If you suffer from ringing in the ears – tinnitus – your first question probably is, “Can anything be done about this noise that I hear?”
The answer is YES! A great deal can be done to help.
To begin, you need to understand what tinnitus is.
Tinnitus is classified as a phantom auditory perception. That is, a sound perceived as inside your ears or head when that sound does not exist outside you. Tinnitus is often generated in the brain, but perceived as being heard in the ears.
People often refer to tinnitus as a ringing in the ears; however it can take many forms, including ringing, chirping, hissing, sizzling, whining noises, or like the sound of rushing air or the humming of power lines. It may be high pitched or low, soft or harsh, faint or loud.
How Loud Is Tinnitus?
The intensity or loudness of sound(sound pressure) is measured in decibels, abbreviated as dB. Normal conversation typically measures between 40 and 50 dB. A home vacuum cleaner or alarm clock measures between 65 and 85 dB, a coffee grinder 70-80 dB, a blender 80-90 dB, and a garbage disposal around 85-95 dB. A tractor, a truck without a muffler, or shouted conversation measure about 90 dB.
Tinnitus sufferers often estimate the noise inside their heads at between 20 and 40 dB, however it more often approaches 8 to 10 dB when measured with an audiometer. A few people, however, experience tinnitus at 75 to 80 or even 90 dB. This intensity level may spontaneously vary from time to time, and in different environments. The majority of adults with normal hearing experience occasional tinnitus, described as high pitched ringing in the ears.
Tinnitus is actually quite common, affecting 20% of all people, and one out of three over the age of 60. When individuals with normal hearing are placed in a soundproof chamber, 95% develop temporary tinnitus. People need some external sound around them at all times. In the absence of external sound, the human auditory mechanism and brain create internal noise while searching for external sound.
Dr Charles & Deborah Smithdeal
I (Dr Charlie) am a retired board certified Otolaryngologist – a former ear surgeon, and a highly qualified hearing expert who truly understands tinnitus and hyperacusis. I also lived with both hyperacusis and tinnitus for several years before finding a solution to my problem.
Deborah Smithdeal PhD is an Anxiety Relief Specialist and Clinical Hypnotherapist. She has considerable experience helping clients who suffer from tinnitus.
We sincerely hope that our personal experience and specialized knowledge about both conditions will benefit you greatly. I no longer suffer, and you don’t have to either.
Help has arrived in the form of http://TinnitusControlCenter.com and http://TinnitusArt.com.
Certain forms of tinnitus can be explained physiologically, such as when a spasm of one of the tiny middle ear muscles vibrates the bones of hearing in the middle ear. Or when throat muscles contract that open the Eustachian tube, or when an unbalanced TemporoMandibular Joint (TMJ–jaw joint) creates a pull or vibration on your eardrum. An abnormal junction of the skull base with cervical vertebrae has been reported to cause tinnitus. Pulsations of a blood vessel will occasionally be heard inside the head or ears.
The most common and most bothersome form of tinnitus, however, is known as SIT: Subjective (only audible to the individual,) Idiopathic (of unknown cause) Tinnitus (ringing in the ears.)
You may very well ask, “Can I get rid of this noise once and for all?” In the best of situations, it will go away completely. In others, you can reduce the intensity of the sound AND train your brain to ignore it. To know which situation applies, you first need to determine what’s causing your tinnitus.
Tinnitus Relief Step One
Where do you start? Certainly NOT by visiting a hearing aid dealer or your family physician.Neither is equipped to provide an adequate examination for tinnitus.
Begin by visiting a qualified Otolaryngologist (ear, nose, throat specialist.) Some causes can be treated and relieved directly. For example, something as simple as ear wax(cerumen) touching the ear drum can cause tinnitus. Some medicines can make your ears ring, so simply discontinuing the offending medication will generally make the tinnitus go away. In addition to obtaining a hearing test, called an audiogram, your ENT doctor will likely perform more detailed tests of your auditory/vestibular nerves—called the eighth cranial nerves. These tests concern balance as well as hearing, since the two are closely related.
You doctor will probably order a CT scan or MRI of your head to visualize your inner ear and surrounding brain areas, especially if you have tinnitus in only one ear. This study is to be certain you do not have an acoustic neuroma – a rare and removable growth on the acoustic nerve. An acoustic neuroma is a non-malignant tumor growing along the eighth cranial nerve. These tumors often cause tinnitus, hearing loss, and/or vertigo, and can be surgically removed. Meniere’s disease also causes tinnitus, hearing loss, and vertigo, and is treated with medications and dietary changes.
In the vast majority of cases, after the examination and tests provide the very important information about what you do NOT have, you will be told that your tinnitus is idiopathic (unknown cause) or that it’s the result of some past exposure to loud noise that damaged your hearing nerve(s) or inner ear(s.)
The inner ear includes the cochlea, a snail-shell shaped organ lined with sensitive “hair cells” that receive sound vibrations and transmit impulses along your acoustic nerve to your brain. Your ears receive and transmit sound, but you actually hear that sound in your brain.
Examination by a qualified specialist described above must never be bypassed.
After all tests are completed, however, be prepared to hear that nothing can be done for your tinnitus. THIS IS NOT CORRECT.
You may be told, “You’ll just have to learn to live with it.” THIS IS NOT CORRECT.
Many ENT specialists are sadly uninformed about the highly effective treatment options available today for tinnitus. They may be excellent, well-trained physicians and surgeons, able to correct complex hearing-related conditions, but training often glosses over conditions that cannot be readily corrected with surgery or medications.
Your ENT doctor may have been taught that there is no effective surgery or medication for tinnitus, so patients just have to accept it. WRONG!
This is where we come in, along with a few others who have discovered:
YOU DO NOT HAVE TO LEARN TO LIVE WITH SUFFERING FROM TINNITUS. A GREAT DEAL CAN BE DONE TO REDUCE YOUR SUFFERING AND TO QUIET THAT INFERNAL NOISE IN YOUR HEAD!
First you need to understand that you can be helped. You also need to understand that there is no magic pill or overnight cure for tinnitus You must become personally involved in every stage of your therapy.
How quickly you find relief from subjective idiopathic tinnitus(SIT) will depend greatly on two factors:
1) how much you want relief, and
2) how enthusiastic you are about participating in your own therapy.
If you follow my recommendations, the sounds in your head will either A) go away, or B) improve dramatically.
My intention here is to guide you through several legitimate options proven to help tinnitus sufferers get better. You do not have to live with this noise forever, so put thoughts of hopelessness, suicide, and other such radical measures aside.
Vincent Van Gogh cut off his ear to rid himself of tinnitus. It didn’t work for him, and it won’t work for you. Severing the auditory nerve will make you deaf, but not stop tinnitus—this has also been tried in the past.
Tinnitus is distressing. It’s downright frightening. It’s frustrating. It makes you feel powerless to do anything at all. But suffering from the noise of tinnitus is also temporary and fixable.
Tinnitus Treatment Options
Several options are available, including:
- Tinnitus Retraining Therapy(TRT)
- Anxiety Relief Techniques® (ART)
- Select Combinations of therapies
1) Medications for Tinnitus. Anti-anxiety medications can be helpful; however, in most instances, I find them unnecessary and often dangerous. I also believe they are greatly over-prescribed today. Many are terribly habit-forming and extremely difficult to stop.
Anxiety Relief Techniques® (ART) is a far better option in my opinion.
Having said that, Xanax delivers nearly a 50% reduction in the perceived volume of tinnitus for more than 75% of sufferers, typically within one to three months. Tricyclic antidepressants such as Pamelor and Elavil reduce tinnitus in about 40% of sufferers. SSRIs(selective serotonin re-uptake inhibitors) such as Prozac and Paxil help many sufferers by elevating their levels of serotonin. Some of the anticonvulsants such as Tegretol or Primidone have proven approximately 85% effective in relieving certain types of tinnitus. These are only a few examples. Medications are discussed in greater detail in my CD program, along with several other effective therapies. Please note that all medications have side effects and/or interact with other drugs or foods, and some of these effects can be dangerous or even life-threatening. For this reason, you will need a local physician familiar with their use to prescribe and monitor all medications.
2) Tinnitus Retraining Therapy(TRT) relieves suffering from tinnitus in approximately 85% of trainees after about 18 months. It is expensive and works very slowly. I find this length of time both unacceptable and unnecessary. For the sake of completion, I will describe it here, though I no longer recommend TRT.
Developed in the 1980s by Dr. Pawel Jastreboff at the University of Maryland, this therapy works through a process called habituation. TRT consists of two closely integrated and equally essential parts: A )The use of sound therapy, and B) Counseling by a knowledgeable professional. Typically, TRT requires 12 to 18 months to achieve maximum effectiveness. To understand how TRT works, you first need to understand that tinnitus involves not just the ears, but multiple structures and nerve pathways within the ears and brain. Sound is collected by the external and middle ear as vibration, converted to electrochemical energy in the cochlea, and transmitted as nerve impulses along the acoustic nerve to specialized brain cells called auditory centers in the temporal lobes of the brain. Brain cells then interpret these nerve impulses as sound. It’s these interpretations that determine how you hear the sound. Even more significant, these and other centers in your brain determine the relative importance of that sound. Think about this for a moment. Your conscious mind can pay attention to only a few hundred bits of information (stimuli) at any given instant. There are thousands of bits of information constantly bombarding you, some deemed by your mind to be more important than others.
To avoid sensory overload, your conscious mind chooses to ignore stimuli not deemed threatening, stimulating, challenging, exciting, rewarding, essential to your survival or well being, etc. That is, your brain ignores things it considers unimportant, so you remain unaware of them until something changes to make them become important. Some of these bits consist of visual (sight) stimuli, others are kinesthetic (touch,) olfactory (smell,) gustatory (taste,) and auditory (hearing.) The relative importance of the stimuli changes constantly, so the degree of attention you grant them also changes.
A new stimulus will always be noticed and evaluated by our brains as to whether it presents a threat or warns of danger. Your mind learns to ignore any recurring stimulus that it considers unimportant. This is called habituation. One of the goals of TRT is to teach your brain to consider any remaining tinnitus so unimportant that you will automatically ignore it unless and until you choose to hear it. Pretty neat choice, huh? When you follow my recommendations for applying Anxiety Relief Techniques™ (ART,) this will become your choice.
A) Sound therapy in TRT consists of presenting a second or new intruding sound(NIS) to your ears, with that sound being far less intense than the tinnitus in your head. The NIS typically consists of a constant low level of white or pink noise, balanced broad spectrums perceived as a gentle hissing. When a NIS is first presented, you notice it because it’s new, and the limbic system in your brain needs to determine if it’s threatening or warning of danger. Because this NIS is constant, innocuous, and fairly faint compared to other environmental sounds, your limbic system quickly decides that it’s not important, so it pushes it into the background. Your mind then switches focus and actively listens for other sounds. In so doing, you quickly ignore the NIS as though it doesn’t exist. This process is slow, but while training your mind to ignore this artificially induced, not real and not important NIS, your mind also learns to ignore other not real and not important sounds inside your head—your tinnitus.
B) Professional counseling is an essential component of TRT. Studies have shown that sound therapy alone results in far less improvement for tinnitus sufferers than the combination of sound therapy and professional counseling. The primary aim of professional counseling is to remove negative emotions associated with tinnitus, such as anxiety, stress, and fear. Understanding the roles of the auditory system and brain plays an important part in removing fear surrounding tinnitus. 75% of all people with tinnitus automatically habituate the sound and generally ignore it. And 85% of those who initially suffer show significant improvement following several months of TRT. Maximum improvement requires approximately 18 months.
It has been my experience that Anxiety Relief Techniques® (ART) is A) more effective and B) works much faster than TRT in relieving the anxiety associated with tinnitus. The result is that with ART, habituation takes place in a matter of hours to days, rather than over a period of 18 months.
3) Hypnotherapy WAS a good choice at one time to correct several issues faced by tinnitus sufferers. Since the development of ART, I no longer recommend hypnotherapy. It is almost impossible to locate a hypnotherapist who is knowledgeable about tinnitus. Also, whether performed in conjunction with one of our video courses or in person, our experience is that ART is more effective than hypnotherapy and works much faster. Self hypnosis can help relieve stress, but almost never lowers the volume of the noise, or removes the associated fear.
4) Anxiety Relief Techniques® (ART) defuses negative emotions through guided imagery AND correcting an imbalance in your own energy system. This is unquestionably the most effective method available today for relieving the anxiety generated by tinnitus. Anxiety is our most basic negative emotion. As you already know, your energy system is what gives you life. Parts of this energy are being measured when you undergo an EEG or EKG.
The onset of tinnitus is a traumatic event, and certainly disrupts the energy system to cause anxiety, fear, frustration, or outright panic. Once this disruption is restored, however, it becomes far easier to habituate the noise because the negative emotions go away.
In more than 30 years of practicing medicine and surgery, I have never witnessed any technique for relieving anxiety as powerful as Emotional Freedom Techniques(EFT)® or Anxiety relief Techniques®.
Our motto has become When Nothing Else Works because ART typically succeeds after everything previously tried has failed. With proper instruction and guidance, ART is self-administered at home. We teach these techniques nationwide through video courses. See below for details. By special arrangement, I (Dr Charlie) also teach personally through distance sessions that incorporate telephone, fax, and e-mail.
5) Select combinations of therapies provide good results for a few individuals. While many clients share common characteristics such as symptoms, medical issues, age, etc, every tinnitus sufferer is unique. All therapies need coordination by a knowledgeable professional to achieve maximum benefit.
Tinnitus & Golden Silence
A word of advice: Tinnitus sufferers must avoid silence at all times. We explain in more detail under Hyperacusis (below,) but beginning right now, keep some sound around you at all times – something you enjoy such as music, a waterfall, etc. Not loud, just at a soothing volume that you find pleasant.
Diet & Tinnitus
Studies show that 90% of tinnitus sufferers have a metabolic disorder called hyperinsulinemia – an increased level of insulin in the bloodstream. In general, tinnitus sufferers should follow a diet low in refined sugar and simple carbohydrates, and limit their intake of caffeine, nicotine, and alcohol. I also advise our clients to strictly avoid the food additive monosodium glutamate (MSG,) and anything containing the artificial sweetener, aspartame (especially diet sodas.) Ongoing self education, ART practice, and sound therapy or enrichment must be carried out at home.
Tinnitus Therapy – Goals
Our goals with tinnitus control are to: 1) reduce your anxiety, 2) relieve your emotional suffering, and 3) reduce your sound’s volume. As distressing as it seems at the beginning, your suffering from tinnitus can become a distant memory.
Hyperacusis is an extremely limiting condition related to and often accompanied by tinnitus. It is generally misunderstood by lay people and physicians alike. Hyperacusis literally means super hearing – perceiving sound as louder than it is. It represents a reduction in your threshold of comfort for sound, and is caused by an alteration in a sound-processing system in your brain.
Sometimes referred to as sensitive ears or tender ears, hyperacusis actually originates in the brain rather than in the ears. Perhaps the biggest problem sufferers experience is a fear of sound. Sufferers fear that loud sounds will permanently damage their hearing. An acoustic guitar, a passing truck on a city street, clanging dishes in a noisy restaurant, or booming sounds in a movie theater are all painful to their ears. The natural tendency is to seek silence – sweet, golden silence. And what is the worst possible thing for these people? Sweet, golden silence.
Sound Therapy for Hyperacusis
Auditory nerve cells in the brain need sound in order to function properly. They don’t do well when idle, so if there’s no sound to hear, they recall earlier sounds and then attempt to duplicate them. This causes tinnitus, a frequent companion of hyperacusis.
Like many sensory sensations, sound is interpreted in relation to other sounds. If you’ve just listened to a loud recording or fireworks display and then somebody walks past whistling a tune, you probably won’t hear the whistling at all. But if you awaken from a deep sleep in a silent room in the middle of the night, and the same whistler walks past your open window, it seems so loud that you think you could hear it from across the block.
Why does that happen? Because either silence or low levels of sound result in an increased sensitivity of hearing. For example, when you wear ear plugs to block out most sound, your hearing system becomes super attentive. It literally searches for sound. Whatever gets through seems far louder than it actually is. Conversely, if you keep some background sound around you at all times, such as a radio or CD playing, or a waterfall or fountain, other sounds will not seem nearly as loud or uncomfortable.
The hearing system thrives best when performing its basic function of receiving external sounds.Even though sounds of 75dB or 80 dB seem dangerously loud or uncomfortable when you have hyperacusis, they will not damage your hearing. Prolonged or repeated exposure to noise levels above 85dB will harm anybody’s hearing. Levels above 140dB may cause permanent damage with a single exposure.
As with tinnitus, we insist that our clients with hyperacusis undergo a through examination in their home area by a qualified ENT specialist. Once that’s completed, we coordinate many of the same therapies we find effective for tinnitus, because these also help hyperacusis. Medication is rarely necessary, but Anxiety Relief Techniques™ works wonders. We designed a course specifically for victims of hyperacusis, and another for victims of tinnitus. This course is available at www.NoiseHurts.com
Remember to enrich your environment with sound because a sound-rich background is essential. Play a radio, CDs, listen to music or conversation on TV, or even purchase a re-circulating fountain. The sound does not have to be loud, just a comfortable level. It is always a good idea to protect your ears from really loud or painful sounds, but remove earplugs for normal everyday activities and noises. Gradually increase the amount and level of sound around you and see how quickly you’ll improve.
The biggest relief generally comes when you realize the following:
1) There is nothing wrong with your ears, and
2) Normal sounds will not damage your hearing.
Tinnitus Cure or Relief?
Only a few specific types of tinnitus can be cured.
More than 90% of our clients obtain significant relief from the suffering of tinnitus and/or hyperacusis.
For relief from the suffering of Tinnitus, visit: TINNITUS ART
For relief from the suffering of Hyperacusis, visit: NOISE HURTS
For more information about tinnitus and hyperacusis, visit: TINNITUS CONTROL CENTER
To find out if we can help your situation, text: (727) 512-5130
Charles Smithdeal, M.D., F.A.C.S., C.Ht.
Deborah Smithdeal, PhD, C.Ht
Anxiety Relief Specialists
St Petersburg, Florida, U.S.A. 33706