Tinnitus Refresher: What Is It?
Tinnitus is the perception of sound in the absence of external auditory input from the environment. It’s a difficult term to pin down because tinnitus can sometimes be described as a symptom or as a disease (or rather, a collection of diseases). People are often confused by this.
For example, an acoustic neuroma is a tumor that grows on the auditory nerve, and tinnitus can be described as a symptom that results from that. Alternatively, tinnitus is often described as a distinct disease that can have multiple possible causes, such as hearing loss. For this article, we’ll categorize tinnitus as a disease with several possible causes.
The most common type of tinnitus is something called sensorineural tinnitus, which is the result of hearing loss (the most common issue for DJs and musicians). Hearing loss can result from age, noise exposure, or other causes. As a result, the sensory input that feeds into the auditory nerve can be partially (or completely) cut off, resulting in sensorineural tinnitus, which manifests as perceiving sound in the absence of any sound from the environment.
a ringing sound in the ears, most often described as a high pitched “eeee” sound
For most people with hearing loss and sensorineural tinnitus, this results in a ringing sound in the ears, most often described as a high-pitched “eeee” sound. Tinnitus sounds may be constant, or they may be pulsatile (repetitive, as if playing on loop). Click here to listen to a sample of tinnitus sounds that patients have reported. Hyperacusis, a sensitivity to sound, also often co-exists with sensorineural tinnitus, and may be due to the same underlying cause.
Tinnitus can be acute (for example, in the hours after going to a loud concert), or chronic (lasting indefinitely). Because noise exposure is a risk factor for hearing loss, and because hearing loss can cause tinnitus, DJs are particularly at risk for developing this condition.
Generally, when you read about tinnitus online, usually people are referring to chronic sensorineural tinnitus — persistent tinnitus which has resulted from hearing loss.
If you experience tinnitus, it’s important to speak to your doctor. In some cases, tinnitus requires specific medical investigations and treatment. For example, pulsatile tinnitus — a rhythmic whooshing sound that repeats on loop — may be due to high blood pressure. By treating the high blood pressure with a medication, the tinnitus may be eliminated entirely.
If you have tinnitus, and want determining your tinnitus frequency, a free tinnitus tuner (a frequency matcher) is available here.
Why Does Tinnitus Suck?
Some of you may be thinking — why does this matter at all? The answer is simple: if you have tinnitus, it can be terrible.
Imagine a sound that never goes away, like a fire alarm that’s perpetually going off inside your head.
Imagine a sound that never goes away, like a fire alarm that’s perpetually going off inside your head. For some people, tinnitus can be a maddening experience. For people with chronic sensorineural tinnitus, they can go decades without a moment of silence. It’s not the tinnitus tone itself that causes harm, but your brain’s reaction to the tone that causes harm. In addition to being annoying, tinnitus has been linked to psychological distress, depression, anxiety, an inability to concentrate, and in some cases, even suicide. For example, abnormalities in the amygdala (the fear center of the brain) may be associated with tinnitus.
Further amplifying this misery: no one except you can see or hear the thing that’s causing you all this distress. Sometimes people will callously tell you to just get used to it, betraying a lack of empathy for your suffering. They can’t quite understand why a simple sound can cause so much harm, and it can feel quite isolating when others don’t understand your pain. That’s why I recommend joining the excellent Tinnitus Talk forum – it’s a great resource and community for those who are suffering.
Some people with chronic sensorineural tinnitus will habituate to the tone over time. Habituation means a person will unconsciously learn to ignore the sound over time such that it no longer causes them any significant distress. Some people habituate gradually, others quickly, and some never at all. Those who do not habituate can suffer greatly. The principle of Tinnitus Retraining Therapy, one of the oldest treatments for tinnitus, is to induce a habituation response.
Why Is Tinnitus So Hard To Treat?
The first thing you have to understand about tinnitus treatment is that for the most common hearing loss tinnitus, there is no definitively proven treatment or cure. If you read anything about a “cure” online, make no mistake: you are being sold snake oil.
Even though sensorineural tinnitus results from hearing loss, it’s actually a disorder of the brain. Once input at certain hearing frequencies is lost, the brain reorganizes its connections through a process called neuroplasticity. Our current models of tinnitus suggest that tinnitus is a result of this process of reorganization.
A helpful analogy is to think of a guitar amp: as you increase the volume of the amplifier (the gain), it becomes more sensitive to input from the instrument (ear), and as many of you have noticed, the amplifier will produce a low humming sound (tinnitus). Such a model accounts for why people with tinnitus from hearing loss often paradoxically experience hyperacusis, which is the increased sensitivity to sound.
Rule Number One: Be Skeptical
The current scientific consensus is that there is no definitively proven treatment or cure for chronic sensorineural tinnitus. Yet, at the same time, there’s a surfeit of available therapies online.
Why? The reason is simple: when there’s demand for something, people find a way to supply it. That doesn’t mean you should believe them. I won’t link to them here, but there’s a multitude of ebooks available online that claim to hold “secret cures” for tinnitus. They have absolutely no scientific basis at all — they’re just marketing gimmicks.
In addition to outright deception, the other important thing to understand is that not all scientific evidence is created equal. Just because there’s a small study that appears to prove that a particular treatment works, that doesn’t necessarily mean that it actually works.
Because of common errors in the statistical analysis of medical studies, most published research findings are false. Research findings are more likely to be true if they:
- Have many participants
- Demonstrate large, not incremental, therapeutic benefits
- Contain randomized controlled trials (they have an experimental and a placebo group)
- Have findings that are replicated by other experimenters several times
The majority of studies with tinnitus contain few participants and have not been replicated successfully. The best studies aggregate results of multiple randomized controlled trials that each have large numbers of participants. This is called a meta-analysis.
Treatment or Coping Enhancement?
There’s two therapeutic approaches to tinnitus: lowering the volume of the tinnitus tone, and reducing the psychological distress caused by the tinnitus tone.
Earlier therapies, such as tinnitus retraining therapy, focused on reducing the psychological distress caused by the tinnitus tone. Newer therapies are focused primarily on directly eliminating or lowering the tinnitus tone itself.
Presently, there is no standardized medication medication regimen that is recognized by clinicians as being effective for the treatment of tinnitus. It is rare for a physician to prescribe a medication for tinnitus, and side effects have been a particularly vexing problem.
Small experiments have been conducted which initially showed some promise but then encountered substantial barriers to widespread use. Here’s some medicines that have been tried:
- a local anesthetic, lidocaine, was found to suppress tinnitus when injected intravenously. However, because of the impractical nature of using an intravenous medication for the treatment of tinnitus, an oral variant was tested for the treatment of tinnitus. Unfortunately, it didn’t work well and came with significant side effects.
- A recent study appeared to demonstrate that clonazepam may decrease tinnitus loudness. Unfortunately, other studies seem to show that clonazepam isn’t useful unless combined with an antidepressant. Antidepressants alone do not appear to alleviate tinnitus, but may help with depression that might be associated with tinnitus (if you have tinnitus-related depression / anxiety, speak to your doctor. These conditions have their own independent treatments).
- Some anticonvulsants may have a small effect in lowering the volume of tinnitus, but not enough to warrant the side effects.
- Supplements like zinc and omega-3 fatty acids failed to show any help in randomized controlled trials.
- Lots of people try gingko, but it’s completely ineffective.
- Many people try homeopathic remedies, but it’s just water, and is ineffective for the treatment of any medical condition.
- A drug being developed by Otonomy, an American pharmaceutical company, is being tested as a treatment for tinnitus. As of the writing of this article, it’s proceeding to a phase II clinical trial. The drug is an NMDA receptor antagonist, which affects the transmission of signals between neurons.
The Old Generation of Sound Therapies
Previous sound therapies were focused on reducing the psychological distress of tinnitus itself. Tinnitus Masking was a therapeutic treatment meant to “hide” the tinnitus tone by flooding the auditory system with a distracting background noise that effectively drowns out the tinnitus tone. The intent is to reduce awareness of one’s tinnitus tone. Unfortunately, a meta-analysis of tinnitus masking did find evidence that it is ineffective in reducing tinnitus severity or loudness.
Tinnitus Retraining Therapy (TRT) is a combination of sound masking and counseling, and is meant to induce habituation to a patient’s tinnitus tone. It can be accessed via audiologists. By retraining the brain to essentially “ignore” the tinnitus tone, the psychological distress (in terms of anxiety, etc.) can be reduced. A meta-analysis demonstrated that this approach is much more effective than Tinnitus Masking alone. TRT has been a staple of tinnitus treatment for years but unfortunately does not directly lower the volume of one’s tinnitus. TRT may produce improvement over the long term in 80% of patients who are treated.
Therapy + Meditation
Multiple randomized controlled trials have been performed to evaluate the effectiveness of Cognitive Behavioural Therapy (CBT) for reducing the psychological distress caused by tinnitus. Most appear to have moderate levels of evidence, but because CBT requires a fair amount of time, patients would often drop out of receiving the therapy.
Meditation via Mindfulness Based Stress Reduction has been shown to have efficacy in reducing tinnitus distress. Mindfulness also has general benefits that cut across your experience of daily life, so it’s a good habit to pick up. More resources are available here.
Newer Sound Therapies
Multiple newer sound therapies have been developed in recent years, typically with an intent to commercialize them. Since profit can be a motivator that sways the results of scientific studies, it’s important to retain a healthy skepticism with respect to individual newer sound therapy options (there are quite a few). Most of the studies in this space have a limited sample size and haven’t been replicated by independent groups of researchers.
Unsurprisingly, independent academics that have evaluated the newer sound therapy options have come to the following conclusion:
“Overall there is currently insufficient evidence to support or refute the routine use of individual sound therapy options. It is likely, however, that sound therapy combined with education and counseling is generally helpful to patients.”
Newer sound therapies generally involve the administration of specially processed audio that is customized to the patient’s particular tinnitus frequency. In general, they are thought to work through the process of neuroplasticity — the brain’s ability to reorganize its own connections.
- One of the original sound therapy companies in this space is Neuromonics Sound Therapy. Initially, they offered sound therapy via a proprietary medical device, but have since transitioned to offering a mobile app. They’ve published clinical trials of their therapy which they state has produced “rapid and profound results.” However, an independent review found that these clinical trials had “limitations” with respect to the Consolidated Standards of Reporting Trials (CONSORT), and they concluded that the “lack of methodological transparency, and the proprietary nature of NTT limits the ability of independent investigators to evaluate the merits of this clinical approach.”
- Another sound therapy option is Acoustic Coordinated Reset Neuromodulation. A randomized controlled trial with 63 patients demonstrated a mean reduction in Tinnitus Questionnaire scores of 50% among those who responded to the sound therapy (the Tinnitus Questionnaire is a measure of the distress caused by tinnitus). However, independent review similarly states that the evidence is still lacking to make any substantial claims about its efficacy.
- Listening to a computer-generated tone that matches your tinnitus tone may result in Residual Inhibition. After listening to this tone and stopping the tone, your tinnitus may be suppressed for up to a minute. You can experiment with this process with a computer-generated tinnitus tone.
- Notched Sound Therapy involves identifying a user’s tinnitus frequency, and then processing audio by removing the sound energy at and around their tinnitus frequency. White noise or music can be “notched,” resulted in Notched White Noise or Notched Music. Sustained listening to these sounds is thought to reduce tinnitus tone volume via lateral inhibition of the tinnitus-producing auditory neurons. It was developed by independent groups of Italian and German researchers, which initially produced a 75% and 26% volume reduction respectively. A larger subsequent clinical trial revealed a smaller volume reduction with Notched Music than that observed in the initial Notched Music experiments. A critical review of Notched Sound Therapy concluded that there is still insufficient evidence to recommend it for standard clinical use. Additional research is available here.
If you have hearing loss, tinnitus can be improved with the installation of hearing aids, which can be fitted by your local audiologist. Unfortunately, it’s possible to have tinnitus with a normal audiogram, possibly because of hearing loss that is not detectable with a traditional hearing test. If you suspect you have hearing loss, speak to your doctor, who may send you for a hearing test (an audiogram).
- Repetitive Transcranial Magnetic Stimulation (rTMS) has been tested as a means for reducing tinnitus volume. Small experiments have shown that it may transiently reduce tinnitus volume. Older studies appeared to show promise that this might be a useful long term therapy for tinnitus, but a newer randomized controlled trial appeared to show that it doesn’t work.
- Transcranial Direct Current Stimulation (applying a weak electrical current to the head) has been used in combination with Notched Sound Therapy, but was not found to improve the effectiveness of Notched Sound Therapy alone.
- Vagal Nerve Stimulation (stimulation of the Vagal nerve with a medical implant) was paired with tones that excluded the tinnitus tone (in a manner analogous to Notched Sound Therapy). A preliminary experiment showed promise, but this device has not yet been approved.
Tinnitus is a complex neurological phenomenon that has been resistant to the development of a clinically validated “cure” or universally acknowledged effective treatment. Experimental treatments show promise, but must be evaluated skeptically. Many treatments are marketed far beyond their evidence and some are outright scams (e.g. e-books, homeopathy, etc.).
It can be overwhelming to research all the available treatments that exist, but being educated is the first step in finding an effective way to cope with this condition.
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Posting this in case it helps anybody else… TL;DR acoustic neuromas are rare, real and really shitty.
I recently went through a major hearing loss/tinnitus ordeal, and I have severely diminished hearing in my right ear – but it’s not uniform, it just severely dips at a certain frequency range. Unfortunately, human speech is entirely within the range of the dip, the frequencies that I still respond to are essentially useless functionally. My left ear, however, is absolutely normal.
After a bunch of doctors, audiograms, CT scans and other tests, nobody could figure out what could cause this kind of severe, specific and unilateral (one ear only) hearing loss. I was having a conversation with the technician who conducted my audiogram once, and she suggested I go in for an MRI. This was something that multiple doctors considered unnecessary, since CT scans and X-rays raised no concerns. I decided to do it anyways, because I wanted to cover all my bases, and I was desperately trying to get to the root cause of my hearing loss and was mostly just blaming myself for not having taken better care of my ears – which is really not something I should’ve been losing sleep over, because while I do attend the occasional gig (with earplugs!) and sometimes play small gigs (just a hobbyist DJ), my doctors agreed that my history didn’t add up to one where I was abusing my hearing to the point of putting it at risk. Also, if it was caused by over-exposure to loud sounds, there was no way it could be entirely unilateral, because again, my left ear is an exemplar of health.
The MRI initially did not reveal anything either, but when performed with galodinium(?) contrast it showed a very, very small tumor that resided right on the auditory nerve, which was creating physical pressure against the nerve on that ear, which was the cause for my hearing loss. The tragedy is that there is neither no known cause or cure for this – my doctors have recommended that I just monitor it regularly, and if it grows enough in size where it is creating additional problems, we can consider surgery.
BUT. Nothing can be done to reverse the hearing loss. And nothing can be done to stop that ear from eventually going deaf. I just have to adapt and live with it.
An annecdotal treatment that came up in the Tinnitus Talk forum a few years ago was not around ignoring your T or distracting yourself from it, but rather acknowledging it and accepting it, then moving on with your day. The concept is quite similar to “floating” in your anxiety during a panic attack. The more you try to ignore it and make it go away, the more you end up focusing on it and it will get more intense. So just like during a panic attack or a bad trip, lol): simply acknowledge that you can hear your T, accept that it is what is is (not evil or good) and simply move forward with your day and don’t make attempts to ignore it or fight it. The sooner you can start accepting it, the less of a burden it becomes. It seems very counterintuitive, but it has helped me more than any audio therapy or lifestyle change (would still recommend both).
TL;DR – No cure. Mindufulness and acceptance plays a huge role in taking your life back from the big T.
Absolutely agree, developed in myself around about 2009 (moving to Indonesia)
Absolute nightmare for the first year, began to realise whilst taking breaks away on holiday in Bali (yeah I know lucky bugger but its on our doorstep) I hadn’t thought about the ringing for a few days. Came back to Jakarta and it started again.
This was when I developed a theory/practice around distraction and white noise to enable in the day to minimize it, and at night to enable peaceful transition to sleep.
But the point is, over the years same as you, I have completely accepted it as part of my life. To the point when other people around me complain about it developing a small part of me now cannot understand the frustration of experiencing it for the first time.
I look at it as part of my internal machinery, kind of like a fan noise from a computer operating, ‘my brain is calculating so it makes sounds’ once you accept it, it completely changes how you can cope.
Maybe I have a less extreme version, who is to know what is in each individuals noise levels, but completely agree. Take mechanisms to cope then learn to accept it.
I have Tinitus since 2012 (5 years) and i suffer the most when i mix on party. It’s really difficult for me to listen to the next track with one of my ear with the headphones and also listen to the track that i play right now. It causes me lot of troubles so dj’s be carreful with the speakers close to you !!!!
Stay away from CATS – caffeine, alcohol, tobacco, salt. Also have heard sugar as well.Get as good of rest sleeping at night. These things together for me have had the best impact.
Stay away from CATS – caffeine, alcohol, tobacco, salt. Also have heard sugar as well.Get as good of rest sleeping at night. These things together for me have had the best impact.
In addition, niccotine and marijuana will make the T louder. Would recommend avoiding those as well. I notice that changes in blood flow and blood pressure have increased the loudness of my T temporarily.
The Article mentions Gingko Biloba as non effective. I have found the opposite.
If I have bad episode after a few days to allow it to ‘kick in’ the levels diminish to a point where it is extremely manageable.
“Cats” please explain. I’ve already cut out unicorns and staring directly at rainbows but am still looking for better results.
I am DJ and suffer from this condition since I was in high-school. Mainly not because of the loudness of the music but because my nose is broken and causes a pressure on the ear as all is connected. A doctor once told me that Tinnitus does not affect on the hearing. And I can tell that my ears are very sharp and have learned to live like that.
One thing that I’ve noticed that takes away the Tinnitus is when taking Mushrooms or MDMA.
That’s fascinating. Has anyone else with tinnitus found that psychedelics help their tinnitus? Is it only for the time the drug is active or is it a lasting effect?
Can confirm. There is also preliminary scientific evidence that suggests MDMA can reduce T or even protect against it in loud environments. At the very least it helps reduce the anxiety caused by T. I find that anxiety related to T is the worst amplifier of T. Acceptance is the best way to coexist with it. And also the hardest. Best of luck 🙂
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Unfortunately, my best treatment for tinitus is wearing my actual hearing aids. Otherwise, my best solution is some constant, pleasant background noise (usually good music) to distract me.
Thank you for the article. I’m sure it will help a lot of people.
Personal testament – I have had tinitus for years and I find that if I manage my lifestyle in a healthy way (like Daniel said CATS) and minimize noise exposure mine “goes away” or rather my brain tunes it out so it’s not present all the time. Occasionally it pops back in for a few minutes as a nice reminder and then fades away…
The first time I found out I had tinnitus was watching your first article on the subject. I hate you so much at that time for make me realize (no hard feelings jo jo). I got very depressed. I realized that it was something I had from a long time ago and probably could have spent much more time without knowing that I had it. I guess it was a matter of time before I knew it. I felt overwhelmed and at the same time I was taking pills to sleep and without realizing this increased my anxiety. I had to leave those pills of course. It was a difficult period. Look for all possible therapies at hand. Something that worked for a while was to record the sound of the night and the sound of the waves of the sea. Recording and listening to atmospheres with high noise content in the background. I brought it all the time in my walkmans and help me to disguise my own noise. To work, to sleep, etc… I pass from listening great music to listening environments sounds, you can not be more eccentric than that haha! 😉 All that was very good for a while but what was killing me, apart from the noise perse, was that I could not take my mind from the fact that I had permanent damage and that I had to live the rest of my life with it. It was hard for me to accept my reality, accept my nonsense, accept that I could be more careful with my ears, accept that I was getting old and that this is a scar of my life. It was a hard moment with my self and my own shit…. Little by little I was redoing my life and I realized that this was not the end of the world and that before I knew that I had this problem my life was normal, so I put my self together. At the end of everything I have learned that if I do not think about it, I do not hear it, that’s easy. The best that one can do is accept the fact and make the passes with oneself. The only therapy that serves is to stay distracted and eventually everything returns to normal.
I have been dealing with increased acute tinnitus now for a couple of years. I have been going to shows with varying frequency since I was 14. Back in high school and college I was at a venue seeing a band or DJ every weekend (with no noticeable problems). In my 20s I started to notice that my ears would ring for the rest of the night after leaving a venue, and sometimes would continue to ring the next morning after a particularly loud or long show. I am 30 now and go out far less frequently, but the effects of tinnitus are still there and have changed. I still get the ringing after the show, but then for a week or two after I will be sitting at my desk at work when, all of the sudden, I will completely lose hearing in one of my ears, followed by the dreaded “eeeeee”. Sometimes it lasts 10 seconds, sometimes it lasts a few minutes. Starts out loud and then dulls, eventually fading away. My hearing goes in the opposite direction, which is to say it completely disappears at the start of the ringing, then slowly fades back in. I’d compare it to putting the world through a low pass filter and slowly bringing it back to baseline. Luckily for me this has not significantly affected my life (more just weird), but I could see it easily becoming maddening if it were chronic.
Have the same thing.
Went to my first show in a while this weekend (on Friday), a farewell show for a band that is quite special to me and my significant other. I wore earplugs (the crappy foam ones) for most of the show, but I was incredibly annoyed because the foam plugs basically just block everything but the lows, so everything sounds muffled like you are listening underwater. This being a farewell show for a band that means a lot to me, I stupidly took the plugs out when the band I came to see went on and made my way to the front of the room. I had a blast. My ears were ringing after the show (normal), but then the next morning I woke up and they were still ringing, loudly. And it seemed like only lows were getting through to my naked ears. This scared me a little, but we got home late and woke up early, so I thought eh maybe it just hasn’t been long enough. About halfway through the day my left ear came back, but my right ear was still ringing loudly and I wasn’t hearing highs and mids properly, which was highlighted by the fact that I could now hear perfectly out of my other ear. When my right ear was still muffled on Sunday morning I really started to panic. There was a lot of self loathing for not just wearing the stupid plugs. Luckily, at about mid-day on Sunday, all of the sudden I hear the sound “pop” back in to my right ear out of nowhere–the ringing stopped and I could hear again.
I’m posting this as a cautionary tale–I got extremely lucky, and am even more lucky that it took this long for signs of hearing loss to set in in the first place, considering that I have been a weekend warrior since I was about 14 years old–and in those days I was going to some pretty grimy DIY shows standing right next to cabs that were feeding back all night.
I’ve ordered some high fidelity earplugs (2 different brands) and will report back on how well they work (i.e. how good a job they do at not compromising the music). I did a lot of research and ordered a set of Earaser Musician Plugs and a set of Etymotic ETY Plugs. both are “high fidelity” plugs that will supposedly still let through highs and mids but at safer levels. As I said, I’ll report back on how they work, and which I like better.
Seriously though, guys, protect your ears. I spent well over a decade not worrying about my ears and pushing my way to the front with no problems, but mark my words the effects will hit you out of nowhere one day and you might not be as lucky as me. I can’t describe the fear and guilt I felt when I thought my right ear was f***ed forever. Trust me, you’d rather keep listening to music than never be able to hear it again.
A white noise app, a mechanical fan, music at low levels. All extremely beneficial for distraction.
Thanks so much for this article .
Stay away from CATS – caffeine, alcohol, tobacco, salt. Also have heard sugar as well.
Get as good of rest sleeping at night. These things together for me have had the best impact.
Jeezus, might as well be dead if yer gonna avoid all that. 🙂
It is absolutely true about the CATS, but cannot miss my morning cup of Coffee. I use a method of ‘if it gets too noisy, cut back’
Take it in moderation.
But as I have mentioned elsewhere, I have accepted my Tinitus, have a coping system, so maybe I am in a better state than a lot of sufferers out there where CATS can affect them in very negative ways.