Imagine a constant high-pitched tone in your ears or an ocean of white noise that never goes away. For the 16 million Americans who suffer from tinnitus, that literally is the sound of silence.
Doctors don’t really know what causes the condition, which can sound to some people like buzzing, roaring, clicking or even hissing. It can come and go and vary in volume for no explainable reason.
Tinnitus is often accompanied by hyperacusis, an extreme sensitivity to loud noises. It frequently shows up in soldiers, who during their tours of duty, are repeatedly exposed to loud explosions and gunfire, but lots of other people get it, too.
In fact, 15 to 20 percent of those who have tinnitus develop it after age 60, says Aniruddha K. Deshpande, a research audiologist at the University of Iowa Hospitals and Clinics in Iowa City, Iowa.
“No one knows for sure what causes this problem, but there are theories,” says Deshpande. These include:
- Damage to the hair cells of the inner ear caused by excessive noise, medicine or even just aging
- Hyperactivity of noise fibers in the brain
- Head trauma
- Ear wax build-up
- A side effect of medication
- A problem with the ganglia, the brain’s noise gatekeeper, which has been shown in some recent studies to be damaged in people with tinnitus
- Hearing loss: Researchers suspect that with hearing loss, the brain almost creates a phantom sound (the way an amputee might experience a phantom limb) to replace the sound frequency that is lost
- Sinus infection: When you’ve had a sinus infection, your whole head is involved — you might feel pain behind your eyes, in your cheeks, even in your teeth. And once it’s finally gone, you can be left with a ringing in your ears, likely the result of the passages that have narrowed and become dried during your infection.
- Anxiety and stress: Although the science on this connection is tenuous, there is a theory that says that many people with anxiety simultaneously suffer tinnitus. If you’re stressed, your body’s “fight or flight” response may be on constant alert, which physiologically affect your nerves, blood flow and more. The result? You may feel this increased pressure in your ears. Anxiety can also up your body’s response to the smallest sensations while simultaneously cutting into your ability to ignore distress. One theory says that because of that, you might be more attuned to some sort of perceived noise in your ears.
Living with Noise
Some tinnitus sufferers are not really bothered by the problem. But about 20 to 50 percent (estimates vary) of people find the condition debilitating and are psychologically disturbed by it, according to Deshpande. They lose sleep, are irritable, unable to concentrate, feel stressed and very often experience depression. Some people miss days of work, find their relationships suffer or don’t participate in social interactions.
Some are able to function all day with it, but when they lay down to go to sleep at night, they feel that they are surrounded by noise and can’t relax, Deshpande says.
How to Treat It
It used to be that there was not much doctors could do to help people suffering from incessant sounds in their ears. Studies of such natural treatments as magnesium, zinc and B vitamins have not proved that these regimens are effective. Similarly, studies on acupuncture have shown no improvement for tinnitus patients.
But one of the more promising advances is a device called a sound stimulus provider.
Your otolaryngologist (ear, nose and throat doctor) will probably refer you to a qualified audiologist to be fitted for such a device, but your insurance may not cover the cost, which can range from $600 to several thousand dollars, says Deshpande. Similar to a hearing aid, a sound stimulus provider will cover the tinnitus with a different, more tolerable sound.
“These are sounds that might be more acceptable to the patient,” Deshpande says, like nature sounds or soft humming.
Because 80 percent of the time tinnitus is accompanied by hearing loss, another treatment is a hearing aid, which ups ambient sounds when it’s very quiet. Hearing aids accomplish two things — they allow the person to hear others more easily, and they also mask the tinnitus noise by turning up the volume on natural sounds in your surroundings, Deshpande says.
Most recently, another option has become available — a combination hearing aid and sound stimulus provider. Again, not covered by insurance, this device offers both sound amplification and the masking sounds.
How to Lower Anxiety
If you go to an audiologist for one of the devices mentioned above, see if you can test it out before committing to it. At Deshpande’s clinic, for example, patients can try the devices for 30 days to see how effective they are. Some brands to look for are Nueromonics and Estone Soundcure, which tout their therapies as “breakthrough” products.
But it’s not enough to just pick up a sound device and walk away, Deshpande says. Most people do better when the devices are accompanied by psychological counseling.
“I have been involved in a couple of studies where we’ve combined cognitive behavioral therapy with the use of the devices, and we’ve found that the devices are more effective when used with a counseling approach,” he says.
Cognitive behavioral therapy (CBT) for tinnitus helps you understand what’s true and what’s not about your condition. For example, you may believe it’s going to get worse over time or that “nothing will help” and such beliefs may make you anxious or interfere with your ability to use the treatments available to you.
CBT, as it’s known, may include some or all of the following techniques to help you cope with your ringing ears:
- Keeping a daily diary: This helps you track when the problem is the worst and when it is less obtrusive.
- Relaxation techniques: Using these can help you when you feel you can’t sleep, are stressed or are experiencing mood swings.
- Guided imagery: By learning to use guided imagery, patients may be able to “turn down” the noise a bit on their own.
- Progressive muscle relaxation: A specific way of relaxing, this technique helps to relax your entire body.
- Deep breathing: Inhaling deeply has been shown to increase relaxation.
- Habituation therapy: A series of exercises that helps patients gradually reduce their perception of the sound in their ears — much the way you may not notice the hum of the air conditioner or the ticking of a clock if you live with it long enough. (Note: anxiety, depression and fear can interfere with habituation therapy, which is why all of the above methods should be used in combination, according to Deshpande.)
If you’re looking for more help, the American Tinnitus Association offers resources and a support network for people with tinnitus and their families.
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