Tinnitus & Hyperacusis

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.

Self Treatment – the first step

If you have tinnitus, simply reading the text that follows may be of benefit to you.  Much of it was adapted from Sizer, D. I. & Coles, R. A. ‘Tinnitus Self Treatment’, as published in Tyler, R. S. (2006). Tinnitus treatment: Clinical protocols. New York: Thieme Medical Publishers and appears here with permission from the author.

This self-treatment may be undertaken before or after seeking professional advice.  However we recommend that you speak to one of our audiologists or an ear, nose and throat specialist via your GP to provide reassurance that there is no underlying health condition causing the tinnitus for you to worry about.  You can, however, start now.

By following the advice in these pages you will begin to self-treat your tinnitus and you may achieve a gradual reduction of your tinnitus to a point where it is present but of little consequence to you.

Introduction

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 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, which then immediately sorts out what is important and what should be discarded or ignored.  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 or we can easily pick out a single instrument in the orchestra or a note in a chord when we listen for it.  Unfortunately, when our tinnitus first appears we tend to do this – naturally homing 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 to the degree to which they select certain important, strange, or worrying sounds (including tinnitus) for special attention, and filter out other sounds.  Also, as you get older, your ability to hear external sounds reduce, and the resulting lack of contrasting sound makes you become more aware of internal tinnitus noises.  This is equally true for other forms of damage to the auditory system, in particular noise  or music induced hearing loss.

Habituation

Imagine you have a new clock.  At first you can’t help but hear its ticking, but after a while you find that 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 as well.

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 viscous cycle of tension and worry that keeps the tinnitus worse than it could be; the figure below 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 viscous cycle.  Monitoring your tinnitus and worrying about it will only make it worse.

Relaxation exercises

To help relieve tension in your body, you can use simple relaxation exercises such as breathing and muscle exercises.  Different relaxation techniques work for different people, and it is a matter of finding one that works for you.  Some find aromatherapy, yoga, reflexology or tai chi have benefits, others prefer relaxation CD’s.

Once you become practiced at relaxation techniques you will gradually learn to relax your body and mind without needing to use the exercises.  The key is to find what works for you and to regularly practice it.

Sound therapies

The normal course of tinnitus is for it to gradually recede into the background so that you eventually become hardly aware of it – the habituation process as described earlier.  You can speed this process up by increasing the amount of background sound near you, what is known in audiological circles as ‘sound therapy’.  This reduces the contrast between the level of your tinnitus and the level of the background sound.  In turn, this reduces the intrusiveness of your tinnitus and the tension it causes, thus promoting the habituation process and interrupting the viscous cycle as described above.  The principles and procedures involved are similar to those used in most forms of sound therapy.  You can discuss sound therapy options with one of our audiologists.

Additional background sounds can come from:

• Pleasant low-level sounds from a television, radio or recorded music, from a fan, a fish tank filter or from outside through an open window
• Sound conditioners: small devices that can be placed on a chair or table-top that generate natural sounds such as running water, the rain or other low level sounds
• A wearable noise generator: a discreet device worn like a hearing aid that makes a low-level rain sound
• Wearing and using a hearing aid, even if you have only a slight difficulty in hearing

Exactly which is the best level of additional sound to use has not yet been established, but a level just below that of your tinnitus would seen sensible – not too loud so you can’t hear your tinnitus and not too soft.  You will find a level that you are comfortable with.  These devices may also be used to mask the tinnitus altogether should you require, but it is thought that this has little long-term benefit in habituation.

The golden rule is to avoid quit 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 sound is rather quiet, as often and for as long as you can.

If increasing the background sound annoys other people around you, use a personal music player and headphones.  You may also find that in-ear headphones custom-moulded to your ears deliver the sound much more effectively and comfortably than standard 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 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, have a ticking clock beside the bed or use a noise generator or under-pillow speaker (i-Pillow).

Speak to one of our audiologists about any of the items mentioned here or browse the website.

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 get involved and there are plenty of options for adult learning activities out there.

Some have seen the positive side of their tinnitus and have welcomed the push it gave them to do something new or to rekindle old interests.

General health is also very important in managing tinnitus, including a good diet, plenty of rest and exercise and enjoyable social activity to combat stress.  The acronym CATS (Coffee, Alcohol, Tobbacco and Stress) is often used to describe things that should be typically avoided to reduce tinnitus.  More generally if you find that certain foods or situations aggravate your tinnitus you should make efforts to cut these out, down or find alternatives.  It may be helpful to keep a tinnitus diary where you can keep track of what you have eaten or participated in and whether your tinnitus on that day was particularly intrusive or not.  Looking back at this may help you find causes of aggravation.

Hyperacusis

Hyperacusis is a condition characterised by oversensitivity to sound.  Those with hyperacusis commonly have troubling tinnitus and it is not uncommon in musicians with troubling tinnitus.  The mechanism for hyperacusis is thought to be similar to that of tinnitus, involving the limbic system but with an involuntary psychological response to external sound.  A desensitisation program is often used to treat hyperacusis, with background sound levels systematically increased over the course of the treatment.

Earplugs, tinnitus and hyperacusis

While earplugs are an essential tool for those working in and around music at high levels, the habitual use of earplugs beyond high-risk environments is not recommended for those who suffer from tinnitus or hyperacusis.  Earplug use in quiet locations will focus the attention of tinnitus sufferers on their tinnitus (consolidating the vicious  circle talked about earlier) and may also cause increased sensitisation to sound for those who suffer from hyperacusis.

Further information and help

If you would like to know more about tinnitus make an appointment with one of our audiologists or visit www.tinnitus.asn.au