Current Treatments for Tinnitus

Ringing in the ears (also called "tinnitus") happens to almost everyone. If you are experiencing tinnitus, know you are not alone; according to the American Tinnitus Association over 45 million people in the United States have tinnitus. So, how do you know when tinnitus is normal and when you need to see a physician?

If you answer "Yes" to any of these questions, the first step on your tinnitus journey is to see your doctor:

• Do you have any weakness or paralysis of any muscles in your face?
• Sudden unexplained hearing loss in one or both ears?
• Extreme anxiety or depression?
• A current plan to end your life and a way to do it?
• The tinnitus pulses with your heartbeat?
• You have ear pain, drainage from your ear, or a foul odor coming from your ear?
• You have vertigo (the feeling you are moving or the room is moving when neither is moving)?

If you answered "yes" to these questions, make an appointment to see your doctor. Any patient with new or persistent tinnitus should see an ear, nose, and throat specialist for appropriate evaluation.

Tinnitus is very complex. Some audiologists are comfortable working with patients who have tinnitus, while others who don't have that interest or training. You can search for an audiologist on the American Academy of Audiology website and should consider calling and asking how they work with tinnitus patients. 

The audiologist will conduct a complete hearing evaluation and discuss the results with you. If you have hearing loss, hearing aids will likely be recommended. In some cases, hearing aids alone will help with tinnitus. In cases where the tinnitus is more severe and has more of an impact on everyday activities, the following treatment options may be discussed.

Tinnitus retraining therapy involves educational counseling and sound therapy. The educational counseling is aimed at helping patients reclassify tinnitus as a neutral signal, while the sound therapy is used to decrease the difference between tinnitus and the other background neuronal activity. This reduces the strength of the activation of the limbic and autonomic nervous systems (demonstrated as tinnitus annoyance), which decreases the negative reinforcement in the conditioned reflex arc and leads to tinnitus habituation. This treatment is applicable to people with or without hearing loss. If no hearing loss is present, wearable noise generators can be fit for constant sound. If the patient needs hearing aids, sound therapy is provided by controlling noise in the environment or through hearing aids with tinnitus programs. Total treatment time is 12 to 24 months, though relief is usually seen within the first few months.

Neuromonics uses counseling and a purchased device to treat tinnitus. There are three levels of devices available for purchase. Depending on the level of the devices, there are options with music and broadband noise to facilitate habituation to tinnitus. The patient wears the device (which looks like an MP3 player) for at least 2-4 hours daily. Treatment usually lasts 6-8 months.

SoundCure uses a temporally patterned sound that is customized to the patient and produces synchronized neural activity in the auditory cortex. This is thought to interrupt tinnitus generation. The device consists of a handheld sound generator and headphones.

Otoharmonics is an Apple-based system (available on Apple iPad Air and iPod touch). It works on habituation principles but differs mainly in that the sound treatment is used during sleep and not waking hours.

Progressive tinnitus management was created by the Veterans Administration system and can be delivered in person or through satellite clinic offices over video conferencing. A workbook is also available on the American Tinnitus Association website for members only. It combines education, use of sound, and cognitive behavioral concepts to change the thoughts and feelings around tinnitus. To be included in this program, veterans with hearing loss must first be fitted with hearing aids. There are four classes veterans must attend to complete the program. 

A final thought to remember: while there is no cure for tinnitus, there are treatments that help. You should never be dismissed with the words, "learn to live with it."