A Candle in a Dark Room

Tinnitus treatments aren’t perfect, but they can offer relief.

Tinnitus is a condition in which people perceive sounds, such as ringing or buzzing, in the ears or head. Causes of tinnitus are varied, but may include long-term noise exposure (or a single loud event), pressure caused by blockage in the middle ear, stress or anxiety, head and neck trauma, dental issues, ototoxic effects from prescription drugs and/or smoking. About 50 million people in the United States suffer from tinnitus, and it is the #1 service-related disability among U.S. veterans.

A sensorineural reaction in the brain to damage in the ear and auditory system, tinnitus is typically accompanied by hearing loss. Sensorineural hearing loss is caused by a problem in the inner ear, often because the tiny hair cells that move sound through the ear don’t work properly because of damage or disease. In many cases, it appears the brain is trying to “correct” the auditory deficit; it is “reorganizing to help hear,” and that is where the tinnitus is coming from.

Tinnitus is not a disease in and of itself, but rather a symptom of some underlying health condition. Sometimes tinnitus is a sign of high blood pressure, an allergy or anemia. In rare cases, tinnitus is a sign of a tumor or aneurysm. Other risk factors include diabetes, temporomandibular joint disorder (TMJ), thyroid problems, obesity, concussion or head injury.

Management Options Available

There are no consistently applied best practices in how to educate patients about what tinnitus is and options for management, according to a study by University of Miami researchers, published in the Journal of Communication and Health Care.

Having evidence-based patient education is particularly important in tinnitus, where there is no cure but there are management options that can restore a patient’s quality of life, says Tricia Scaglione, Au.D, director of the Tinnitus and Sound Sensitivities Clinic and assistant professor of Otolaryngology at the University of Miami Miller School of Medicine. “Numerous health care providers, including some ear nose and throat [ENT] specialists, do not realize that there are useful options for managing [tinnitus].”

Scaglione continues, “as a result, far too many patients are misled to believe that there is nothing they can do about their tinnitus and that they have to live with the chronic and disturbing symptoms.”

Best Practices

Any time a patient reports tinnitus, a complete medical evaluation is recommended; since the condition is typically accompanied by hearing loss, a comprehensive diagnostic audiologic evaluation as well as functional hearing assessment is also recommended.

After having ruled out medical concerns, the next best step is to identify the perceived pitch and loudness of the tinnitus. We now have tools to retrain the brain at that pitch and loudness to help patients manage their tinnitus. This process, called “sound therapy,” does not eliminate the tinnitus, but by giving the patient some control, it’s a significant benefit to their quality of life.

The two most common types of sound therapy are masking and habituation. Mask- ing exposes a person to background noise, such as white noise, nature sounds or ambient sounds, to mask tinnitus noise or distract attention away from it. Habituation retrains the way the brain interprets tinnitus; essentially, the brain learns to reclassify the unwanted sound as something neutral or unimportant.

Hearing aids may also reduce tinnitus symptoms by ensuring external sound sources provide alternate auditory stimulus. When the brain’s attention is distracted and internal “head noise” is not alone, blended perceptions may be less noticeable and troublesome.

I counsel patients to think of their tinnitus as a candle in a dark room. Due to the contrast, the candle/tinnitus is very apparent. Using sound therapy, we do not try to eliminate the brightness of the candle/tinnitus per se, but rather increase the brightness of the room, thereby reducing the contrast and making the tinnitus less apparent. With appropriate adaptation, the patient learns
compensating strategies. Sound therapies, sound machines, phone apps, behavioral therapies and relaxation strategies are often recommended in combination.

Original article published in Sonoma Health Magazine.