Tinnitus is the perception of a ringing or buzzing noise in one or both ears. It may come and go or be a permanent condition. Its causes are usually neurological, and it tends to affect “neurologically sensitive” folks, who are more artistic and introspective and may also be prone to migraines. If you experience tinnitus, the first step is to see an ear, nose and throat doctor to rule out a serious underlying condition (although this is rarely the case). For some people, adjusting to tinnitus is relatively easy, but for others it is an extremely difficult process. If you are in the latter group, there are several pieces of sound advice, ways of coping, and tricks to easing the process of habituation.
During the daytime it is helpful to have some background music or ambient sound playing so that you are less tempted to zero in on the tinnitus. The sound should be something that is enjoyable and relaxing but doesn’t completely block out (or mask) the sound of the tinnitus. Although it is tempting to do complete masking, this prevents the process of habituation, wherein you gradually get used to the sound over time until it is no longer bothersome. Many people find that classical music or nature sounds, like waves or rain, are particularly helpful. If wearing an iPod or playing music through speakers is not an option at work, there are tinnitus instruments that play sound directly into your ears and fit right into your ear like a hearing aid. In fact, they can be combined with a hearing aid if hearing loss is also an issue.
Sound therapy is especially important at night since dead quiet makes tinnitus seem louder, and it can interfere with sleep. SleepPhones are like a winter headband with flat speakers that go over the ears, allowing for comfortable sleep while listening to an iPod or similar device. Pillow speakers serve the same function, but their drawback is that you can only have sound in one ear at a time unless the volume is cranked up very high, and the volume changes as you shift position. Since getting enough rest is so important for tinnitus sufferers, the rule of avoiding masking is less strict at night, and allows for masking on occasions when the ringing is too loud or distracting to sleep. The Tinnitus Help app, available on iTunes, lets you customize background noises for masking. Note: do not use the option in this app that plays a constant tone that perfectly mimics the tinnitus, as this could potentially make it worse. Ideally, over time as you habituate, sound therapy becomes less necessary.
If your tinnitus is related to hearing loss, a hearing aid will likely be beneficial for quieting the sound at least partially. This is because tinnitus is a bit like phantom limb syndrome, where the nerves that were formerly occupied by processing sounds are left with nothing to do, and sometimes begin to generate the perception of sound on their own.
Find meaning and don’t quit your day job
One of the most important, yet commonly overlooked, pieces of advice is to make your world bigger, not smaller. If you are tempted to quit your job because of tinnitus, don’t. The more you withdraw from normal daily routines and ruminate, the worse you will feel. Continue with hobbies, keep socializing, and find what gives you meaning. If you don’t have enough of these things in your life, perhaps think of tinnitus as the motivation needed to push yourself to get out there and try new things.
Although anxiety and depression are usually not the original cause of tinnitus, they certainly perpetuate it and affect your resilience. The good news is that if you have these conditions, treating underlying anxiety and depression can help enormously to let you habituate or, in some cases, resolve the tinnitus completely. Be sure to manage stress with regular exercise, good nutrition, mindfulness, and cognitive behavioral therapy or potentially antidepressants if needed.
Medications and supplements
Most of the medications recommended for tinnitus are medications that also treat anxiety or depression, such as SSRIs and Neurontin. Starting a new antidepressant can initially cause tinnitus to flare up. If this happens, increase the dose only gradually and take comfort in the fact that the volume will go back down after a couple of weeks. There is not much evidence to support the effectiveness of supplements, but melatonin at night helps with sleep, which indirectly helps with tinnitus. Magnesium and B vitamins are a safe way to start, and may be effective for some people.
For some people, TMJ is contributing factor to tinnitus. Tightness in the temporal muscles on the side of the head can push on nerves, activating the perception of a ringing sound. If you have tightness in your jaw and head muscles, you are a good candidate for getting relief from TMJ physical therapy, craniosacral therapy, or a bite splint (especially if tinnitus gets louder when taking a bite or lying down). Be mindful of clenching your teeth as this tends to cause tightening of the temporalis. A bite splint is used to prevent clenching during the night, when it’s not possible to control jaw position consciously.
The list above covers what to do; here is the much shorter list of what not to do. Do not take a high dose of NSAIDs for more than a couple of weeks. Also, avoid tonic water and prolonged exposure to loud noises. Avoid people promising a cure for a price or using scare tactics to get you to buy their products. Tempting as it may be, don’t spend too much time reading about tinnitus on the internet, or joining support groups or message boards for sufferers; spending time around people going down the rabbit hole of tinnitus panic, likely armed with misinformation from the message boards, is more harmful than empowering. One of the most important ways to put tinnitus in perspective is through managing your state of mind. Tinnitus is not dangerous. Think of it as a sound rather than a noise – words matter! Most importantly, take solace in the fact that you are not alone, and you can get through it.