Understanding Tinnitus Solutions, from Recent Sufferer Who Is a Techwriter
… who hates vague, non-committal blather. This article …
- … is NOT about tinnitus caused by a specific health event/problem/disease/disorder. This is generally called ‘somatic’ tinnitus. For that you see a doctor and attempt to fix the causative problem. I am not a doctor. After the problem is fixed you might still have tinnitus symptoms, in which case read on.
- … IS about the overwhelming majority of people who have tinnitus from some reduction of their hearing, and are frustrated by the information available on solutions. I am now calling this ‘common tinnitus,’ and ask the world to follow my lead.
Summary of Solutions: 1) Sound Therapy, 2) Hearing Aids, 3) Psychology
First, no one talks of ‘cure,’ and I accept that, just as I’ve learned with chronic overuse syndromes like repetitive strain. That’s fine; any sufferer would be fine with ‘reduction/relief/mitigation/management.’ But note that all of those are different than ‘coping skills’… to me at least.
Here’s what the world has to offer — just 3 things — after scanning several scholarly articles and websites, and watching a lot of very good — seriously — YouTube videos:
- Sound therapy. They have several wishy-washy ways to label and sell this to you (habituation, masking, retraining, conditioning), but it all amounts to listening to sounds that you find relieving. Every detail of how you do this (timing, duration, volume, types of sound) is vague, various, unsubstantiated, and subjective. Sorry, despite some claims of “evidence basis” in some articles, I’m not buying it because I see that, for instance, they ultimately boil down to patients’ subjective answers to surveys. I firmly believe in sound therapy, but I don’t have the slightest evidence of any lasting or long-term benefit. I’m just hopeful because it makes sense as follows: if tinnitus is, as widely believed, the brain’s (auditory cortex) reaction to some reduction in hearing, then replacing the lost frequencies with ambient noise that mimics your own tinnitus sounds makes sense to possibly get the brain to stop reacting that way. Basically, that’s all we’ve got anyway so I’ll keep trying it. And it feels good.
- Hearing aids. I’ll let the research world convince you whether this is genuinely supported by ‘evidence’ — I haven’t actually scoured the data for that specific matter — but it simply makes sense. Some people on social media comment that hearing aids make their tinnitus worse, and I don’t deny their situation at all, but that’s not an excuse for others.
- Psychological techniques. Everyone’s favorite topic. They’ve got several names for this and no shortage of articles claiming evidence basis that it helps a lot of people. You’ll see …
- mindfulness,
- distraction,
- counseling,
- retraining,
- relaxation therapy,
- cognitive behavioral therapy (CBT=controlling your willful reaction),
- tinnitus retraining (TRT=sound therapy, CBT, and mindfulness),
- progressive tinnitus management (PTM- lots of the above),
and others. But to me, they all claim to address NOT the auditory cortex’s reaction to the reduced functionality of the ear, but the conscious/cognitive brain’s reaction, in turn, to the auditory cortex’s freakout. Again I can draw a parallel to my long experience with repetitive strain injuries: many people get locked in a soul-crushing feedback loop between the original condition (constant sound) and the anxiety that it causes. The anxiety causes lost sleep, which in turn causes exhaustion, and then worsens the symptoms or maybe just reduces our ability to counteract the disorder… such as the recuperative aspects of sleep. For people who have reached such a point, any and all psychological help can be wonderful and necessary.
But for me, and I suspect, for many who have moderate tinnitus and have not become exhausted (yet?), I find the presumptive over-emphasis on this insulting. In fact, I’ve finally put my finger on what upsets me about it. Let’s use an analogy (and remember, no analogy is perfect, otherwise it wouldn’t be an analogy): let’s say you showed up at the doctor’s office with a badly broken arm. Would the doctor say “Yeh, that armbone sure is sticking through your skin, but your reaction to it is really over the top, so we better order us some o’ that good old fashioned behavioral therapy.” CBT is fine… but only after a patient has been observed to be suffering from the mental side of a malady. To presume that a tinnitus patient needs psychological help sort of plays right into the offensive logic that “it’s all in your head.” Go CBT yourself.
What About Stress As a Cause and Solution?
A gray area is the general notion of stress as a cause, and therefore the elimination of stress, as a clear and distinct cure. I suppose for some people stress is a tinnitus activator and therefore reducing your stress is either a management technique or outright cure. As an autobiographical case study, I don’t personally have one damn thing to be stressed-out about so I can’t relate to this as a factor, let alone seeing stress reduction as a cure. But I can offer you this argument against stress-reduction as a cure: if it were as simple as stress, we’d all be reading a LOT of great, concise, on-off stories of eliminating — almost curing — tinnitus. But we don’t.
That’s it. There apparently are no medicines and no supplements. And despite all the talk about caffeine and alcohol (and stress, too), a foundational research article seems to debunk all these sorts of things.
The Sources from Which these Conclusions Were Reached
- “Recent Updates on Tinnitus Management”
Journal of Audiology and Otology, 2023 Oct;27(4):181–192.
https://pubmed.ncbi.nlm.nih.gov/37872753/
PDF: https://pmc.ncbi.nlm.nih.gov/articles/PMC10603282/pdf/jao-2023-00416.pdf
I’m putting this scientific article first because it debunks some of the vague “blame the patient” stuff like caffeine. It’s a scientific article, and my favorite type, called a “review” or “systematic review,” which looks back through the previous scientific articles and summarizes the body of knowledge… with the benefit of hindsight and preponderance of findings. It’s like hiring a scientific crew to find the best answers. Two excerpts:
1) MYTH: “Caffeine makes tinnitus worse.” … a clinical trial found that caffeine had no effect on tinnitus severity.
2) MYTH: “Tinnitus will get worse over time.” … In general, the severity of tinnitus decreases over time. - WebMD???
Yes, you will learn a lot about tinnitus, but — if I am right — you will simultaneously end up feeling like you’ve learned nothing. In other words, it will list everything known to mankind about tinnitus but won’t give any weighting or insight to the most common situation or what to do. So sound therapy and psychological methods will be mentioned, but as if every piece of information is put in a blender and spread out evenly over a long web page like so much beige paint. Read WebMD and the like, but only to know what they DON’T know. So I’m not even giving a link. - Awesome 8-Minute Med Students’ Video on Tinnitus Causes
https://youtu.be/NjvUXns5irg?si=s2tl0KDhfYsNSABQ
Really concise presentation entirely of diagrams and whiteboard text. Diagrams are the highest level of techwriting because they take the most work from the author. Contrast that with “talking head” video which can be nice, but takes much less authoring work.
Highlights: At 04:00, the author explains his “tip” that he thinks of tinnitus as the ear trying to turn up the volume for sounds it is losing the ability to sense. Note that most of the literature tells us that the ‘turning up’ is in the auditory cortex, not the ear, but that discrepancy is minor. I think the author is being too careful, and it’s not just his tip, but the genuine explanation. It makes sense that the only thing the brain does after receiving a signal from the ear is control amplification… exactly how much to bother our conscious brain with each signal or portion thereof. - 53-Slide PPT (as a web page PDF) from a famous Tinnitus Researcher/Clinician
https://img1.wsimg.com/blobby/go/737b9c76-10e2-4266-8c9b-9ad790c48367/downloads/Tinnitus%20is%20Priimary%20Care%20Audiology.pdf?ver=1709837537552
There are no notes, just slides, but if you’re a serious reader, you can get the full picture (good and bad) on how the clinical leaders tell their peers about tinnitus. You’ll see a strong emphasis on psychology, even the placebo effect.
Some highlights: Slide 6, percentiles of specific tinnitus sounds such as ringing, crickets, and high-pitched tone. - 84-Page (!) Dissertation on “Progressive Tinnitus Management” (PTM) from the Veterans Administration Employee Education System.
https://pueblo.gpo.gov/DOD/pdfs/HCE-850.pdf
Picture how seriously the VA must take tinnitus, with millions of soldiers exposed to gunshots. I’m not suggesting you read 84 pages, but I found the keys of therapy in just a few pages: starting at “PDF page” 76, which is “publication page” 60 (the page numbers shown in the document) in the topic “Three Types of Sound,” you’ll find the only concrete information on actual use of sound. By page 65 it moves into the psychological (CBT) stuff, so you can see how little is really known about sound therapy… but that’s all we have.
Other highlights:
Page 60, the three types of sound are background, interesting (distracts), and soothing.
Page 61, the notion of the mixing point is introduced: “patients are instructed to adjust the level of the broadband noise to below the “mixing point,” that is, below the level at which their tinnitus sound starts to change” - Youtuber-Audiologist: Treble Health’s 18-Minute Summary, including sound therapy (and general recommendations)
https://youtu.be/msiv4AbZk8A?si=Wyw_fpYDRO6eZphU
Treble Health is a full Youtube channel from an audiologist who sells his own group’s counseling sessions and some sound devices from cheap to exorbitant. But his video content — and more importantly — the viewers’ comments, provide a great understanding of tinnitus… in the brave new world of Youtube as education. The particular video I’m linking to here is an honest, no-fluff summary of his entire advice to sufferers, from getting a hearing test to all the feel-good stuff. But in the middle is the stuff on sound therapy. Like others, he tries to make it sound like precise medicine, but if you’ve gotten this far, I’ve probably convinced you they all have no idea. Instead, it is simply helpful to listen to certain sounds, and maybe some day someone will prove exactly how and how much it helps in the long term (curative vs palliative). And his channel has a “soothing sounds” playlist that is my “go-to” set of sounds. Their “peaceful summer” is my favorite and playing right now. - “And finally we circle back to this article you are reading. You might consider it my own “review article” on the state of tinnitus solutions. So a synopsis of what I have found and what I still wonder about:
1. Sound therapy seems like the main tool, and I’m trying it. They try to parse it into sub-methods, but that’s all unproven. Learn your own methods. Below, I’ll spell out everything I’ve learned about ‘how,’ meaning dosage.
2. Psychology: The practitioners are so overwhelmed with the psychological damage that is seen in serious tinnitus patients that they can’t help themselves from talking up the stress reduction and mental side… and cloud the only message they have about physical medicine (short of hearing aids), namely sound therapy (above).
3. I’m curious why we don’t hear more about things like biofeedback and hypnosis.
Speculation on Dosage Information for Sound Therapy
The detailed dosage instructions for sound therapy are undefined. By dosage, I’m referring to 1) sound type, 2) sound frequency/s, 3) listening durations and days, 4) sound delivery device, and so on. In all my approximately 30 hours of tinnitus scrounging, I don’t think I saw the word ‘dosage’ once. When searching Google it appears a bit in topics on speech therapy. People who aren’t very good with words will tend to say things like, “The dosage is too individual to define.”
My non-doctor speculation on the sound therapy dosage (for the intended hope of reconditioning the auditory cortex to stop amplifying frequencies that have been reduced in one’s hearing), is as follows:…
SEE A HEALTH PROFESSIONAL.
A. SOUND PROFILE: One tries to find a sound that is BOTH enjoyable for you to listen to AND seems like it resembles your own tinnitus sound. I suspect that a tinnitus-specializing healthcare practitioner will do this step for you.
B. DELIVERY DEVICE: One listens to that sound (typically from a website/youtube or other download or stream) however is comfortable for you, whether on a television, phone, or headphones. I suspect that a tinnitus-specializing healthcare practitioner will offer you a more expensive option (that resembles and/or includes a hearing aid) to play the sound. Potential advantages of this is that it can be programmed, and you can’t walk away from it, so the sound can be more frequent.
C. ‘PLAYING’ DURATION: I suspect that no one has the slightest idea what the “medical evidence,” convincingly tells us about duration, so I’ll guess at this as the dosage duration: listen to your sound from 1–4 hours per day. I’m thinking that less than an hour isn’t much of a brainwashing; and anything over 4 hours constitutes the risk of having too much of a good thing. However, Treble Health’s practitioner, in a comment on one of his YouTubes, expresses the belief that there is little risk of overuse of sound therapy; interesting.
D: CALENDAR/COURSE-OF-THERAPY DURATION: Treble Health’s practitioner, in a comment on one of his YouTubes, speculates that one year might be some sort of yardstick. Some patients report success in 4–6 months; others 18 months.
E: ‘PLAYING’ VOLUME: I like that idea of the “mixing point,” from page 61 of the PTM document above. So, one listens to the sound at a volume slightly lower than the point at which you can’t tell which one is which, loudness-wise. Alternatively you might set the volume to the lowest volume at which you can comfortably hear it… which is what you’ll be forced to do anyway, if your playing sound never matches your tinnitus sound much. But again, no one has the slightest idea what the “medical evidence,” convincingly tells us about playing volume.
My Personal Sound Therapy Tools
- Using a noise generator app to determine and mimic your own tinnitus sound.
SEE A HEALTH PROFESSIONAL.
I use a free iPhone app called Noise Generator from TMSoft.
It has some minor usability imperfections but it’s free and they don’t get in the way for one’s own one-time use. (You can’t set the frequency overall in one slider… you have to set the low and high ranges separately. But after setting the high range, you can drag the low slider all the way to match it, in a single action.)
Step 1: To use it, I set the overall frequency until I start to be unable to hear it for one ear. You have to set a narrow range to get anything close to a single frequency. You might notice how your ear seems to rely on a range of frequencies when you get near your ‘blind spot.’ Save as a Preset, named for the ear side.
Step 2: Hold the phone speaker at the other ear and repeat. Maybe each ear has different blind spots. Save another preset.
Step 3: Experiment with the sound ‘colors’ described on the app’s home webpage, again to mimic your internal tinnitus sound.
Step 4: Experiment setting a range that has a low value at one ear’s blind spot, and a high value at the other ear’s blind spot. Save a new preset.
Step 5: Experiment setting the volume up and down slowly until you can’t tell if you’re hearing your own tinnitus or the Noise Generator. Some research calls that the mixing point. Resave the preset.
Step 6: Consider listening to your generator sound — not on headphones — at low volumes, just below the mixing point, in the hope that your brain will eventually start being satisfied with the external sound and stop supplying its own. Hey, it’s as good a theory as all the so-called ‘evidence.’
Step 7: Find a school where you can get a degree in audiology.
Step 8: Write a scholarly article with your ‘evidence.’ Submit it to Nature or Science, maybe. - Play sounds from http://www.youtube.com/@dalesnale
Started using this more recently than TrebleHealth both are good. More of a personal vibe from a sound engineer under his own label. Maybe he does the TH sounds??? I never looked for a credited name. After determining that one of my ears might top out at 8kHz and the other at 10kHz, I’m listening to his track that mixes 8, 10, and 13 kHz, entitled Tinnitus Interrupter. - Play sounds from TrebleHealth Same idea, lots of long tracks with different styles: rain, crickets, static.
Good luck.