Advances in technology, research and tinnitus treatment approaches have led to a resurgence of interest in tinnitus care, or “ringing in the ears,” as an important component of comprehensive hearing healthcare services. While there is no cure for tinnitus in 97%-99% of cases, there are many devices, treatments, and apps that can help lessen the symptoms.
This article highlights best practices in managing tinnitus. It also provides a summary of tinnitus treatment tools to consider offering at your practice. But first, let’s step back and look at what recent research has revealed about tinnitus and explore some solutions for managing it.
How one hearing care expert describes tinnitus:
“It’s a phantom sound perceived in the ear(s)–most often described as ‘buzzing, ringing, crickets, whistling, humming, static, or a high-pitch tone.’ One cannot easily adapt to it” (that is, “habituate” to it).” – Douglas Beck, AuD, Director of Academic Sciences at Oticon Inc & Senior Editor for Clinical Research at The Hearing Review
So many people suffer from tinnitus — about 33 to 35 million in the United States. Of those, 10% say their tinnitus is “bothersome.” Knowing that millions of people are coping with ringing in the ears, buzzing, whistling and a variety of other annoying sounds, you can bet that the hearing care industry is taking a closer look at current research and potential solutions.
What causes tinnitus?
Tinnitus can result from any number of underlying causes.
- One of the most common causes is noise. In July 2016, a study published on JAMAnetwork.com showed that work-time and leisure-time exposures to noise are related to developing tinnitus.
- Other common causes include ear infections, heart disease, head injury or ear-wax buildup!
“Tinnitus can be a manifestation of stress…” comments Douglas L. Beck, AuD, who presented recent findings of a public health study on tinnitus in an HLAA webinar. The recent study concluded that “stress” is the difference between mild and significant or debilitating tinnitus.
Proper Diagnosis is Key
As most hearing care professionals know, the patient should always get a tinnitus diagnosis before treatment is started.
“Patients with or suspected of having tinnitus or related problems should be seen by a medical professional–an otolaryngologist specializing in ear and hearing problems (rather than one whose primary interest is nasal surgery, for example) and/or an audiologist,” says Maurice H. Miller, PhD, Professor Emeritus of Audiology at NYU Steinhardt School of Culture, Education and Human Development. Dr Miller has served four decades as Chief Audiological Consultant, NYC Department of Health.
In general, there are two types of tinnitus:
- Objective Tinnitus (1-3%). This type can often be fixed! (eg, by treating a punctured ear drum, or managing ear wax). It has a physical source. The ENT may offer medicine or surgery—whatever is appropriate.
- Subjective Tinnitus (97%). Generally, this type cannot be fixed. But it is not likely to cause any physical damage and can be managed 90% of the time!
You really can’t tell which kind the patient has unless he or she undergoes a professional evaluation. “No two people perceive tinnitus the same way…our perception of sound is a unique individual experience,” stated Douglas L. Beck, AuD, in the recent HLAA webinar on diagnosing and managing tinnitus patients. You’ll need to obtain a complete medical history and audiology evaluation of the patient. This may include coordinating care among several health professionals.
Tinnitus Treatment Tools
After ruling out any underlying medical condition, consider these two primary tinnitus treatments (or tools):
1) Hearing Aids (effective in masking tinnitus), and
2) Cognitive Behavioral Therapy (retraining the brain to perceive sounds without being disturbed by them).
Research shows that most tinnitus patients respond well to “well-fitted hearing aids.” When they work with a coordinated care team comprised of psychologists (for CBT and other therapies), physicians and audiologists, the treatment tends to be more effective.
The #1 treatment for tinnitus appears to be hearing aids, according to David Baguley, PhD. He has published more than 150 peer-reviewed publications, and is co-author of Tinnitus: A Multidisciplinary Approach, Second Edition.
“Hearing aids are an enormous help for most tinnitus patients, most of the time, even when their hearing loss is mild,” says Dr Baguley. But Baguley is careful to point out that tinnitus poses challenges for the healthcare provider. “Although there are no shortages of success stories for the tinnitus patient using hearing aid amplification, as a profession we haven’t been very good at documenting the specific details as to how to select the best candidates, which approaches work best, which tools are best for which patient, and so on.”
A study reported in The Hearing Review showed that:
- 28% of patients report moderate relief of tinnitus when using hearing aids;
- 66% of hearing aid users reported tinnitus relief most of the time with hearing aids, and
- 29% of hearing aid users said their tinnitus was relieved all of the time with hearing aids.
Other research supports that hearing aids gave “significant benefit with regard to reducing the effects of tinnitus, but importantly, there were no statistical differences in the outcomes based on the instrument selected—with or without a masker.” (Henry, Frederick, et al). Dr. Grant Searchfield, Head of Audiology at the University of Auckland — who himself has done significant research in tinnitus — commented that this and other studies show that about 87% of tinnitus patients treated with hearing aids have reported reductions in their tinnitus symptoms using either type of device—clearly a remarkable outcome!
Sound therapy is another useful treatment for tinnitus, according to studies in peer-reviewed literature on the subject. Sound therapy introduces other noises to try to “drown out” the tinnitus and let the patient “habituate” to their symptoms.
Sound therapy may also come in the form of hearing aid amplification and other products that make background sounds louder to lessen the difference noticed between background noise and the tinnitus noise.
- When sound therapy is combined with education or counseling, it has been shown to be superior to other treatments.
- Sound therapy without counseling is less effective than sound therapy combined with counseling.
Sound Therapy Tips
If sound therapy treatment is used, then check that the devices recommended are reliable, flexible, and easy to use. Other considerations include:
- Rain, ocean, air and water sounds – these are the most popular
- Following an exact protocol – this should be determined by the professional
- Personal motivation matters!
Another thing to keep in mind is that everyone’s brain perceives tinnitus differently. Further, “brains are plastic and they change and adapt over time.” This means that a patient may need new sounds as treatment progresses to maintain good management of tinnitus (and to keep things interesting)! This is called a “progressive strategy,” and it means that preferences and needs for a tinnitus patient may change over time. Make sure the patient is made aware at the outset of treatment that the therapy may need to be adjusted over time.
Sound therapy options, such as SoundCure® Serenade® – are clinically safe and found to be effective (ie, sound therapy is natural – no pills, surgery, or drugs). This includes a handheld device, which is programmed much like a hearing aid. The SoundCure Serenade device has four tones (2 customable S-Tones, 1 narrowband, and 1 broadband sound).
HaRT™ (Habituation Retraining Therapy) – this includes tinnitus education and guidance, use of sound therapy and personal treatment by an audiologist with experience in tinnitus care and relief.
Tinnitus Sound Therapy Apps – There are many popular sound therapy apps available, such as:
Relax – an app from Starkey Hearing Technologies (works with iOS and Android to give those who use it a dozen unique relief sounds, along with guidance on how to manage the symptoms. This app can be used together with other treatments your patients are using, such as: Hearing aids – the ambient sounds can be amplified to cover tinnitus; Sound Therapy – use the Relax app with patients’ sound therapy program to decrease loudness of tinnitus
Tinnitus Balance – an app from Phonak (works with iOS 7.0 or later and is compatible with iPhone, iPad and iPod touch). It offers 3 different “situations” and four soothing sounds, like campfire or rain.
ReSound Relief™ – a multisensory app that helps educate people who are experiencing tinnitus. It provides personalized sound therapy options.
Apps to help improve sleep – Other well-known sound therapy apps are Relax Melodies®, My Noise®, and SleepStream®.
Approaches to Sound Therapy
- There is not a specific “one-size-fits-all” approach to sound therapy. With so many options, how can you select the best ones for your patients?
- Make a list of sounds that the patient enjoys and finds comforting, and another one with sounds he or she thinks are annoying and uncomfortable.
- Note any situations in which the patient finds their tinnitus to be more bothersome. From there, you can begin choosing sounds that work best for your patient.
- Include music libraries on a smartphone or tablet as part of the sound therapy protocol.
- “Sound pillow” – this system generates sound through a connected smartphone or MP3 player and can be useful for those with sleep issues.
Knowing Which Tinnitus Treatments to Trust
How do you help patients filter out the “snake oil,” “lipo lie” or “smoke and mirrors” miracle cures for tinnitus that con artists are pushing? Where should your patients turn and how do they know which treatments are legit?
Consider the Tinnitus Network. In September 2016, Tinnitus Treatment Solutions (TTS) and Fuel Medical collaborated to form Tinnitus Network to offer professional tinnitus care and advanced tinnitus devices. TTS, a telehealth tinnitus care provider, has a large network of partnerships with more than 4,500 sites nationwide. Fuel Medical is a practice management resource company with over 1,000 affiliated member network sites.
- TTS offers Habituation Retraining Therapy (HaRT™) that focuses on tinnitus counseling and education, the proper use of sound therapy for long-term relief, and regular interaction with an audiologist to guide the process.
- TTS works with tinnitus hearing aid technologies from Oticon, Siemens, Widex, Starkey, ReSound, and Phonak.
- Fuel Network clinics offer in-person care, which could include diagnosis and evaluation for conditions underlying tinnitus, and amplification care for tinnitus patients with hearing loss.
The Final Analysis
A “universal” solution is highly unlikely to help each patient bothered by tinnitus. There are many factors at play in tinnitus, including how their brains and nervous systems are affected, and no two individuals experience it in the same way. Many factors must be weighed as hearing health professionals develop a customized solution for each unique individual who suffers with tinnitus. As you meet with tinnitus patients, remember that most of them have probably searched nearly everywhere for a cure. You can offer them hope and solutions that can work best for them.
- Hearing aids are the primary treatment for managing tinnitus. When used together with counseling, aids help manage tinnitus 50% – 90% of the time.
- Advanced hearing aids have alternatives that were not available until recently – these include connectivity, extended bandwidth, and other features that can be tailored for those with tinnitus.
- Counseling (with CBT) can be quite effective when used with hearing aids.
- And sound therapy, in its many forms, is a viable solution for many patients!
- Many apps are now available for tinnitus patients, and many more apps or add-on features to other devices are on the way.
With advances in evaluation, treatment and technology, there are many resources available to care providers, and there is hope for managing tinnitus successfully.