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What is Tinnitus?

If you hear ringing, humming or hissing, you might be one of the millions of people who have tinnitus. Tinnitus is a symptom with few treatable causes, however, if you have tinnitus all the time and/or only in one ear, if your tinnitus onset was sudden, or you have tinnitus that interferes with your concentration, sleep or mood, you should be evaluated by an otolaryngologist. Tinnitus is most often a side effect of changes in the auditory system, namely hearing loss. Tinnitus itself is generally benign, but it can become debilitating if a connection develops between the tinnitus sound and other systems in the body which are responsible for control of emotions, heart rate, breathing and digestion. Once this connection is established, people report significant difficulty being able to concentrate, getting to sleep or staying asleep, and feelings of depression and anxiety.

It is possible to have tinnitus and never have these connections develop, in which case the person may habituate naturally to the sound. Habituation is the simple process of repeated exposure to a sound; when the sound is not important and not threatening, the brain can learn to ignore the sound. A good example of habituation is the sound of the refrigerator in your kitchen - the sound is always there but you are probably not aware of it.

Although there is no cure for tinnitus, there are ways to make it less intrusive so that it does not affect concentration, sleep or mood. Tinnitus Retraining Therapy is a method that has been in clinical use since the early 1990s. This method combines informational counseling and the use of sound to facilitate habituation to tinnitus. The purpose of the informational counseling is to help patients understand what tinnitus is and what it isn’t, so that it becomes less threatening. It is important for patients to understand the importance of avoiding complete silence and to enrich their sound environment. Like a candle in a dark room, which is hard to ignore because of the contrast between the brightness of the candle and the darkness of the room, tinnitus is perceived as much louder when there is no other sound in the environment, making it harder for the brain to ignore it. Sound therapy helps the process of habituation by reducing the contrast in the brain between the sound inside and sound outside, kind of like turning on the lights in the room with the candle. The candle can still be seen, but it’s not as noticeable so it becomes possible to ignore it.

The key to the effectiveness of habituation and desensitization protocols is education and counseling. It’s the emotional reaction to the tinnitus that creates all the havoc so sound therapy alone is not as effective as sound therapy in conjunction with education and counseling. Some patients benefit from cognitive behavioral therapy with a licensed therapist in conjunction with sound therapy, to help reduce the maladaptive behaviors and thought processes evoked by tinnitus.

Sound therapy can be implemented in several ways. When hearing loss is present and interfering with day-to-day communication, hearing aids are an excellent way to reduce the perceptual contrast between tinnitus and everyday sounds. Hearing aids also facilitate easier listening which will reduce stress and reducing stress is a key factor in decreasing tinnitus intrusiveness. Another way to provide sound therapy is with ear-level devices that produce a low-level broadband noise. The goal, again, is to reduce the perceptual contrast which over time makes it easier for the brain to ignore the tinnitus sound. A relatively new device is the Neuromonics Tinnitus Treatment device, which is an MP3 player that delivers spectrally-modified music and is used in a two-stage approach. The goal of any sound therapy is to stimulate the auditory pathways to promote neural plastic changes. Over time, new connections in the auditory pathways help the brain to ignore tinnitus.

If you have tinnitus that is affecting your sleep, concentration or mood, first, see an otolaryngologist to rule out an underlying medical condition. Second, know that there is help available. You may be told there is nothing you can do about it or that you will just have to learn to live with it – keep in mind this refers to the lack of a specific medical or surgical procedure, and does not mean there is truly nothing you can do about it. Tinnitus does not have to ruin your life.

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