Custom White Noise: There is generic white noise... and then there is white noise that can be customized to make it sound nicer or more pleasant. White noise basically masks the tinnitus. It also helps you to avoid focussing on the tinnitus. The more you focus on the tinnitus, the more you are reinforcing the tinnitus. Do whatever it takes to avoid focusing on the tinnitus!
Notched Audio: This tinnitus treatment strategy utilizes white noise... BUT, the tinnitus frequency is completely absent or "notched" out. Theory goes that if you listen to this "notched" white noise, eventually, when you turn off the white noise, it tricks the brain to also turning off the tinnitus as well. This treatment strategy requires you to know your tinnitus frequency.
CR Neuromodulation: Unlike white noise which is a continuous sound, this strategy uses a series of mathematically determined tones that play both above and below the tinnitus frequency followed by pauses. Researchers have determined that by playing these tones that dance around the tinnitus frequency, over time, the tinnitus will fade away. This treatment strategy requires you to know your tinnitus frequency.
Custom Complex Audio Files: Using the above "basic" acoustic programs for tinnitus treatment, more complex sounds can be created for those who are interested such as double notched audio, variable pause duration neuromodulation, double frequency neuromodulation overlap or alternating tone sequences, etc.
Other Tinnitus Treatment Options: Other strategies can be found in our online store.
Continuous tinnitus is the most common form of tinnitus and is the hardest to treat. Patients often describe this as a high-pitched noise that is continuously present, especially when it's very quiet (such as when trying to go to sleep at night). An audiogram is first obtained to determine whether any hearing abnormalities are present. Subsequently, radiological studies (MRI of the IAC) may also be ordered if any asymmetry is noted. However, most continuous tinnitus is due to nerve-damaged hearing loss. This situation is analogous to phantom limbs after an extremity amputation. Hearing loss is the "amputation" and tinnitus is the phantom limb. Another common cause is due to TMJ oddly enough through a mechanism that is not entirely clear. Eliminating salt, caffiene, and alcohol have been found to be helpful in reducing the severity of tinnitus. However, if tinnitus has been present for years, stopping caffiene may make it worse.
If hearing loss is present, hearing aids with a tinnitus program may be quite helpful. Otherwise, an easy way to address this problem is to have white noise in the environment continuously whether it be a fan running or having the radio tuned to a station where there's static. One can even buy "noise-makers" (also known as tinnitus maskers) specifically to address this problem, though some patients find the noise-makes just as aggravating as the tinnitus itself. Here are a few found on Amazon.com.
There is unfortunately no 100% definitive treatment for continuous tinnitus although various new treatments are being studied. One promising treatment with improvement or cure rates approaching 80% is neuromonics as well as neosensory. Another tinnitus treatment is intra-tympanic steroid injections in certain eligible patients in which the onset of tinnitus was sudden (within the last 10 days) and associated with hearing loss.
In those where the tinnitus has been present for a long time, low-dose of amitriptyline or melatonin may be helpful. For those who feel that anxiety, stress, and sleep issues seem to be contributing to tinnitus, tinnitus retraining therapy and/or cognitive behavioral therapy with a psychologist and/or trained audiologist can be very helpful.
Other forms of tinnitus treatment including audio notching can be found in our online store.
Many patients have tried pills such as multi-vitamins, mineral supplements, and other forms of herbal medicine with some success. However, none of the treatments have been found to be as effective as a plain placebo (sugar pill). In such studies, tinnitus was found to get better in 20-30% of patients taking a placebo which was no better than the drug under investigation. Such a response does point to an underlying mental factor contributing to the continuous tinnitus.
The key take home point is that there IS treatment for tinnitus, but no bullet-proof one. One general strategy to treat continuous tinnitus is as follows taking into consideration cost (none of which is covered by insurance) as well as amount of supporting research. You do not have to follow these exact steps, but it is one suggested sequence.
- Melatonin 3mg at night
- Generic white noise
- Eliminate salt/sodium from the diet
- If significant anxiety/stress is present, start tinnitus retraining therapy and/or cognitive behavior therapy
- If hearing loss is present, purchase a hearing aid with a tinnitus program (ie, Widex Zen)
- If no significant hearing loss is present, start neuromonics
- Start listening to more sophisticated programmable white noise (I usually suggest MyNoise.net)
Level 3: Start some type of neuromodulating program
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