Tinnitus management

Tinnitus is the name used to describe when we can hear a sound (or sounds) but, the sound you are hearing is not coming from the environment around you. The sound is not able to be heard by other people in that place/environment.

‘Tinnitus’ can describe many different sounds, including ringing, buzzing and humming. Sometimes sounds are heard like voices and music; this is less common.

Tinnitus can either come and go or be more continous. Some people experience a variety of sounds and sometimes experience more than one at one time.

The answer to the question ‘what causes tinnitus?’ is not fully understood. One suggestion is that tinnitus is a signal that we all have that it is usually not ‘heard’ or we are not aware of because the part of the brain that is responsible for hearing it automatically filters it out because it knows what it is.

Tinnitus is not a disease and is not something that you can ‘catch’ or inherit genetically. One suggestion is that tinnitus is a sign that ‘something has changed’ in the body. This could be a change in hearing for example, or in some cases it can be a change in how we feel. This change in feeling can be an ‘emotional shock’, for example a bereavement, an accident or injury, or something more persistent, such as long-term anxiety, stress or depression.

It is thought that these changes, either to our hearing or to how we feel, cause the filters in the brain to stop working as they should. This then means that we become aware of the noise from the signal that had always been there, but was previously being filtered out.

Sometimes it happens that neither of these situations seems to be the cause and in this case it seems that there is an unknown cause for the filter to stop working correctly. Unfortunately, this is also something that is not yet fully understood.

Whatever is the reason why the tinnitus starts it is believed that the emotional impact that it causes is why we continue to hear it and focus on it.

This idea is demonstrated when we think about how there are many noises around us in the world all the time that we automatically filter out. If someone lives next to a busy road and if the traffic noise isn’t bothering them, they will eventually get out of the habit of paying attention to the sound of the cars and their awareness of the noise will drop. But if the noise of the traffic is really annoying them, the emotional upset and impact that the car noise causes, will keep them focused on the traffic noise. And as a result, their awareness of it will never drop away. This is the same with the tinnitus, as the annoyance and upset that it causes is the thing that keeps us focused on it and makes us continue to be aware of it.

Tinnitus is a very common symptom. About 30% of people will experience tinnitus at some point in their life, and about 10% of people will live with persistent tinnitus.

For the majority of people, tinnitus is more of a minor annoyance than a major problem. For some people, only certain environments are a problem, such as quiet rooms and when lying in bed at night. A small number of people with tinnitus will find that they have much bigger problems though. For these people the tinnitus will seem to severely disrupt their normal life and more direct help is needed.

Tinnitus is more common in people with a hearing loss, but people with normal hearing levels can also experience tinnitus.

The overall message to take from this is that although many people with tinnitus often feel that no-one understands what they are going through, you are not alone.

Tinnitus awareness is linked to tinnitus distress. How much someone is troubled, upset or annoyed by the tinnitus, is what determines whether or not someone pays attention to the tinnitus and whether or not they remain actively aware of it. Tinnitus management does not aim to ‘fix’ or ‘cure’ or ‘turn off’ the tinnitus. It aims to look at putting strategies and tactics in place to help you to be affected less by the tinnitus in the situations that you individually find difficult.

For most people tinnitus generally improves over time as they put strategies in place to help the tinnitus to be managed better and cause less of a reaction emotionally.

The choice of ‘what is best’ for tinnitus management strategies, is something that is person specific. The options chosen depend on what situations someone is struggling with, as well as what they individually find to be useful. The management strategies should not be seen as ways to ‘fix’ tinnitus though. Instead, they should be thought of as options that people often find useful in helping them to be less affected by their tinnitus. Over time, these tactics then allow people to pay attention to their tinnitus less and as a result break down the cycle of awareness that has developed.

The following sections of information will look at some individual management options that are often found to be helpful with tinnitus. The British Tinnitus Association is the main UK charity that focuses on tinnitus and helping those who suffer from it. The information on their website is exceptionally well sourced and is provided by experts in the research field. Although there is often a fine line between helpful self-research and unhelpful self-diagnosis, the British Tinnitus Association website and the resources it contains are the recommended sources of information if you do wish to read some information on tinnitus.

No matter which management tactics someone chooses to try, the process of learning to manage tinnitus should always begin with ‘tinnitus support’. This is a discussion of the specific problems that they are having and of the particular situations that they are struggling with. It should also include some information on what is known about tinnitus and should try to help them to put their individual problems in context with this. This discussion also helps to deal with any concerns and worries that someone may have about their tinnitus. Discussing any unhelpful information or management strategies that someone has come across is often a very useful thing to do.

One commonly used tinnitus management strategy is sound therapy, which is also sometimes known as sound enrichment. It can be used in different situations and in different ways, but the main idea of it is to help to make the tinnitus less of a problem in quiet places in the day and in bed at night.

Sound therapy works by choosing a sound that is not annoying and not distracting in itself and playing it quietly into the room/environment around you. Different people will use different sounds to help them and the sounds that people choose vary greatly and include sounds like ocean noise, rain noise, birds tweeting, distant traffic and the noise of a desk fan. There are many others to choose from though and these types of noises can be found easily through free apps for mobile phones or tablets, through YouTube videos, CDs, MP3 files and desk-top noise generators.

Having a noise playing into the room in this way often helps people to be distracted from the tinnitus and less bothered by it. Using this over time can then help them to focus on the tinnitus less in the long-term and help them to be generally less aware of the tinnitus in that place or situation.

A useful analogy in describing how sound therapy works is one of a candle in a darkened room. If the room is dark, the candlelight is prominent and noticeable. However, if the room light is turned on, the candle is now light in light and as a result is much less prominent and noticeable. It is the same with tinnitus and the sounds in the surrounding room/environment. If the room is quiet, then the tinnitus is noise in relative quiet and therefore prominent. The opposite is true if some sound is added to the environment through using sound therapy.

Sound therapy can be used in different ways to help in different situations. The simplest way to use sound therapy is to have the sound that you have chosen playing into the room around you through a speaker or pillow speaker. This is often useful for help with falling asleep at night and in quiet situations in the day, for example if someone is struggling to concentrate when reading. When it is used to help with sleep at night, the sound therapy should be set playing when you go to bed to help with falling asleep, but then left playing all night. This will help make the tinnitus less of a problem if you wake up in the night and/or when you first wake up in the morning. The volume of the sound therapy noise should also not be set too loud. The ideal way to use sound therapy in all situations, is to set the noise to a loudness that distracts from the tinnitus as discussed earlier, but doesn’t completely cover up the tinnitus noise. Remember, the aim of the sound therapy is to help you to focus less on the tinnitus noise: you can’t get out of the habit of paying attention to a noise that you can’t hear.

Another way to use sound therapy is for sound to be delivered through noise generators worn in the ears, rather than through a speaker in the room. This method may be useful when someone is particularly struggling with their tinnitus in a quiet situation and needs extra help. It is also useful in situations where it is not socially acceptable to use sound from a speaker, such as at work in the office, in a meeting, in a lecture/classroom or in a library. There are also some noise generators that can be worn in bed at night. If this is something that you think may be useful to you, please mention it to your audiologist.

One final way of using sound therapy is through the use of a hearing aid. For someone with a hearing loss, the sounds in the room around them are quieter than they should be. This is especially noticeable when they are in a quiet room and this makes the tinnitus seem more prominent. By improving this situation with a hearing aid (where appropriate), someone may find that they notice their tinnitus less, as well as noticing an improvement with their hearing. Please speak to your audiologist if you think this option may apply to you. There is a fact sheet about Sound Therapy (Enrichment) available via the British Tinnitus Association website. 

Relaxation exercises are another frequently used tactic for people struggling with tinnitus. There are many situations where tinnitus can cause someone to have a strong emotional and physical reaction, such as anxiety or stress. This can also work the other way around though, as people will often comment that they notice their tinnitus more when they are feeling stressed or anxious about other things. 

When someone is stressed or anxious, the physical reaction in their body causes various body systems (including the part of the brain responsible for hearing), to become more sensitive than they would normally be. The result of this is that the tinnitus will potentially seem more intrusive and troublesome.

Relaxation exercises are usually recorded exercises that can be found in many mobile phone apps and YouTube videos, as well as in CD and other formats. The exercises are usually made up of a combination of controlled breathing and muscle relaxation exercises and are used to help to trigger the body to go back into a more relaxed state and reduce the intrusiveness of the tinnitus as a result. They are a skill to be learned and need to be practiced regularly to be most effective, but they are often considered to be a very useful tinnitus management tool.

Your audiologist in the tinnitus clinic can explain what is involved in relaxation exercises in more detail. There is also a fact sheet about Relaxation exercises and an online recorded exercise, which are available via the British Tinnitus Association website. 

Mindfulness is a meditation-based approach that has its origins in Eastern Buddhism. Over recent years it has been used very successfully across many fields of medicine and as part of various therapies. This includes being used in the management of tinnitus.

The basic technique in a mindfulness exercise is centred on someone focusing on the sound, rhythm and sensation of their breathing and using this to become more aware of the present moment in time. The aim to the meditations is for someone to ‘change their relationship’ with the tinnitus and to be more comfortable in its presence, instead of trying to actively ‘get rid of it’ or ‘push it away’. Looking at the tinnitus in a ‘non-judgemental’ way without feeling the need to change it can be an effective tool that can lead towards tinnitus acceptance. This can result in positive changes in how much someone struggles with their tinnitus.

There is a fact sheet about mindfulness and tinnitus available via the British Tinnitus Association website. There are also many classes and courses available on mindfulness that are publicly available for people to access.

Distraction techniques are simple tactics that someone can use to actively push their attention away from the tinnitus.

When used appropriately, distraction techniques can often be an effective tool to complement other management options, such as sound therapy or relaxation.

Distraction techniques can come in different forms and different people will find that they prefer some tactics to others. The following are three examples that could be used when lying in bed at night.

Repetitive tasks

Mental tasks similar to ‘counting sheep’ or some sort of ordering task, such as listing something in alphabetical order or counting down from a large number by a certain numerical amount. Essentially the aim is to find a repetitive task like this that can be done in your head. It is important that the task isn’t too interesting to you and doesn’t demand too much active thought as this will keep you awake. Tasks like this can take your attention away from the tinnitus though.

Imagery

This is when you close your eyes and imagine that you are in a specific place that you know well. This may be a favourite beach, park or other location. The aim of the exercise isn’t to simply imagine the place, it is for you to actively put yourself in that place. Bringing in your other senses as well is key to success in this technique. For example when imagining a beach, it is advisable to imagine that a hand is being dipped in the water and questions like,’ is it warm or cold?’, ‘is it clear or murky?’, ‘is it calm or stormy?’ be thought about. Drawing pictures in the sand with a finger and thinking about if the sand is coarse or soft, wet or dry, warm or cold. What is the weather like? Are there any people or animals around you? What can you hear, smell or taste? Exploring all these types of factors make the amount of concentration required more intensive and make distraction from the tinnitus easier.

Telling a story

Creating, telling and actively being a part of a story (made up or otherwise) and playing it through in your head. This is effective for some people, as it occupies them and distracts from the tinnitus awareness.

The following are some techniques that could be used in the day time to distract attention away from tinnitus:

Puzzles

For many people crosswords, Sudoku puzzles, word search puzzles etc, offer significant mental distraction and are sometimes quite effective for helping to manage tinnitus distress.

Colouring/sketching

Also considered to be distracting and relaxing by many. This is sometimes an effective distraction from tinnitus.

Crafting, wood working or modelling

This might include making something new or simply assembling a pre-made kit, but either way is a frequent source of distraction for many people.

Gardening

Frequently considered to be relaxing and distracting by many and it comes with the added benefits of being a source of exercise (which is generally good for health and well-being). Gardening is also an out-door activity, which means that the natural noises around you will serve as sound therapy. Gardening is also thought by some researchers to be good for our mental health.

Exercise

This may be going to a gym, going for a bike ride or a walk, it may be playing an organised sport or something such as climbing. There are many activities that provide physical exercise and they all add to health and well-being, which is always a positive not just for the body, but also for mental health. Exercise can therefore have positive effects on tinnitus for other reasons than simply being distracting.

There is a fact sheet about ‘Relaxation without sound’ available via the British Tinnitus Association website.

There are many instances when tinnitus is only one factor that someone is dealing with at a particular moment in time. Longstanding issues with stress, anxiety and/or depression are often issues that exist alongside tinnitus problems. The effects and upset caused by the tinnitus can often overlap with the effects and upset of the stress/anxiety/depression issues and so putting some help in place to improve this situation is often helpful. Talking therapies are counselling based services that aim to provide individually tailored assistance for stress, anxiety and depression issues. As a result of the service that they provide being directly targeted to your needs, the exact method that talking therapy services use to help you will vary compared to what they may do to help someone else. The core aim for what they do though, is to try to give you tactics and strategies to help you to manage anxiety, stress and depression issues more effectively. Managing stress, anxiety and depression issues more effectively can then help prevent them from having a big impact on your tinnitus.

Talking therapies are sometimes accessed through self-referral and sometimes accessed through a GP or audiologist referral. Please discuss this with your audiologist or your GP for more information in your local area.

One of the common thoughts that people struggling with tinnitus have is that they feel like they are alone. Family members, friends, and others around them will often listen to the difficulties that they are having; however for an individual with tinnitus, having someone who has experienced tinnitus and ‘understands what I am going through’ is often far more valuable. This is where support groups can play a part. They are groups in various locations around the country that are run by tinnitus sufferers for tinnitus sufferers. The British Tinnitus Association has helped to support and build over a hundred such groups across the UK and they are a valuable resource for many people, as well as a pleasant social environment.

Information on local support groups near to you is available from the British Tinnitus Association and also from your local audiology led tinnitus clinic.