Behandeling van tinnitus

Treatment options

Is there anything that can be done about tinnitus?

The answer is: yes and no. There are many things on the market for tinnitus, such as special hearing aids, medicines, psychological therapies, and even implants.

The shocking reality, however, is that all of these solutions actually provide relief for a small percentage of patients. They usually do not remove the annoying sounds, but teach the patient to deal with them better, to ignore them.

The brain is, as it were, distracted, so that the patient pays less attention to it. There is nothing wrong with any of these methods per se. However, they are symptomatic treatments, the cause is not removed.

Acute tinnitus

Als de “piep” of “brom” acuut is ontstaan of als er sprake is van acuut gehoorverlies (pop-concerten zijn beruchte veroorzakers) is het zaak niet te lang met de acute tinnitus door te lopen, maar medisch advies in te winnen. Er zijn experimenten met medicijnen die bij acuut tinnitus voorkomen dat het chronisch wordt. Verder kan acute tinnitus veroorzaakt worden door een ophoping van oorsmeer. Laat niet je oren uitspuiten (dat is een bekende oorzaak van tinnitus) maar netjes met een instrumentje (cerumenhaakje) onder zicht verwijderen.

Chronic Tinnitus

The course of chronic tinnitus is unpredictable. Sometimes the symptoms stay the same, and sometimes they get worse over time. In about 10% of cases, tinnitus affects daily life to such an extent that professional help is needed.

How to deal with Tinnitus

It is important to first determine whether the tinnitus is objective or subjective. Objective tinnitus can also be detected by a treating physician. This facilitates the path to finding the cause and to a possible treatment.
Subjective tinnitus, perceiving the sound without identifying the source of it, is the most common and difficult form to treat. Although there is no cure for tinnitus, the sufferer may, as time passes, be less affected by tinnitus. This is because it is less noticeable or because they learn to "deal with it". You can reduce or ease the symptoms yourself by educating yourself about the condition - for example, so that you understand that tinnitus is not dangerous.

Two types of treatment

Tinnitus treatments can be divided into two categories: 1) aimed at directly reducing the intensity of tinnitus and 2) aimed at relieving the nuisance associated with tinnitus. The former includes drug therapy and electrical suppression, and the latter includes drug therapy, cognitive and behavioral therapy, sound therapy, and habituation therapy. No approach works for everyone, and you may have to try different things before you find something that works for you. If you have age-related hearing loss, an hearing aid can often make the tinnitus less noticeable by making sounds from the surroundings harder.

Medication

With objective tinnitus (which another can also hear) it is possible to prescribe drugs that remove the underlying cause (increased blood pressure, Meniere's disease, inflamed Eustachian tube etc). The drug treatment for subjective Tinnitus is often focussed upon to reducing the stress caused by tinnitus

Masking

There devices are intended to produce white noise at a low level. This leads to less tinnitus being experienced. Sometimes this effect continues even after the device is turned off, even if only for a short time. This is known as Acoustic Neuromodulation Therapy. But it doesn't always entail using a specialised device - listening to music, turning on a radio, turning on a fan, or playing white noise in the background can also help. If you wear an hearing aid, you can see if it can be programmed to produce a masking sound Acoustic Neuromodulation Therapy. But it doesn't always have to be a specialized device – listening to music, turning on a radio, turning on a fan or running white noise in the background can help too. If you wear a hearing aid, you can see if it can be programmed or if it produces a masking sound.

Biofeedback

Tinnitus creates stress, and stress, in turn, can make tinnitus worse. Biofeedback is a relaxation technique that helps control your stress by changing your physical responses. Electrodes attached to the skin provide information about bodily processes such as heart rate, body temperature and muscle tension. This output is then displayed on a screen and patients learn to change these stress response by adjusting their thoughts and feelings.

CGT

CBT (cognitive behavioural therapy) uses cognitive restructuring combined with relaxation to reverse the way patients think about tinnitus. Patients usually keep a diary and do homework to build up skills to deal with tinnitus. Therapy is often short-term - for example, weekly sessions for 2-6 months. A large study found that, although, the noise had not diminished after behavioural therapy, patients were significantly less affected and that their quality of life had improved significantly

TRT

TRT (Tinnitus Retraining Therapy) is based on the assumption that tinnitus results from an abnormal neural activity. The goal is to get the auditory system used to the tinnitus sounds, making them less noticeable or less bothering. TRT consists of individual therapy that explains everything about the auditory system and how tinnitus develops. This approach also includes sound therapy. A device is placed in the ear and this generates a low noise and ambient noise that matches the noise level of the tinnitus.

Neuromodulation

The largest group of patients with Tinnitus consists of those with hearing loss. The brain "replenishes" the lost frequencies, as it were, and thus creates a "phantom sound". It is therefore not surprising that scientists are looking for ways to tell the brain not to do that anymore. Three key studies are:

rTMS rTMS: repetitive Transcranial Magnetic Stimulation in which certain parts of the brain are stimulated by placing electromagnets on the skull.
TDCS: Transcranial Direct Current Stimulation
NVS: Nervus Vagus Stimulation

Beware of quackery

Especially on the Internet, a wide range of possible remedies for Tinnitus are offered for sale. Although there is often no scientifically substantiated effect, there are still patients who benefit from some of them. It is generally thought that this beneficial effect is based upon the placebo effect. There are also laser devices and even vagal nerve stimulators on the market, some of which can be called downright dangerous.

Pay attention! None of these treatments are yet recommended in the “Tinnitus Guideline” of the Dutch Association for Throat – Nose – Ear Medicine. These treatments are also rarely reimbursed by health insurers.