Tinnitus: Top 12 Topics I Teach

Tinnitus. It’s a subject I  discuss at least 2-3x every time I hold a clinic. There’s a lot of misinformation out there. I’m going to break it down the way that I describe it for my patients in clinic. There is far more information out there that I’m not going to go into, but these are the bullet  points I think most everyone with it should at least hear once.

1 – Tinnitus is common. If you took every person on the planet and individually put them in a soundproof booth with a complete absence of sound, 98% of those people would hear a noise in their ear.

2 – It’s a real noise. Your ear is making it. So when you think it’s all in your head, you’re right, but it’s not an imaginary sound. There is objective tinnitus, when I can hear it too and there is subjective tinnitus when only you can hear it.

3 – Tinnitus comes from the latin tinnire meaning “to ring.” However, some people hear crickets, some buzzing, some the ocean in a shell, and yet others hear a hum. Tinnitus now has come to mean any noise in your ear.

4 – Tinnitus is probably protective. It probably acts as a warning system. Much like pain is a warning to you that there’s something wrong with a part of your body, tinnitus is a warning that there’s something wrong with your ears. That’s because in the vast majority of cases, tinnitus is related to hearing loss. Pretend with me for a minute that you’re an antelope head buried low eating the high grass of the Serengeti. If you have hearing loss and don’t know it, you may not notice the lion sneaking up on you. However, if your ears are ringing, you may look up more, use your other senses more often, move around a bit more, and perhaps spot that lion before he eats you. Similarly, if our ears are ringing, maybe we’re more likely to look both ways before walking out into the street in front of that oncoming bus.

5 – Tinnitus can be made worse by many things. NSAIDs (ibuprofen and aspirin are the worst offenders), caffeine, diurectics, and many many other medications. Stress makes it worse. Our bodies release the same chemicals to both physical and emotional stress. These chemicals can increase the loudness of tinnitus. Stress can include poor sleep, pain, pressure at work, poor relationship with loved ones, financial strain, death, divorce, etc. Likewise, thinking about the tinnitus will frequently make it louder. The more you think about it the louder it gets.

6 – So what to do? You can see a good discussion of options at the American Tinnitus Association website and even on the Wikipedia article, although I think the former is more appropriate. The best site that I know of is from eMedicine.com which is written by doctors for doctors.

7 – Hearing aids are a great option for those who have significant hearing loss and tinnitus. They’re not magic, the tinnitus will be present when not wearing the hearing aid, but at least there’s relief there when you do need to hear things better, and not the ringing.

8 – The single most effective treatment of which I’m aware is tinnitus retraining therapy. The single best version of this (different than tradition tinnitus retraining) I have found is the Neuromonics device. It’s expensive but over 85% of patients who use it get a dramatic improvement in their tinnitus to the point they are happy with the results. In the DFW area, I usually refer patients to the Callier Center for their tinnitus clinic.

9 – A word on pills. OTC medications have been used for years to treat tinnitus. None have ever been found to be better than 40% effective. Many of these medications say that you have to use them for 3-6 months or longer to get benefit and I think this is bologna. I’ve never seen someone use it for a month and not have improvement but then suddenly started having improvement at 3 months that was attributable to those meds. Although there are many preparations (like Arches Tinnitus formula) most combine several elements but haven’t shown efficacy better than 1 ingredient alone (lipoflavanoids or sometimes called biolipoflavanoids). You can buy these alone, not mixed into some “super tinnitus killing” formula. They’re cheap, without risk of significant side effects, and work on up to 30-40% of patients. I think they’re worth trying.

10 – Acupuncture also works in about 30-40% of people. Problem is that acupuncturists know that it is more likely to fail than to work so the dishonest ones may tell you that of course they can treat tinnitus when they may not have much experience. If you want to try acupuncture, ask the therapist for references who have been treated for tinnitus.

11 – Other new interventions include transcranial magnetic stimulation (TMS). Google it. There’s not a great amount of data on it yet, but there are free studies for willing participants.

12 – I don’t like tinnitus that is unilateral (only in one ear) or which is pulsatile (instead of a constant sound). If it’s on one side and/or if it pulsates, this could indicate another problem. This kind of tinnitus definitely needs to be evaluated.

So there’s 12 things you may or may not know. Hope it helps somewhat. Visit us if it doesn’t, I can tell you the same thing in person, but more importantly we can test you to make sure there is not any more concerning problem as the cause.

–Richard D. Thrasher III, MD

 

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