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Newman, Sandridge, and Jacobson1 estimated 50 million people in the United States experience tinnitus. Clearly, the majority of hearing care professionals (HCPs, audiologists, otolaryngologists, and hearing aid dispensers) manage patients with tinnitus every day.
However, tinnitus also may be a sign or symptom consistent with a medical issue or condition such as Meniere’s disease, otosclerosis, acoustic neuroma, glomus tympanicum or glomus jugulare (tumors), all of which require medical attention. It almost goes without saying that step one is a differential diagnosis for the patient perceiving tinnitus, and step two is treatment. Noted tinnitus researcher Aage Moller, PhD,asserts curing tinnitus is not likely and arguably should not be the goal for the patient or the HCP.4  Rather, successful management of tinnitus is likely, and remains a reasonable and pragmatic goal. Further, it’s important to realize the perception of tinnitus may be different in each person who experiences it.
Folmer et al6 reported “effective treatments for tinnitus are generally outnumbered by ineffective strategies, medications, devices and surgeries…” that are marketed and promoted to treat tinnitus.
Zagolski and Strek7 report tinnitus pitch and minimum masking level (MML) depend on the etiology of the tinnitus.
Henry5 reports the primary tinnitus management tool (based on peer-reviewed literature) is cognitive behavioral therapy (CBT), and he reports acoustic therapies (ie, sound-based) have the next largest evidence base (after CBT). Further, Fagelson reports hearing aid amplification provides a method through which sound can be delivered therapeutically, because hearing aids amplify environmental sounds (which reduces the contrast between the perceived tinnitus and the acoustic environment), potentially allowing the patient to feel more secure and to relax. Folmer et al6 explored the peer-reviewed literature from the last 70 years related to tinnitus and determined there are effective noninvasive tinnitus treatments that are useful and often help manage the problem. Interestingly, Folmer et al6 reported some over-the-counter and prescription medicines may be of value—not because they directly impact tinnitus (they do not), but because they may be useful to facilitate sleep, and reduce anxiety, stress, depression, or obsessive-compulsiveness, which may help manage tinnitus. Hoare et al9 also report there is insufficient evidence to support one particular sound therapy over others. Henry5 reports the primary management tool, based on peer-reviewed evidence, is cognitive behavioral therapy. Cima and colleagues10 report the specific CBT protocol does vary across practitioners, situations, and specifics, but in general “a common ground of therapeutic elements” has been established and was determined to be robust enough to guide clinical practice.
Fagelson8 notes multiple studies support the consistent and substantial benefits of CBT with regard to reducing distress while improving quality of life. CBT protocols may include completing “thought” diaries, which allows review and analysis at a later time, and may provide the professional and the patient the opportunity to examine and challenge irrational thought processes. Diaries can be used to identify “automatic negative thoughts” that cause stress and distress. To fully benefit from CBT, a commitment from the patient to complete homework between visits is often required. CBT management of tinnitus has been occasionally criticized due to the need for focused attention on the tinnitus, and focused attention may indeed prevent habituation. Importantly, the benefits of CBT are limited in cases where patients are not motivated to change, or are unwilling to participate in homework or self-help techniques.
Progressive Tinnitus Management (PTM) is an evidence-based and clinically tested approach developed by Department of Veterans Affairs research audiologists. Patients generally enter PTM at the triage level and progress through each stage as necessary and appropriate for their unique needs.
The goal of these individualized appointments is to learn skills and techniques that empower patients to self-manage their tinnitus across multiple environments.
PTM can be considered a framework consisting of multiple evidence-based approaches organized in a “progressive” treatment order. Tinnitus Retraining Therapy (TRT) is based on a neurophysiological model of tinnitus first introduced by Jastreboff.21 This model is guided by the hypothesis that bothersome tinnitus has origins within the limbic (emotional) and autonomic (involuntary) nervous system. Taking advantage of the plasticity of the brain, tinnitus habituation retrains “conditioned reflex arcs” that connect the auditory, limbic, and autonomic systems and modifies subconscious levels of the auditory pathway. Counseling sessions incorporate demystifying tinnitus, educating patients about the underlying causes of tinnitus and its effects, and introducing methods that can lead to tinnitus habituation.
TRT entails a detailed approach to sound therapy to desensitize the limbic and autonomic nervous systems via the presentation of constant low-level broadband sounds.
For permanent habituation, sounds should be used 24 hours a day.22 In addition to structured sound therapy, patients engaged in TRT are encouraged to avoid silence while enhancing ambient background sounds using nature sounds or music. As we assess, manage, and treat tinnitus patients, we should keep in mind the vast majority of tinnitus patients have almost certainly searched dozens of websites looking for a cure. Further, counseling techniques that involve (and perhaps are centered on) cognitive behavioral therapy appear to be the most successful, to date. Finally, of all the sound generating devices available—literally thousands of options—the advanced modern hearing aid, programmed via personalization (ie, based on the patient’s sound preferences and with due consideration for the likely sensorineural hearing loss, recruitment, temporal, loudness, and spectral distortions perceived by the patient) with alternative sound sources, remote microphone connectivity (to maximize the signal-to-noise ratio), extended bandwidth, and vast programming and feature options, appears to be the most likely device to successfully help the majority of patients manage their tinnitus. If you are putting into a ballewick to be used as a natural antibiotic then don't use anything but about 40 drops per cup and no a lot more than 3 x each day.
By eliminating certain foods or substances from your diet you may well be capable to reduce or even eliminate tinnitus from the life.
It is extremely nice to see the greatest details presented in an easy and understanding manner. This section is visible on every page of your website. The sidebar is a great place to put important information like contact details, store hours, or social media links. Posted on May 15, 2014November 29, 2015 by Damon GrantAre Your Ears Ringing, and Why You Should Be Worried About It!
The risk to your hearing from noise exposure depends on how loud the volumes are AND how long you’re exposed to them. A decibel is a unit used to measure the intensity of a sound or the power level of an electrical signal by comparing it with a given level on a logarithmic scale.
One way that noise can permanently damage your hearing is by a single brief exposure to a high noise level, such as a firecracker going off near your ear.
The generally accepted standard to monitor any risk to your hearing is based on an exposure to 85 dB for a maximum of eight hours per day, followed by at least ten hours of recovery time (at 70 dB or lower).
I keep my earplugs with me pretty much all the time, and especially if I am heading out to see some music or a social event where there might be loud noise (like a bar or sports arena).
Lastly, I try to get my hearing checked (and ears professionally cleaned) by my ear, nose, and throat doctor about once a year. Fortunately, 95% to 97% of all people who perceive tinnitus are not disabled by their tinnitus.2 That is, for 95% to 97% of the people who perceive tinnitus, they may notice it now and then, but their tinnitus does not cause stress, anxiety, or depression, or cause them to lose sleep. For them, tinnitus is a major problem that may significantly attenuate quality of life and may significantly facilitate and exacerbate behavioral and physiological problems.
Therefore, the goal of this article is to review contemporary thoughts and findings, as well as the status quo, with regard to managing the patient with subjective tinnitus.
Subjective tinnitus is a phantom sound or noise perceived in the ear(s) most often described as buzzing, ringing, crickets, whistling, humming, static, hissing, or a tone (most often high-pitched) which occurs in the absence of a known external stimulus. That is, objective tinnitus occurs secondary to a physical anomaly such as a foreign object in the ear canal, a perforated tympanic membrane, a patent eustachian tube and more. Objective tinnitus can often be managed medically or surgically, and therefore a differential diagnosis is extremely important.


Unfortunately, in their haste to discover and implement treatment, many consumers skip step one (diagnosis), placing themselves at substantial risk. Moller reasoned curing cancer, tinnitus, or pain (with a single solution) remains a noble cause and honorable goal, but is not likely to happen. They report “consumers should be wary of medications, devices or procedures” marketed or promoted to “cure” tinnitus. MML was defined as the level at which tinnitus was rendered inaudible and defined in dB SL. In his JAAA editorial, Henry reports “sound therapy can be effective when combined with education or counseling, and no one form of sound therapy is proven to be superior (to others).” Henry recommends the tinnitus interdisciplinary management team should minimally include an audiologist, otolaryngologist (or neurotologist), and a psychologist.
Fagelson says the management strategy selected should be tailored to the specific patient’s needs (such as cognitive behavioral therapy).
Additionally, hearing aids restore audibility in frequency regions associated with “deprivation related changes in (auditory) pathway activity.” Fagelson states hearing care professionals should be aware of the benefit availed to the tinnitus patient via well-fitted hearing aids, and they should work with psychologists (for CBT and related therapies) and MDs as needed, to best manage specific patients. Among the many pragmatic, reasonable, and rational factors, they noted “acoustic therapy” is useful.
Nonetheless, they state “sound therapy combined with education and counseling is generally helpful to patients.” They note multiple sound sources have been used to help manage tinnitus, such as noise, music, environmental sounds, and hearing aids.
Cima et al10 report cognitive behavioral therapy is the most evidence-based treatment option with regard to managing the tinnitus patient.
They say various CBT approaches “share the premise that psychological distress and resulting problems are based in a malfunctioning information processing mechanism.” Therefore, CBT appears to be the most successful and pragmatic treatment approach for modifying dysfunctional behaviors and beliefs in order to reduce symptoms, increase daily life functioning, and ultimately recover from the disorder. CBT often fosters an improved patient response to their tinnitus in tandem with their perception of tinnitus becoming less handicapping and more manageable. Diaries can be used to chart the progress of therapy and patients, and patients often keep an additional journal recording their thoughts and concerns.
Goal setting can be used to help the patient move forward as they address irrational thoughts and fears.
Further, to ensure therapy is effective, a supportive and collaborative partnership is formed between therapist and patient.
However, the evidence base does show attending to tinnitus via CBT allows the individual to reconstruct their perception of it.19 The meta-analysis by Hesser et al17 indicates long-term benefits. Key to PTM is the inclusion of multiple treatment options to address individual audiologic and psychological needs.
Triage occurs when a healthcare professional (other than the audiologist or ENT) learns of a patient’s tinnitus. Of course, for some audiologists in certain clinical settings, it may not be logistically feasible to include mental health professionals on the clinical team assessing and treating patients with tinnitus.
However, the audiologist incorporating PTM is afforded the flexibility to use what makes the most sense based on unique patient needs and available resources.
Therefore, TRT targets habituation of the body’s reaction to tinnitus and secondarily habituation of the actual perception of tinnitus. This is accomplished through two factors: intensive individual counseling and sound therapy. By reclassifying tinnitus into a neutral signal, adverse reactions to the presence of tinnitus are reduced or eliminated. According to TRT, the ideal loudness setting for a sound generator is when the perception of tinnitus and external sounds begin to blend together and the tinnitus is still audible. For individuals with hearing loss, background sounds can be increased by the use of hearing aids.
It appears highly unlikely that a specific “universal” solution will be appropriate for each patient who is bothered by the perception of tinnitus. It would not be a stretch to assume some of the “snake oil and mirrors” and marketing claims are appealing, and so debunking pseudo-science and marketing claims must be handled with compassion and understanding, while allowing the patient to maintain their dignity and self-respect. Indeed, when counseling is combined with sound (or acoustic) therapies, we provide the most successful and reasonable approach to managing the tinnitus patient. The sound differs for each person and may be static, ringing, hissing or some other form of noise. His experience of loud noises throughout his life included hunting, playing the drums and attending earsplitting concerts. How the GSE works would it be kills the bacteria that produces acne because GSE is a brand natural bacterial fighter along with an antibiotic. All of these things can be used when describing the serenade that is happening in your head, and no you're not crazy. Well, if you’re like me and it drives you crazy and is an all day, every day kind of thing there are treatment options.
There are certain decibels that you can withstand for longer amounts of time, as they are at a lower deibel level. But hearing damage can also occur gradually at much lower levels of noise, if there is enough exposure over time. I also have a free app on my phone that is a decibel meter so I can measure the noise around me and see if I need to put my earplugs in.
Try to make sure your ENT also has an audiologist on staff, as they can run a bunch of tests and check how your ears are fairing. Instead, they relegate tinnitus to the background, and they habituate to it without very much effort and without discomfort. Subjective tinnitus can only be perceived by the patient, and this type of tinnitus represents 95% to 98% of all tinnitus presentations.
Therefore, we recommend all tinnitus patients be evaluated and diagnosed by a physician or a hearing care professional who has intimate knowledge of the topic area. When people say they want to cure tinnitus, it’s very much like saying they want to cure cancer or cure pain. Nonetheless, we can often successfully manage these problems, and therefore the successful management of the tinnitus patient is our goal. Henry5 reports the tinnitus patient searching the web may fall prey to the millions of websites that promise to silence, quiet, or cure tinnitus.
He notes sound-based interventions help promote the patient’s ability to manage their response to their tinnitus. Specifically, acoustic therapy may be delivered via hearing aid amplification and other products that make background sounds louder, thus reducing the loudness difference between the background noise and the perceived tinnitus. In general, sound therapy appears to be beneficial through tinnitus masking as it reduces audibility (of the tinnitus), or may induce “a sense of relief” through habituation via “reversing abnormal cortical reorganization or activity…,” which may create or promote the tinnitus sensation.
The authors note severe tinnitus distress may come from “cognitive misinterpretations, negative emotional reactivity, and dysfunctional attentional processes,” which likely facilitate dysfunctional tinnitus habituation.
With regard to the cost-effectiveness of CBT, Maes et al11 report the cost-effectiveness (ie, economic evaluation) of multidisciplinary tinnitus treatment based on cognitive behavioral therapy is more cost-effective than usual care. The goal of therapy is to develop skills to empower the individual to challenge their own irrational thoughts. Cima and colleagues10 note that improvements in tinnitus management via CBT have been reported to last up to 15 years.


Using information provided to them, they provide the appropriate referral for further clinical services to assess and potentially treat the disorder.
The audiologist may administer workshops to introduce sound therapy (ie, acoustic therapy) and to teach patients to incorporate sound therapy to meet their needs. At this level, the patient is provided one-on-one services with their audiologist, psychologist, or both.
Treatment options for hyperacusis (oversensitivity to sounds), misophonia (negative reaction to sounds), and phonophobia (fear of sound) are included in the TRT protocol via exposure, desensitization, and reassociation with more pleasant sound images.
It is important that the sound enrichment from the environment or a device never causes an aversive reaction. Nonetheless, many factors are important as we develop a solution for the individual tinnitus patient.
Of note, when providing sound therapies, we recommend flexible sound options (as patient preferences clearly change over time) and, of note, while providing acoustic therapy, the HCP must avail sounds that are not aversive and do not create negative associations or feelings for the patient. Cost-effectiveness of specialized treatment based on Cognitive Behavioral Therapy versus usual care for tinnitus. A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Effectiveness of a cognitive behavioural group therapy (CBGT) for social anxiety disorder: immediate and long-term benefits. Standardized tinnitus-specific individual cognitive-behavioral therapy: a controlled outcome study with 286 tinnitus patients. A systematic review and meta-analysis of randomized controlled trials of cognitive–behavioral therapy for tinnitus distress.
A randomized controlled trial of mindfulness-based cognitive therapy for treating tinnitus. It is quite natural for you to hear a high pitched ring or buzz periodically, lasting just a couple seconds.
For example, if you have been at Austin City Limits (ACL) and you find that your ears are ringing the day after, it might go away.
I definitely monitor the use of my headphones and make sure the volumes are such that I can still hear loud noises like emergency sirens.
I started protecting my ears early in my musical career and I was told I have hearing in the 99th percentile. Just over half the participants reported bilateral tinnitus for a total of 625 ears with tinnitus. However, sound therapy without counseling is less effective than sound therapy with counseling.
They identified specific counseling techniques shown to help the patient better manage their tinnitus, including cognitive behavioral therapy, psychological counseling and hypnosis, biofeedback, and relaxation training.
They say researchers and clinicians more or less agree the larger part of tinnitus suffering is associated with negative psychological reactions to tinnitus, and these negative psychological reactions need to be addressed properly to effectively manage tinnitus. For example, someone afraid of being in noise because it will make their tinnitus worse may find the idea of attending a large social gathering impossible. Additionally, a mental health professional (ie, psychologist) may provide workshops implementing CBT principles focused on coping skills to supplement the use of sound therapy. It is when the time between these events gets shorter and shorter and the duration of the ringing becomes longer and longer that tinnitus becomes an issue. Before you go down this path realize that the damage on that nerve is unique to you, and the level of relief is not something we will know until we try. Peterson is Board Certified in Audiology and is currently accepting new adult and pediatric audiology patients.
These vibrate in response to sound waves, while the outer hair cells convert neural signals into tension on a membrane.
If I am playing drums somewhere I try to use my in-ear monitors as I can keep an eye (or an ear) on how loud the music is coming back to me.
My ENT actually said, “You have eavesdropping level hearing and can probably hear through walls if you wanted to.” However, most people don’t get it checked until it is way too late.
It has been estimated3 that 80% of all patients with hearing loss have tinnitus, and very likely 80% of all patients with tinnitus have hearing loss—thus indicating a high correlation, but certainly not causation. However, graded exposure to conversation in a variety of settings that gradually become larger and noisier may be manageable with the support of a therapist who addresses concerns and helps build coping strategies at each stage. Back to tinnitus, at this point that ringing is your body’s way of telling you to knock it off, you have done damage to the sensory cells of the cochlea and the nerve fibers of your auditory nerve. These options run the gamut from oscillating fans to tinnitus retraining therapy (TRT), ear level masking devices, and hearing aids. Great Hills ENT serves the greater Austin area including Georgetown, Cedar Park, Lago Vista, Jonestown, Steiner Ranch, Lakeway, Spicewood and Point Venture. Then there are sensing and vibrating cells that carry these vibrations to the brain where in the auditory brainstem, these are converted into audible sounds we can recognize. You can see the two charts I added to get an idea of how loud certain sounds are acceptable, and for how long. If I am in a situation where wedges or floor monitors are used, then I use my earplugs without question. For approximately half the group, tinnitus was sudden onset, and for the other half, a gradual onset was reported. There hasn’t been a reproducible study that shows any long-term benefit from the supplements. It’s that same ringing after turning up your headphones too loud while going for a run, rocking that new Kanye track.
It is usually resulting from altered blood flow or increased blood turbulence near the ear. When these hair cells (stereocilia) are overworked (usually exposed to excessive noise levels for long periods of time) they go into shock producing the ringing you hear. The musician type earplugs are great as they lower a lot of the damaging frequencies and you can still discern pitch, in case you need to sing or adjust intonation on a horn, etc. The authors state “tinnitus pitch was highest in subjects with acute acoustic trauma and lowest in patients with prolonged estrogen and progesterone pills utilization….” MML values were “lowest in patients with tinnitus caused by acute acoustic trauma and congenital hearing loss…” and MML values were highest in patients with stroke and presbycusis. If this happens continuously, they can cease to respond at all to certain frequencies resulting in hearing loss.
The authors categorized their patients into groups according to probable tinnitus etiology. That is because there are several different causes for it and most of those are the same conditions that cause hearing loss.
The most common cause is noise-induced hearing loss (loud noises causing damage), but it can also be caused from a side effect of some medications or from an abnormally low level of serotonin activity as a couple of examples.




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