Tinnitus Treatment Options
Tinnitus is the term used to describe the condition of perceiving a ringing, buzzing or whooshing noise in the absence of an external sound source. This is typically only experienced by the person with tinnitus and has a variety of different causes. We use sometimes one or more of these methods to treat your tinnitus:
Tinnitus Retraining Therapy (TRT) has a success rate greater than 80% in substantially improving tinnitus perception and annoyance: Sheldrake(1996); Bartnik, (1999); Heitzman (1999); Herraiz, (1999); Jastreboff (2001); Mc Kinney (1999). That is, patients often report that their tinnitus ceases to be an issue in their lives. This approach employs the temporary use of soft sound, often in the form of broadband noise generators purposely set at a volume that does not mask the tinnitus. The contrast between the tinnitus signal and environmental sounds is thereby decreased, thus facilitating habituation to the tinnitus signal. Habituation means that the subconscious mind is passively retrained to filter out and not respond to the tinnitus signal the same way the subconscious mind naturally filters out the meaningless sound of a refrigerator or a computer fan. This can be accomplished with combination devices, which are wearable units that function both as a hearing aid and noise generators. Currently, most hearing aids have a tinnitus module that can combine amplification with some form of sound therapy (Starkey, Unitron, Phonak, Oticon, Signia). However, Widex is the only manufacturer that has the capability to combine noise, music, and amplification to accomplish retraining. Broadband noise generators are also other choices but do not produce music as a medium. If hyperacusis is associated with the tinnitus but there is no hearing loss, broadband noise generators are the device of the choice. A consultation and evaluation is needed to determine what Is the Best instrument for each patient. In some cases, over-the-ear devices are not necessary.
Neuromonics uses the neurophysiologic model as its basis but holds that most patients who suffer from tinnitus have some degrees of hearing loss between 250-16000 Hz. Therefore, there is a lack of stimulation perceived by the brain. This causes the central auditory nervous system to develop a compensatory action to offset this loss of stimulation. The Result is an artificial gain the central auditory nervous system that is perceived by the brain as sound. Accordingly, if we use a highly sophisticated algorithm to compensate for this loss of sound to the brain, we can re-train the brain into reducing the artificial gain which will reduce the patient’s annoyance and in turn the volume of the tinnitus (known as minimum masking level). This calls for a very detailed evaluation of the auditory system, including high-frequency audiometry, tinnitus pitch measurement, and tinnitus matching, loudness discomfort levels, and residual inhibition. If sleeping is affected due to tinnitus, Neuromonics can be a significant help since patients can wear the device to bed.
Masking or Partial-masking tinnitus involves partially or completely covering up the tinnitus sounds with other sounds from an external source. In fact, masking raises the threshold of the perception of tinnitus when an external source is presented. In clinical settings, masking is accomplished through the use of wearable noise generators (maskers) or combination devices, which are wearable units that function both as a hearing aid and masker. Currently, almost all major manufacturers can combine amplification with some form of sound therapy (Starkey, Unitron, Phonak, Oticon, Signia, Widex, and Resound) to accomplish masking or partial-masking. Dr. Jack Vernon and his colleagues at the Oregon Hearing Research Center in Portland introduced the principles and concepts behind masking which helped improve the quality of life for literally millions of tinnitus sufferers.
Notch Therapy- This method is available through Signia hearing instruments. The audiologist has to first identify the tinnitus frequency and then reduce the amplification in that frequency region. When tonal tinnitus and hearing loss, is present in a patient, Notch Therapy is clinically proven to reduce the annoyance of tinnitus. By permanently relegating tinnitus sounds into the background over a long period, over-stimulation is reduced and the brain ‘learns’ to stop paying attention to the tinnitus sounds, so it’s no longer perceived as disturbing. Unlike the sound therapy approaches, which introduce an additional therapy sound, Notch Therapy treats tinnitus inaudibly and unobtrusively.
Cognitive Behavioral Therapy (CBT) – The way one thinks about his/her tinnitus determines how he/she feels about it. When we modify the response by changing the distorted thought processes commonly associated with tinnitus, the patient’s emotions toward tinnitus change. This in turn makes the patient notice the annoyance of the tinnitus less than before. Most treatments use CBT in one way or another. We modify CBT to address each patient’s needs. In some cases, patients need to use some form of sound therapy along with CBT.