Treatment Options

Is there anything to do for tinnitus?

The answer is: yes and no

The answer is yes and no. There are a variety of anti-tinnitus products on the market, including special hearing aids, medicines, psychological therapies, and even implants. However, the shocking reality is that all these solutions actually only provide relief for a small percentage of patients. They do not usually remove the annoying sounds, but teach the patient to manage them in a better way, to ignore them. The brain is, as it were, distracted, so that the patient pays less attention to it. In itself there is nothing wrong with all these methods; however, they are directed at the symptoms; the cause is not removed

Acute Tinnitus

If the “buzzing” or “humming” has occurred acutely or if there is an acute hearing loss (Pop Concerts are notorious causes), it is important with the acute tinnitus not to wait and see, but to seek medical advice. There are drug studies that show that you can, in some cases, prevent acute tinnitus from becoming chronic. Furthermore, acute tinnitus can be caused by an accumulation of earwax. Do not allow your ears be flushed (which is a known cause of tinnitus), but ask the doctor to remove the wax with an instrument (cerumen hook) under direct vision.

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 it is a case of objective or subjective tinnitus. Objective tinnitus can be heard by a treating doctor who can then try to identify the physical cause and then possibly prescribe a specific 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.

MedicationMasking Biofeedback CGT TRT NeuromodulationBeware of quackery
 With objective tinnitus (which another can also hear) it is possible to prescribe medicines 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

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. 

 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.
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 (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.
The largest group of patients with Tinnitus is those whose cause must be sought in the hearing loss. The brain constantly fills in the lost frequencies, as it were, creating a “phantom sound”. It is not surprising then that possibilities are being sought to tell the brain not to do that anymore. Three main study areas are:

  • rTMS: rTMS: repetitive Transcranial Magnetic Stimulation in which certain parts of the brain are stimulated by placing electromagnets on the skull.
  • TDCS: Transcraniale Direct Current Stimulation
  • VNS Vagal Nerve Stimulation
In fact, none of these treatments are yet recommended in the “Guideline Tinnitus” of the Dutch Society for Ears Nose and Throat (ENT) specialists and these treatments are rarely reimbursed by health insurers.
Lees here more about the state of science

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.

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