Whether it torments daily or just annoys from time to time, the ringing, buzzing and similarly sinister sounds of tinnitus are a surprisingly common plight.
Estimated to affect more than 50 million Americans, and for nearly as many reasons, tinnitus (TI-nuh-tuhs) is defined as the perception of sound when no external noise is present. Not a disease itself, but a symptom of underlying conditions, the disorder can result from some 200 different causes, according to the American Tinnitus Association.
Noise exposure and hearing loss are the most common catalysts. But experts say anything from high blood pressure to prescription drugs to plain old earwax can set it off.
“Tinnitus can happen to anyone, and can happen because of almost anything,” says UC Davis’ Rodney Diaz, M.D., F.A.C.S., a professor of otolaryngology and head and neck surgery whose specialties include tinnitus.
BLAME IT ON YOUR BRAIN—Not everyone with tinnitus needs treatment. For most, it’s a minor nuisance that ultimately becomes a new normal. But some 10% of tinnitus sufferers have what’s known as “bothersome” tinnitus, significantly impacting their lives, says Kirsten McWilliams, Au.D., owner of The Hearing Solution in Sacramento.
Tinnitus is tricky terrain, starting with the fact there is no simple way to test for it and no real cure. But there are effective ways to manage it-and that’s what McWilliams, a tinnitus management specialist and sufferer herself, wants people to know. ”.A lot of people end up in my office because their doctors have told them there’s nothing they can do for their tinnitus, that it’s permanent,” she says. “That’s the last thing you want to tell a patient.” Education is key, McWilliams says. “It’s important for patients to understand that hearing happens in the brain, not the ears-the ears are really just the vehicle,” she says. The focus of tinnitus treatment, then, is managing the brain’s perception of sound. If the science seems confusing, this much is clear: Because most tinnitus patients have hearing loss, a hearing evaluation should be step number one. For the vast majority of these patients, McWilliams says, hearing aids can help. In one survey, hearing health professionals reported that hearing aids provided approximately 60% of their tinnitus patients some relief, while roughly 22% found significant relief. As McWilliams explains, hearing aids stimulate the “bored neurons” that start firing randomly on their own (leading to a perception of sound, or tinnitus) in individuals with hearing loss. In other words, the better we hear, the less the brain perceives phantom sounds.
UC Davis’ Diaz, who has conducted clinical studies on tinnitus treatment, concurs. “Hearing aids are the single best treatment for tinnitus patients with hearing loss,” he says. But what about those with normal hearing? “We do see patients with normal hearing who complain about tinnitus,” says Diaz, “so it’s kind of a conundrum.”
But “normal hearing” is not always what it seems. For starters, standard hearing tests don’t always reveal high-frequency hearing loss. This is clinically significant, Diaz says, because high-frequency hearing loss is common in the older population—and is also a common precursor to tinnitus.
A CLASSIC CASE—Sacramentan Scott Gregory’s tangle with tinnitus is in many ways classic, beginning with the fact he’s a musician. Along with construction workers, military personnel and others whose lifestyles routinely put them at the epicenter of ear-splitting volumes, musicians are among groups at highest risk for the condition. A few notables who’ve gone public with their tinnitus troubles include guitar legend Eric Clapton, Coldplay’s Chris Martin and singer Barbra Streisand.
A lifelong guitarist who likes things highly amplified and has performed in local bands, Gregory, 63, believes he’s had tinnitus since his mid-20s. “That was a time I was attending a lot of concerts and going to clubs, exposing myself to high sound levels,” he recalls. “I had the usual experience of coming home after a show and hearing a high-pitched ringing in my ears.” Some four decades later, Gregory says he continues to hear that sound “constantly. It’s a very high-pitched, tinny kind of sound.” It has worsened through time, he says.
While he hasn’t yet sought the help of a tinnitus specialist, Gregory does due diligence with regular hearing checks. His tests have revealed steady hearing loss, he says, especially in the higher frequencies.
Hearing aids have helped to address Gregory’s double trouble, simultaneously sharpening his hearing and providing tinnitus relief. “They’ve been quite helpful, especially with the current digital technology,” he says. The problem, he says, mostly creeps up at night. “When I take them out at night and go to bed, that’s when I notice the ringing the most. As I like to say, I can no longer bear the ‘sounds of silence.”‘
TREATING SOUND WITH SOUND—Hearing aids aside, the mainstay of tinnitus treatment is sound therapy-literally treating sound with sound. Easy to achieve at home with a white noise machine, ceiling fan or by simply turning on the TV, the idea is to use external noise to distract your brain and alter your perception of tinnitus, explains Diaz.
“It sounds too simple, like ‘how could that treat tinnitus?”‘ says Diaz. “But for 99% of patients, sound therapy works.” The logic behind it is indeed simple: The quieter the environment, the more people notice their tinnitus. It’s a pattern that becomes quickly obvious, Diaz says, when he asks patients to identify the times their tinnitus bothers them most. “I ask, ‘Do you notice your tinnitus at night in bed when you’re trying to sleep? Do you notice it when you’re at a cocktail party or wedding, talking to people?'” Universally, Diaz says, the answers are the same.
For Diaz and other hearing specialists, this dynamic came to roost when the COVID-19 pandemic hit, sending throngs of workers from noisy offices to quieter home environments-and ultimately to their door. “As the workplace shifted to home over the year of COVID, I’ve seen more younger people and working people complaining of tinnitus, I think because the home office is quieter than the work office,” says Diaz. He counsels these patients to create more sound in their home workspaces, comparable to the din of the office.
In today’s digital world, resources for the tinnitus-challenged continue to expand, notes McWilliams, who offers a list of sound therapy apps: Starkey Relax, Widex Zen Tinnitus Management, ReSound Relief. But regardless of therapy used, the key to overcoming tinnitus is habituation, she says-retraining your brain to push tinnitus out of conscious awareness.
BEHAVIORAL THERAPIES—Cognitive behavioral therapy and mindfulness based stress reduction are other evidence based tools that can help. Multiple studies have shown behavioral therapies can decrease tinnitus severity, reduce tinnitus related fear and decrease general depression and anxiety. Online therapies show promise as being as effective as in-person: At UC Irvine, a recent study using internet-based CBT in addition to sound therapy found the treatment-group patients showed a significant reduction in how much tinnitus affects their daily lives.
Working on your own mindset can also pay big dividends, says McWilliams. “Changing your reactions and feelings to the tinnitus is key,” she says. “If your brain has negative reactions and negative emotions associated with the tinnitus, it will become more of a problem.”
Getting into the “zone” with a hobby or pleasurable pursuit can also serve as a solution. “One of my patients with severe tinnitus says it goes away when he works on his model airplane, because that’s something he loves,” McWilliams says.
OTHER AVENUES—The chase for innovative new tinnitus therapies continues. Current research focuses primarily on electromagnetic stimulators, which reduce neural activity and are thought to reduce the perception and severity of tinnitus. Pharmacological research is also ongoing.
Those seeking a holistic approach may want to look at their diet. A large-scale study of nearly 35,000 U.K. adults, published last year in Ear and Hearing: The Official Journal of the American Auditory Society, suggests higher intakes of iron, calcium and fat may increase the odds of developing tinnitus, while higher intakes of vitamin Bl2 and meat may reduce the odds.
Revee Barbour (aka “Dr. Ray”), N.D., a naturopathic doctor who practices privately in Sacramento, has frequently found supplementing with zinc, CoQlO and other antioxidants (including vitamins A and Bl2) helpful in reducing patients’ tinnitus symptoms. But proper testing, she cautions, comes first. “There is often a connection with tinnitus and nutritional deficiencies, but this does not mean you should automatically start taking these supplements if you have tinnitus,” she says.
Barbour emphasizes there are many underlying causes of tinnitus-she’s often seen it in patients with high blood pressure, for example-and that the first order of business is to find and address the root cause. Many times, she says, tinnitus is connected to more global issues such as insomnia, stress and high inflammation. And take a hard look at the medications you take: “Even if you take low-dose aspirin or ibuprofen regularly,” she says, “it may contribute to tinnitus.”
WORDS TO THE WISE—Experts emphasize the importance of using ear protection, getting hearing checks and seeking professional help for tinnitus when needed. To these practical tips, Scott Gregory offers one more: Be patient.
“My hearing issues have been a real challenge with my wife, Lynn, because even with the hearing aid, I still have to ask her to repeat things,” he says.
Patience goes both ways, he adds-both for the person with hearing issues and the people in their life.