosclerosis, tinnitus can result.
→ You may also have excessive earwax, which can cause tinnitus.
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→ Talk to your doctor about age-related conditions. Unfortunately, many times the exact cause of tinnitus cannot be determined. Many times, it may simply be due to aging, such as the following conditions:
→ Age-related hearing loss (presbycusis)
→ Menopause: Tinnitus is one of the rarer symptoms of menopause and it may be actually due to age rather than the menopausal transition. Often, the tinnitus disappears along with other menopausal issues. Hormone replacement therapy with synthetic progestins has been associated with increased tinnitus.
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→ Mention your exposure to loud noises. If you work in a constantly loud environment, or you have been exposed to loud noises, be sure to mention this to your doctor. This will help him diagnose your condition.
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→ Ask your doctor about blood vessel disorders. Many disorders that impact blood flow can cause tinnitus. Talk to your doctor about the following disorders:
→ Head and neck tumors that press on blood vessels and change the blood flow
→ Atherosclerosis or the build-up of cholesterol-containing plaques on the insides of arteries
→ High blood pressure
→ Anatomical variations in the carotid artery in the neck that can cause turbulence in blood flow
→ Malformed capillaries (arteriovenous malformation)
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→ Ask your doctor if your medications might contribute to tinnitus. Many medications can cause or exacerbate tinnitus. Some of these medications can include:
→ Aspirin
→ Antibiotics, such as polymyxin B, erythromycin, vancomycin and neomycin
→ Diuretics (water pills), including bumetanide, ethacrynic acid and furosemide
→ Quinine
→ Some anti-depressants
→ Chemotherapeutics, including mechlorethamine and vincristine
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→ Ask about other causes. Tinnitus can be caused by many different conditions, so be sure to get your doctor’s opinion on whether you have any of the following conditions:
→ Meniere’s disease: This is an inner ear disorder caused by increased inner ear fluid pressure
→ Temperomandibular joint (TMJ) disorders
→ Head and neck injuries
→ Benign tumors including acoustic neuromas: These usually only cause one-sided tinnitus
→ Hypothyroidism: Low thyroid hormone levels
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→ Visit your doctor if you suddenly experience symptoms. If you get the symptoms of tinnitus after an upper respiratory infection (URI), suddenly and without any known cause, or you experience dizziness or hearing loss along with the tinnitus, make an appointment to see a physician right away.
→ See your regular physician first. He may refer you to a specialist such as an Ear, Nose and Throat specialist (ENT specialist or otolaryngologist).
→ Tinnitus can cause other problems, including fatigue, stress, insomnia, difficulties with concentrating and with memory, depression and irritability. If you are experiencing any of these, make sure to mention these to the doctor.
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→ Consider trying medical treatments for underlying conditions. Treatment for tinnitus will depend to a large extent on the discovery of an underlying cause, but may include the following:
→ Earwax removal.
→ Treating underlying conditions: Examples of this might include treating high blood pressure or atherosclerosis.
→ Changing medications: If your tinnitus is due to a reaction to a specific medication, your doctor may change the medication or change the dose.
→ Try medications specifically for tinnitus: While there is no specific drug to treat tinnitus, some medications have been used with some success. These include antidepressants and antianxiety drugs. These, however, are also associated with a number of side effects including dry mouth, blurry vision, constipation, heart problems, drowsiness and nausea.
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→ Ask about a hearing aid. Hearing aids may be useful for some people. Your physician might recommend a hearing aid after you have been examined by a licensed audiologist.
→ According to the American Tinnitus Association, “hearing loss causes less external sound stimuli to reach the brain. In response, the brain undergoes neuroplastic changes in how it processes different sound frequencies. Tinnitus is the product of these maladaptive neuroplastic changes.” Essentially, this means that with progressive hearing loss, the brain tries to adapt. But sometimes, that adaptation doesn’t work and tinnitus is the result. In general, the hearing loss is often at and above the frequency of the tinnitus itself.
Method 3 - Trying Acoustic Therapy
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→ Use calming background sound. Mask the noise in your ears by turning on background music or other sounds. You can use tapes or CDs with “white noise” of the ocean, a babbling brook, rainfall, soft music or whatever works to help block out and cover up the sounds in your ears.
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→ Listen to soothing sounds as you fall asleep. White noise or other soothing sounds can also be used to help you sleep. This can be important, as many people find it difficult to sleep with tinnitus. At night, the sound in your ears can become the only sound audible and can make it hard to fall asleep. Background noise can serve to provide a peaceful sound to help you sleep.
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→ Try listening to brown or pink noise. “Brown noise” is a collection of randomly generated sounds and is generally perceived as much deeper sounds than white noise. “Pink noise” uses lower frequencies and is also perceived as deeper sounds than white noise. Either pink or brown noise is often recommended to help with sleep.
→ Find examples online of both pink and brown noise. Choose the noise that sounds best to you.
4
→ Avoid loud noises. One of the most common triggers for tinnitus is the presence of loud noises. Avoid these as much as possible. Some people may not be affected by loud noises. But if you do experience worsening or aggravated tinnitus after hearing loud noises, you’ll know that this may be a trigger for you.
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→ Look into music therapy. A German study involving music therapy in tinnitus showed that music therapy employed in early cases of tinnitus can prevent that tinnitus turns into a chronic condition.
→ This therapy involves listening to your favorite music with its frequency altered to center on the same frequency as the ringing in your ears.
Method 4 - Trying Alternative Health Treatments
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→ Get a chiropractic adjustment. Temporomandibular joint (TMJ) problems, which can cause tinnitus, can be successfully treated with chiropractic approaches,, TMJ problems are thought to promote tinnitus because of the proximity of muscles and ligaments that attach to the jaw and the hearing bones.
→ A chiropractic treatment would consist of manual manipulation in order to re-align the TMJ. The chiropractor might also manipulate the vertebrae of the neck in order to decrease the symptoms of tinnitus. Chiropractic adjustments are not painful, but they may cause some temporary discomfort.
→ The chiropractic treatment may also include the application of heat or ice and specific exercises.
→ Chiropractic treatments can also help with Meniere’s disease, another relatively rarer cause of tinnitus.
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→ Visit an acupuncturist. A recent review of studies of the success of acupuncture for tinnitus concluded that there was some cause for hope. Acupuncture techniques would vary based on the underlying cause for the tinnitus. These techniques also often include traditional Chinese herbs.
→ More studies are needed to assess the effectiveness of acupuncture on improving tinnitus.
3
→ Ask your doctor about aldosterone. Aldosterone is a hormone found in the adrenal gland that regulates sodium and potassium in the blood. One study found a tinnitus patient with hearing loss to have an aldosterone deficiency. When the patient received bioidentical aldosterone, the patient's hearing was restored and the tinnitus went away.
4
→ Try personalized sound frequency treatments. There is a relatively new approach that may be useful for some. The idea is to find the frequency of the particular sound in your ears and masking that specific frequency with specially designed sounds.
→ Your ENT or audiologist may have recommendations about these treatments.
→ You may also find these treatments available online for a fee through websites such as Audionotch and Tinnitracks. These services walk you through testing for the specific frequency of your tinnitus and design a treatment protocol.
→ There have been limited studies on this approach, but they do appear promising.
Method 5 - Trying Supplements
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→ Take CoQ10. Your body uses CoQ10, or coenzyme Q10, for cell growth and maintenance. It is also an antioxidant. CoQ10 can also be found in organ meats, such as heart, liver and kidney.
→ One study indicated that CoQ10 supplements could be helpful for some patients with a low serum level of CoQ10.
→ Try taking 100 mg three times a day.
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→ Try ginkgo biloba supplements. Ginkgo biloba is believed to increase blood flow to the brain and has been used to treat tinnitus with variable results. This is likely because tinnitus has many known and unknown causes.
→ A recent review concluded that there was insufficient evidence to support the use of ginkgo biloba to treat tinnitus. Another recent report, on the other hand, concluded that a standardized extract of ginkgo, EGb 761, was an effective treatment. EGb 761 is a “standardised extract of Ginkgo biloba leaves and has antioxidant properties as a free radical scavenger. A standardised extract of Ginkgo biloba leaves is a well-defined product and contains approximately 24% flavone glycosides (primarily quercetin, kaempferol and isorhamnetin) and 6% terpene lactones (2.8-3.4% ginkgolides A, B and C, and 2.6-3.2% bilobalide).”
→ Commercially, this particular supplement is sold as Tebonin Egb 761.
→ Follow manufacturer’s instructions if taking this supplement.
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→ Increase your intake of zinc. In one study, almost half of tinnitus patients improved with 50 milligrams (mg) of zinc daily for 2 months. This is actually a rather high dose of zinc. The recommended daily intake of adult males is 11 mg and for females, the recommended dose is 8 mg.
→ Don’t take this amount of zinc without talking to a knowledgeable healthcare professional first.
→ If you do take this high amount of zinc, don’t take it longer than 2 months.
→ Balance your intake of zinc with copper supplements. A high intake of zinc is associated with copper deficiency and copper-deficiency anemias and taking the extra copper will help prevent that. Take 2 mg of copper every day.
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→ Try melatonin supplements. Melatonin is a hormone that is involved in the sleep cycle. One study indicated that 3 mg of melatonin taken at night was most effective in men without a history of depression and those with tinnitus in both ears.
Method 6 - Changing Your Diet
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→ Avoid salty foods. It is generally recommended to avoid salty foods because of their association with high blood pressure, which can cause tinnitus.
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→ Eat a healthy, whole-foods diet. A reasonable recommendation is to eat a healthy, whole-foods diet low in added salt, sugar and saturated fats and to increase the amounts of fruit and vegetables in the diet.
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→ Try cutting down on coffee, alcohol and nicotine. Some of the most common triggers for tinnitus include coffee, alcohol, and nicotine. Avoid any and all of these as much as possible. We don’t really know why these are triggers for different people. Because tinnitus is a symptom of a number of different possible problems, the reason these are triggers may vary on an individual basis.
→ Cutting out these substances may not improve your tinnitus. In fact, one study showed that caffeine was not associated with tinnitus at all. Another study indicated that alcohol may actually help relieve tinnitus in older adults.
→ At a minimum, watch what happens if you have any coffee, alcohol or nicotine, especially being aware of what happens to your tinnitus after you indulge in any of these. If the tinnitus gets worse or harder to deal with, you may want to consider avoiding those triggers completely.
Method 7 - Finding Support
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→ Try cognitive behavioral therapy and tinnitus retraining therapy. Cognitive behavioral therapy (CBT) is an approach that uses techniques such as cognitive restructuring and relaxation to change a person’s response to tinnitus. Tinnitus retraining therapy is a complementary practice that helps desensitize you to the noise in your ears.
→ The therapist will teach you different ways to cope with the noise. This is a process in CBT known as habituation, where you can learn to ignore the tinnitus. The therapist will teach you about your tinnitus and will teach you a variety of relaxation techniques. This person will help you adopt a realistic, effective attitude in dealing with tinnitus.”
→ A recent review of the technique indicated that it didn’t affect the level of noise, but it positively affected how the individual responded to the noise. The response after CBT included less depression and anxiety, with higher reported levels of satisfaction with life.
→ A recent large review of therapeutic approaches to tinnitus determined that a combination of sound therapy (background noise) plus CBT provided the best overall results.
→ Another study reviewed nine high-quality studies evaluating the efficacy of tinnitus retraining therapy and cognitive behavioral therapy. In each study, a variety of standardized and validated questionnaires was used. The investigators found that both tinnitus retraining therapy and cognitive behavioral therapy were equally effective in relieving the symptoms of tinnitus.
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→ Join a support group. You might find it useful to find a tinnitus support group, especially if you are experiencing depression or anxiety associated with the tinnitus.
→ This support group can help you develop tools to cope with your condition.
TIPS
→ Experiment with what works for you. Since tinnitus is a symptom and not a disease, it can be caused by a variety of factors. Different approaches will work better for some than for others. Sometimes, a combination of approaches will work better, so don’t give up. Try different approaches until you find what works best for you.
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