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Tinnitus Self-Treatment
Tinnitus is a disorder where the degree of distress caused by the symptoms depends to a large extent on the amount of worrying and attention that the person devotes to it. A vicious cycle results, the anxiety and overattention leading to mental and physical tension, which in turn causes the auditory centers in the brain to increase their selectivity for seemingly important or threatening sounds, such as the tinnitus. That then causes more anxiety, and so on. This cycle, however, usually can be broken and reversed, either as a result of appropriate counseling or due to the gradual spontaneous process of habituation to an ongoing sensation.
Almost any tinnitus counseling that explains the condition and allays some of the anxiety while suggesting improvement is possible will enhance the treatment.
Explanatory counseling, together with “patient expectation nurturing,” a term first used by Tyler (1999) for nurturing the expectation of improvement and further elaborated by Tyler et al (2001), will help most patients with tinnitus (see also Roberts et al, 1993). In a small group of patients, the tinnitus may disappear entirely. However, this should not be held out as the aim of treatment because it will only lead to disappointment for most. Instead, the target for treatment is for the tinnitus to become something that is little or no trouble, although still there and audible to the patient when listened for. Although nearly all people with tinnitus will eventually achieve this spontaneously, many can be speeded on their way by appropriate counseling. Even those who are severely affected often can be helped.
Purpose of Self-Treatment Brochure
We feel that a brochure detailing self-treatment information can help tinnitus patients either as a reinforcement of or an extension of the advice given them by professionals: family physicians, otologists, audiologists, hearing therapists, and clinical psychologists. It also helps to update those professionals who are not especially interested in or concerned with tinnitus. Our brochure aims to impart
• The essential underlying counseling principles, together with advice on the additional benefits that result from sound reinforcement or enrichment
• Reassurance about the lack of a serious cause (subject to a medical examination)
• Some form of explanation as to how the tinnitus has arisen and that worrying will prolong it or make it worse
• A statement that relief will gradually come from understanding it and putting it in its rightful unimportant place
• The nurturing of an expectation of gradual relief
The presentation of low levels of background sound is also recommended for the quiet times of day or night, including when asleep, and is delivered by wearable noise generators and/or environmental or bedside sound sources.
Within the United Kingdom, this brochure, together with a similar one, Tinnitus Explained from the Hull Tinnitus Group (www.tinnitusexplained.org), has proved very popular with both audiological professionals and self-help groups. Its main text, slightly modified for the international nature of this book, is reproduced following here. We have no personal or copyright objections to all or parts of it being copied, with local details inserted. However, we would request that such use be acknowledged in any new leaflet and that we be sent a copy of it.
Text of a Tinnitus Self-Treatment Brochure
If you have tinnitus, you should be able to get a very worthwhile degree of relief with the approaches suggested in this brochure. This self-treatment can be done either before or after seeking professional advice. However, we recommend that you visit an otologist or audiologist to reassure you that there is no underlying health condition causing the tinnitus for you to worry about. If you are not reassured, you could ask to be referred to a hospital or specialist to make sure. It is possible that you may have to wait for an appointment—so why not start to help yourself manage your tinnitus now?
By following the advice in these notes, you can actually treat your tinnitus yourself and possibly achieve a gradual reduction of tinnitus to something that will eventually no longer matter much or at all.
What Is Tinnitus?
Tinnitus is the experience of hearing a sound coming from within one or both of your ears, or your head. It is often described as a ringing, buzzing, or whistling noise. It is usually due to a minor disorder of your hearing system and is often associated with aging or exposure to loud noise. It is a symptom, not a disease.
Although tinnitus can sometimes be very distressing, it is usually not life-threatening, and the quality of your life can be recovered. You may not be able to get rid of your tinnitus noise completely, but you can gradually reduce or eliminate the way tinnitus affects you, so that you hardly notice it. Most people who are upset by their tinnitus learn to manage it through doing things for themselves to improve their tinnitus. However, it may take several months—this is quite normal, so don’t feel disheartened.
Your Hearing System
When you hear outside sounds, those sounds travel in waves in the air and are converted by your inner ear (cochlea) into nerve signals that are like tiny electrical currents. These signals pass up your hearing nerve to the base of your brain. Your brain then sorts out what is immediately important. It usually ignores meaningless sounds, and it can learn to do the same with the internal sound of your tinnitus.
We can distinguish particular sounds in a great hubbub of other sounds. For example, most people can probably pick out the sound of their name uttered by someone in a room of chattering people and can detect a single musical instrument in a full orchestra. Unfortunately, many people with tinnitus tend to do this with their tinnitus when it starts—we naturally home in on that new, unfamiliar, and unwanted noise.
SELECTIVITY AND ATTENTION
Your hearing system has an automatic property of selectivity. That is, parts of the hearing system within your brain increase the degree to which they select out certain important, strange, or worrying sounds (including tinnitus) for special attention, and filter out the hearing of other sounds. Also, as you get older, your ability to hear external sounds reduces, and the resulting lack of contrasting sound makes you become more aware of internal tinnitus noises. Any other form of hearing disorder or damage, such as from repeated exposure to loud noise (for example, gunshots, noise at work, or very loud music), can add to this natural hearing loss and make tinnitus even more noticeable.
HABITUATION
Imagine you have a new clock. At first you can’t help but hear its ticking, but after a while you find you are no longer aware of it. Other people hearing your new clock for the first time say how loud it is, but you have habituated to it—you are no longer conscious of it, your brain has decided to stop monitoring its constant, meaningless, nonthreatening ticking. This is a natural process, called habituation, that your brain uses to stop overloading itself with the need to monitor all sorts of harmless information—and that applies to tinnitus too.
Tinnitus naturally subsides over time. It isn’t a progressive condition that gets worse the longer you have it or the older and more hard of hearing you become—it’s quite the opposite! But you can do things to speed up this habituation process, and to alleviate some of the effects tinnitus causes until it does subside.
Anxiety, Tension, and Learning How to Relax
It is very common to worry about tinnitus and for this to cause tension, so learning how to relax is part of the relief process. Tinnitus often creates a vicious cycle of tension and worry that keeps the tinnitus worse than it could be; Fig. 2–1 shows how this works.
But you can break this cycle! If you break it, the chain of events will reverse.
As a first step, read these notes again to make sure that you understand how worrying about your tinnitus and constantly listening to it will feed this vicious cycle. Monitoring your tinnitus and worrying about it will only make it worse.
Figure 2–1 The vicious cycle of tension and tinnitus.
RELAXATION EXERCISES
To help relieve the tension in your body, you can use simple relaxation exercises that involve training your body to relax. You can read about such exercises in books, listen to them on audiotapes, or often best learn how to do them at relaxation exercise classes, whichever you prefer. Your local or national tinnitus self-help association can tell you about relaxation tapes. For example, the American Tinnitus Association (www.ata.org) and the British Tinnitus Association (www.tinnitus.org.uk)
Here are some simple examples of relaxation exercises.
1 Find a comfortable position, and breathe in slowly and clench your fist. Feel the tension in your hand and wrist. Now breathe out, and as you do so relax your hand and feel the difference. You can extend this to other parts of your body, such as your other hand, each arm, leg, and foot, your back and neck, face movements, and jaw clenching.
2. Breathe slowly and deeply, hold your breath a moment, relax, then let it out, wait a moment, then breathe slowly and deeply again, and so on.
Once you have learned such breathing and muscle relaxation exercises, you can do them regularly, wherever and whenever you can find the time and space. It will take a bit of practice, but you should quickly start to feel the benefits, and you will gradually learn how to relax your body without having to do the exercises. As you learn to relax your body, you will also find it easier to relax your mind.
Some people find that aromatherapy, improved posture, massage, reflexology, craniosacral therapy, yoga, and tai chi have similar relaxing benefits, as can simply resting in a relaxing environment, perhaps with special aromas, dim lights, and soft music. The key is to find what helps you relax the most and easiest, then practice it often.
Sound Therapy
The normal natural history of tinnitus is for it to gradually recede into the background so that you eventually become hardly aware of it—the habituation process described earlier. You can speed up this process by increasing the amount of background sound near you, what some audiologists call “sound therapy.” This reduces the contrast between the level of your tinnitus and the level of background sound. In turn, this reduces the intrusiveness of your tinnitus and the tension it causes, thus promoting the habituation process and interrupting the vicious cycle described above. The principles and procedures involved are similar to those used in most forms of sound therapy.
Additional background sounds can come from
• Pleasant low-level sounds from a television, radio, or recorded music, from a fan, or from outside through an open window.
• Sound conditioners—bedside, chairside, or tabletop devices that play natural sounds (such as the sound of gentle waves, the rain, or a stream), or “white” noise (a continuous “shhh”-like sound)
• A wearable noise generator—a device that looks like and is worn like a hearing aid, but which makes its own “shhh” sound
• Wearing and using a hearing aid, even if you have only slight difficulty in hearing
Exactly what is the best level of additional sound to use has not yet been established, but a level just below that of your tinnitus would seem sensible—not too loud so you can’t hear your tinnitus, but not very soft either. However, if that is too loud for you, then use the loudest level you can put up with. But if you want to use more noise and drown out (mask) your tinnitus, do so if you find it suits you.
The key is to avoid quiet, or remove it. In the quiet your brain will try to hear any sound more clearly, and that will include the sound of your tinnitus. You should reinforce your background sound whenever the background is rather quiet, as often and for as long as you can.
If increasing background sound annoys other people around you, use a personal music player and headphones. You may find that using rechargeable batteries saves money, and that using “in-ear” earphones delivers the sound into your ears better than headphones.
Most importantly, you also need sound therapy in bed, whether asleep or awake. It is particularly harmful if you lie in the quiet of the night listening to your tinnitus when you can’t get to sleep, or when you wake up during the night. You could try sleeping with the window open, or have a gently ticking clock in your room, or use an underpillow speaker or sound pillow attached to the sound source of your choice. You are less likely to disturb others this way.
Recreation and Health
Having active interests and hobbies can enhance the quality of your life. They can put your tinnitus into a better perspective so you can still enjoy life to the full. It’s never too late to learn or to get involved, so look through those adult education brochures!
Some people have seen the positive side of their tinnitus and have welcomed the push it gave them to do something new, to rekindle old interests, or to take on the challenge of working for a tinnitus support group.
How is your general health? Are you getting a good, varied diet, plenty of exercise and rest, and some enjoyable social activity? If you find that certain foods or drinks, or activities or situations aggravate your tinnitus, you could cut down a little, cut them out, or find alternatives. With just a few adjustments you will find that tinnitus won’t stop you carrying on with life the way you want to.
Hyperacusis (pronounced hyper-a-KOO-sis)
This means a condition of oversensitivity to loud sounds, even moderately loud sounds. It is found in many people with troublesome tinnitus and might be caused by a similar brain mechanism. Like tinnitus, hyperacusis can usually be improved using sound therapy procedures already described, although for hyperacusis the level of added sound is gradually increased, step by step, over a period of weeks or months. This treatment process is called “desensitization.”
Earplugs
If you have tinnitus, you should not wear any kind of earplugs that make it more difficult to hear, except when you are in a very loud noise. They will not help your tinnitus: indeed, they will probably make it seem louder while you wear them. Generally, it is not a good idea to wear earplugs if you have hyperacusis (unless you are using earplugs temporarily in a noise that is unbearably loud to you) as they can prevent your ears from getting accustomed to sounds. On the other hand, you should always use ear protection when you are exposed to very loud sounds, whether or not you have tinnitus or hyperacusis.
Temporary Deafness and Temporary Tinnitus
If you have been exposed to a particularly loud sound, for example, a disco or fireworks or working around loud noise, you may often experience dullness of hearing or tinnitus, or both, immediately afterwards. Provided you don’t let yourself get into a state of great anxiety about it, this will usually disappear after a few minutes or hours. These temporary effects should be taken as a warning, though—there is a risk of permanent damage if you expose your ears repeatedly to such loud sounds.
Further Information and Help
With this insight into tinnitus, you may feel you can now learn to ignore yours. If you want to know more about tinnitus, contact your local or national tinnitus self-help organization. These can provide further information, advice, and support.
Acknowledgments
We gratefully acknowledge much assistance in the preparation of this brochure from nurse-tutor Alison Clark as well as Bill Howard of the Hull Tinnitus Group.
References
Roberts AH, Kewman DG, Mercier L, Hovell M. The power of non-specific effects in healing: implications for psychological and biological treatment. Clin Psychol Rev 1993;13:375–391
Tyler RS. The use of science to find successful tinnitus treatments. In: Hazell JWP, ed. Proceedings of the Sixth International Tinnitus Seminar. London: Tinnitus & Hypercusis Centre; 1999
Tyler RS, Haskell G, Preece J, Bergan C. Nurturing patient expectations to enhance the treatment of tinnitus. Semin Hearing 2001;22:15–21
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