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A combination of approaches can help you manage the "phantom sounds" of tinnitus.

If bells are ringing in your ears, you may have tinnitus. More than 50 million Americans have the condition, which causes sufferers to perceive noise in one or both ears even though there is no external sound. The noise can occur intermittently or persistently, interfering with sleep and affecting concentration--at worse, tinnitus has been linked with depression and stress.

"Tinnitus usually can be traced back to a problem with the inner ear, but sometimes the underlying cause is less clear," says Eric Smouha, MD, associate professor of otolaryngology at Mount Sinai. "This can make effective treatments elusive--however, tinnitus frequently improves over time, and you also may be able to manage the problem by altering your reaction to it."

Various possible causes Tinnitus is most often described as ringing in the ears, although some people with the condition report hearing buzzing, hissing, roaring, clicking, or chirping. "These sounds typically originate from the inner ear," Dr. Smouha explains. "As we get older, tiny sensory hair cells in the inner ear die off or are damaged, a process that may be exacerbated by exposure to loud noise, poor cardiovascular health, and some medications, including aspirin and acetaminophen, as well as certain diuretics and antibiotics. Loss of and damage to these cells is commonly associated with tinnitus."

Problems in other parts of the ear also may be to blame. "Middle ear infections, and rare conditions that cause the ear bones to harden, or the two tiny muscles in the ear to spasm, also may underpin tinnitus," Dr. Smouha says. Some non-auditory conditions and lifestyle factors also are associated with tinnitus. Temporomandibular joint (TMJ) disorders (which affect the hinge joint that attaches the jaw to the skull), depression, anxiety, insomnia, and muscular stress and fatigue may cause tinnitus, or worsen existing tinnitus.

Dr. Smouha notes that tinnitus in one ear is more concerning. "This is because most of the causes of hearing loss--including age, genetics, and cumulative noise exposure--affect both ears," he says. "Patients who are experiencing tinnitus in one ear only should be evaluated audiologically, and usually have additional testing to determine the cause." One possible cause may be pulsatile tinnitus--the sound of a heartbeat in the ear. "This usually has a vascular origin, and occasionally is caused by a tumor," Dr. Smouha says.

Living with tinnitus If there is a specific cause for your tinnitus, addressing it may eliminate the noise in your ears. If no specific cause can be identified, one or more of the strategies listed here may bring you relief. It's also worth connecting with a local self-help group--the American Tinnitus Association ( has a support network--where other sufferers can offer tips for what helps them.

1 Be aware of what makes it worse Pinpoint anything that exacerbates the symptoms--for example, drinking caffeinated beverages, taking particular medicines, or exposure to noise--and avoid that trigger if possible.

2 Use hearing aids If you have hearing loss, wearing a hearing aid may reduce tinnitus by reintroducing ambient sounds that mask it. Consult a qualified audiologist (find one via the American Speech-Language Hearing website, at for a thorough hearing evaluation.

3 Change how you react Biofeedback is a relaxation technique that teaches people to control certain autonomic body functions, such as pulse, muscle tension, and skin temperature. "During a biofeedback session, you're connected to electrical sensors that pick up body signals and transmit them to a special computer that displays the signals via images or sounds that indicate your stress levels, skin temperature, blood pressure, heart rate, and brain waves," Dr. Smouha explains. "You are then guided in how to vary your thoughts and emotions so that you see a change in the signal display. The idea is that you learn how to consciously control your body's responses--including its response to tinnitus."

Cognitive behavioral therapy (CBT) also may help by changing how you react to the tinnitus. "A counselor trained in CBT can help you recognize negative behaviors and thought patterns related to your tinnitus, and then consciously alter them," Dr. Smouha says. " I his should help to reduce any distress from the noises, making them tolerable to the point where they eventually become less noticeable." A similar approach is tinnitus retraining therapy, which utilizes a combination of counseling and sound therapy (see below) to help you retrain your brain to stop paying attention to the tinnitus. "Instead, you tune it out in the same way you are able to tune out background noises like the refrigerator motor," Dr. Smouha says.

4 Seek out other sounds You'll likely notice your tinnitus more in a quiet environment. Sound therapy fills that silence with a constant, neutral sound that distracts you from the noise of your tinnitus. Tuning a radio into static can often be enough--alternately you can purchase a "white noise" machine, or an environmental sound machine with a choice of relaxing sounds, such as rainfall or rustling leaves.

5 Be mindful Mindfulness based stress reduction (MBSR) relieves tinnitus in some sufferers. MSBR teaches you to experience the moment you are in without judging it--in the case of tinnitus, the noises you hear become just another sensation that comes and goes. "By separating the noise you're hearing from the tension it arouses, you hone the skill of not reacting to it," Dr. Smouha explains. "There is evidence that MSBR can help decrease the severity of tinnitus, promoting restful sleep."
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Title Annotation:HEARING
Publication:Focus on Healthy Aging
Date:Apr 1, 2015
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