Tinnitus: common, constant, incurable — but very manageable

Dr. Crutchfield, my sister told me recently that she was suffering with severe ringing in her ears. Her doctor told her it was something called ‘tinnitus.” What is tinnitus?

Great question. I’ve asked one of my colleagues, Inell Rosario, MD, an
expert on the subject, to enlighten us with a discussion on tinnitus
this week.

Dr. Rosario: Tinnitus is a fairly common medical malady that afflicts
many people in mild forms, although they may not always be aware of it.
As many as 50 to 60 million people are affected by a phantom ringing,
whistling or buzzing noise that is usually only perceived by them. A
much smaller percentage (usually one to two percent) describes the
condition as debilitating and, although there is no cure, must seek
treatment to see a significant impact on their condition and to live a
normal life.

Most of the time, the cause of tinnitus is unclear. In the absence of
damage to the auditory system (such as head or neck trauma), things
like jaw-joint dysfunction (TMJ), chronic neck-muscle strain, and
excessive noise exposure have been suggested as causes. Certain
medications can also cause tinnitus, which, in this case, can either
disappear again after usage of the medication ends or can cause
irreparable damage that results in permanent tinnitus.

Other causes may be wax buildup, cardiovascular disease, or a tumor
that creates a strain on the arteries in the neck and head. These tumors
are usually benign.

Tinnitus can be managed through strategies that make it less
bothersome. No single approach works for everyone, and there is no
FDA-approved drug treatment, supplement, or herb proven to be any more
effective than a placebo.

Behavioral strategies and sound-generating devices often offer the
best treatment results; this is partially why distracting the
individual’s attention from these sounds can prevent a chronic
manifestation. Some of the most effective methods are:

Cognitive behavioral therapy (CBT) 
Uses techniques to relax and restructure the way patients think about
and respond to tinnitus. Sessions are usually short-term and occur
weekly for two to six months. CBT usually results in sounds that are
less loud and significantly less bothersome, with the overall quality of
life improved.

Tinnitus retraining therapy 
Effective based on the assumption that the tinnitus results from
abnormal neuronal activity. This therapy habituates the auditory system
to the tinnitus signals, making them less noticeable or bothersome.
Counseling and sound therapy are the main components, with a device that
generates low-level noise that matches the pitch and volume of the
tinnitus. Depending on the severity of the tinnitus, treatment may last
one to two years.

Use of devices generating low-level white noise that can reduce the
perception of tinnitus and what’s known as residual inhibition. Tinnitus
will be less noticeable for a period of time after the masker is turned
off. A radio, television, fan, or another sound-producing machine can
also act as a masker.

A relaxation technique that helps control stress by changing bodily
responses to tinnitus. A patient’s physiological processes are mapped
into a computer, and the individual learns how to alter these processes
and reduce the body’s stress response by changing their thoughts and

Treatment options are vast, but vary in effectiveness depending upon
the type of tinnitus. Research shows more than 50 percent of tinnitus
sufferers also have an inner-ear hearing impairment. While hearing aids
act as an effective relief method for those with tinnitus by amplifying
external sounds to make internal sounds less prevalent, they are not the
only method.
Careful diagnosis by a professional with years of experience creating solutions for tinnitus sufferers is essential.

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