Tinnitus is an auditory perception, not produced by external sound, and commonly described as hissing, ringing or buzzing. It can be heard in one ear, both ears or in the head. It can begin suddenly or gradually and can be constant, pulsed or intermittent. Often referred to as “ringing in the ears”, tinnitus affects an estimated 50 million Americans. While the exact cause is unknown, one of the prominent theories is that there is excessive neural activity in the auditory system which the patient perceives as sound. Any factor that can cause hearing loss is also a likely source for causing tinnitus, including but not limited to, exposure to loud sounds, head injury, disorders of the ear and the natural part of the aging process. Additionally, certain medications and jaw/neck disorders (ex: TMJD) are also considered to be causes of tinnitus.
Hyperacusis is a reduction of normal tolerance for everyday sounds. The ear perceives an abnormal increase in the sensation of loudness for signals of normal volume. A person with severe hyperacusis has difficulty tolerating everyday sounds, i.e. dishes, silverware, laughter, etc. which are not uncomfortably loud to others.
When Tinnitus or Hyperacusis first begins, most people are concerned and seek information as to the cause. They worry about whether it is a sign of something “bad” which causes significant distress. Discovering there is no “cure” can make the initial reaction worse. Curious and concerned patients come to our clinic to get detailed information and strategies for reducing the impact of their tinnitus. Patients who are very bothered by their tinnitus require further treatment to reduce the stress and improve their coping abilities. Everyone’s tinnitus is unique and we all have different circumstances which affect the impact the tinnitus can have on our lives, thoughts, emotions, hearing, sleep, and concentration.
Tinnitus Evaluation and Treatment
Goals of the Tinnitus Program at the Hearing and Speech Center
An audiologist specializing in tinnitus will work with a patient, using a comprehensive and integrative approach to establish an appropriate and customized treatment plan.
Our goals include:
- Resolve outstanding medical issues
- Protect residual hearing
- Provide realistic expectations
- Facilitate habituation using a combination of sound therapy and counseling/education
- Reinforce changed perception of tinnitus
An audiologist who specializes in the area of tinnitus will conduct a comprehensive evaluation that can often take 3-4 hours. Each person who comes to the Center will be sent a tinnitus packet to fill out prior to their evaluation which documents the history and impact of their tinnitus. The tinnitus packet also contains several scales to assess the severity and handicap tinnitus is having on one’s life.
The tinnitus evaluation starts with an in depth interview followed by a comprehensive audiologic evaluation which includes standard pure tone audiometry as well as ultra-high frequency audiometry up to 14kHz ( not usually completed for regular hearing tests) . Speech testing includes speech reception thresholds, word recognition scores, MCL, UCL and also ANL (acceptable noise levels). Otoacoustic emission testing is also conducted which evaluates the presence and function of outer hair cells in the cochlea. Tinnitus studies include pitch and loudness matching, masking studies, LDLs (loudness discomfort levels) and tests for residual inhibition.
The hyperacusis evaluation includes some of the same tests depending on the loudness discomfort levels (LDLs) of the individual.
Following completion of the evaluation, the audiologist will review the findings with you and discuss the variety of treatment and therapy options available for management of tinnitus and/or hyperacusis. Below is a list of sound therapy options and counseling services offered at our clinic.
- Cognitive-behavioral therapy (CBT)
- Tinnitus Retraining Therapy (TRT)
- Sound Desensitization Therapy (for Hyperacusis)
Acoustic (Sound) Therapies
- Amplification/hearing aids
- Combination instruments
- Sound Generators
- Serenade by Sound Cure
- Custom Musician’s Plugs
- Biofeedback therapy
- Guided imagery
- Progressive muscle relaxation
Additional Treatment Options
Below is a list of additional treatment/management options. These are not currently offered at our clinic, but are often discussed during the tinnitus evaluation and the audiologist can make appropriate referrals if needed.
- Sleep Aids
- Anti-anxiety medication
- Anti-depression medication
- Repetitive Transcranial magnetic stimulation
- Cochlear Implants
- Oxygen Therapy
- Laser Therapy
- Nutritional/Dietary changes
- Craniosacral/chiropractic manipulation
- Mindfulness Based Therapy
- Davis, P. Living with Tinnitus. Rushcutters Bay, N.S. W.: Gore & Osment; 1995
- Hallam R.S. (1989), Living with tinnitus: Dealing with the ringing in your ears. Wellingborough, Northamptionshire, Thorsons; 1989
- Henry JL, Wilson PH. Tinnitus: A self-management guide for the ringing in your ears. Boston: Allyn & Bacon; 2002
- Tyler RS. The Consumer Handbook on Tinnitus. Auricle Ink Publishers., Sedona, 2008
- Henry J, Zaugg T, Myers, P, Kendall, C., How to Manage Your Tinnitus: A Step-by-Step Workbook
- American Tinnitus Association
- The Hyperacusis Network
- Dangerous Decibels
- Tinnitus Research Initiative
Tinnitus Support Group
What Is Biofeedback?
Biofeedback is a therapy technique which makes unconscious or involuntary bodily processes (ex: heart rate, breathing, body temperature, muscle tension, etc.) perceptible to an individual and reinforces that information (using audio or visual equipment) in order to manipulate them and self-regulate them by conscious mental control. This group of therapeutic procedures offers a non-pharmacological treatment approach and has been used for many years to treat a variety of symptoms and disorders.
How Does Biofeedback Therapy Work?
Using a combination of therapeutic skills and instrumentation (equipment), biofeedback therapists initially teach a patient to monitor and control an external signal during therapy sessions and eventually the patient is able to self-regulate using internal sensations and cues, also known as, “sensory memory”.
Success in biofeedback requires patient motivation and compliance so that generalization of skills learned during training sessions can be applied to everyday life and maintained over time to facilitate homeostasis.
What Can Be Treated with Biofeedback?
- Migraine and Tension (stress) Headache
- Chronic Pain
- TMJ/Bruxism (Dental Disorders)
- Stress Reduction
- Muscle Spasms
- Raynaud’s Syndrome
- Post-Traumatic Stress Syndrome
Biofeedback Evaluation and Treatment
At the initial evaluation, the therapist will complete a comprehensive psychophysiological profile to determine the possible success of biofeedback intervention. Several modalities will be measured and recorded to determine which bodily processes offer the most useful physiological information for training purposes. Modalities may include: heart rate, breathing, body temperature, muscle tension, skin conductance (sweating), and blood volume pulse. Results from the initial evaluation are used to establish a treatment plan.
Treatment sessions involve the therapist (trainer) teaching the patient (trainee) different techniques to gain control over physiological processes that are otherwise thought to be involuntary. Sophisticated audio/visual equipment is used to measure, process, and feedback activity to the patient, reinforcing self-regulation of the monitored modality.
Significant results are generally seen after 5-10 training sessions, depending on the disorder/symptom that is being treated. Patients are given exercises to complete at home to facilitate generalization of skills learned in the clinic.
The Use of Biofeedback Therapy for Tinnitus and/or Hyperacusis
Individuals with severe buzzing or ringing sounds in the ear(s), who seek treatment or are disabled by their tinnitus often have comorbid psychological disorders such as depression and anxiety. Severe tinnitus is also characterized by sleep disturbances, increased levels of stress and fear, and difficulties with communication and concentration.
Left untreated, the emotional, cognitive, and psychophysiological factors can have a negative effect and actually maintain tinnitus related distress. Tinnitus research suggests that hyper-reactivity in the autonomic nervous system can hinder the habituation process and result in long term maladjustment to tinnitus. In other words, the body remains in a chronic state of stress and is not able to facilitate habituation to the tinnitus, nor restore homeostasis in the body.
Research has found that tinnitus patients have increased heart rates and muscle tension. In addition, studies have found that tinnitus patients have elevated chronic cortisol (the “stress hormone”) levels –linking tinnitus and stress.
Biofeedback therapy is an evidence-based treatment.
Association of Applied Psychophysiology and Biofeedback www.aapb.org