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Coping techniques help you tune out tinnitus: today's management strategies can help you neutralize the troublesome tones in your ears and regain your quality of life.

By the time many patients with tinnitus see Craig Newman, PhD, they've been told by another medical provider to learn to live with their condition.

But for many patients, he says, there's no learning to live with the constant noise that keeps them up at night or preoccupied during the daytime.

That's partly because no specific cure for tinnitus has been identified and, as a recent study suggests, guideline-recommended management strategies for tinnitus aren't often implemented.

Yet, as experts gain more insight into this problematic disorder, they've developed new techniques that can help you tune out the bothersome tones of tinnitus and shift your focus back to what's important in your life.

"I tell patients that I may not be able to get rid of your tinnitus or completely eliminate your perception of it, but we can get patients to a point where it isn't affecting them in their everyday life," says Dr. Newman, head of Audiology at Cleveland Clinic. "My goal is to make tinnitus a neutral event for them."

A Prevalent Problem

In a study published online July 21 in JAMA Otolaryngology--Head & Neck Surgery researchers found that nearly one in 10 U.S. adults experienced tinnitus in the past 12 months.

The study authors also reported that treatments recommended in the American Academy of Otolaryngology's 2014 guidelines were not frequently presented to tinnitus patients. Instead, medications were the most frequently mentioned treatments, but Dr. Newman points out that no medications or supplements have proven effective or gained regulatory approval specifically for treating tinnitus.


More than a third of the study patients had nearly constant symptoms, but only about half had discussed their tinnitus with a physician. "Sometimes, tinnitus just isn't brought up, and, particularly with primary care physicians, I don't think it always gets addressed," Dr. Newman says. "The focus, understandably, is on chronic medical conditions, but for many of these patients, tinnitus is an issue."

Find Answers

Not all people with tinnitus are bothered by the hallmark ringing, hissing, roaring, or buzzing sounds.

However, if you have persistent, bothersome tinnitus, especially if it develops in only one ear and is accompanied by unilateral hearing loss, Dr. Newman recommends undergoing a medical evaluation to rule out potentially serious causes, such as an acoustic neuroma (a growth on the auditory nerve). Also, seek more immediate help if you experience pulsatile tinnitus, which follows the pulsing of your heartbeat and may signal a cardiovascular problem.

Your healthcare team can identify common modifiable triggers of tinnitus, such as earwax buildup, thyroid disorders, nicotine, certain dietary components, and any of a long list of medications.

One of the main contributors to tinnitus is hearing loss resulting from overexposure to occupational and recreational noise, the JAMA study found. By some estimates, about three-quarters of patients with some degree of hearing loss who visit an audiology clinic also report tinnitus, Dr. Newman says. Experts theorize that hearing loss caused by noise exposure or other factors can result in hyperactivity in the central auditory system.

"You can have hyperactivity in the central auditory system to compensate for this loss of hearing at the peripheral level," Dr. Newman says. "Your brain is interpreting electrical code and it's perceiving this electrical signal as tinnitus."

Emerging research suggests that other neurological pathways may cause hyperactivity in the auditory system. For instance, bruxism (clenching/grinding your teeth) and jaw problems such as temporomandibular joint disorder (TMJ) can contribute to or worsen tinnitus. Also, in some tinnitus patients, neck and back problems resulting from injuries or even poor posture may be to blame.

"We're finding that patients we're putting through physical therapy, working on everything from spine alignment to teaching them how to sit and stand properly to help their posture, are getting some relief from tinnitus," Dr Newman says. "The first thing a tinnitus patient should do is be seen by a physician to rule out any of these conditions. Then, if there's no medical condition that needs treatment, there are other therapies we can get into."

Tame Your Tinnitus

One of the key components of tinnitus treatment is sound therapy, which employs soothing tones to mask tinnitus and distract your brain from the bothersome noise. These treatments can range from simple tabletop sound generators to MP3 players to an array of free smart phone apps that provide sound therapy for little or no cost. And, because tinnitus often accompanies hearing loss, many tinnitus patients benefit from hearing aids, with or without built-in sound generators.

"For many patients, sound therapy can provide immediate relief from tinnitus," Dr. Newman says. "If you have some background sound, the brain doesn't perceive tinnitus as loudly anymore. Over time, your brain no longer tunes in to the tinnitus."

In many ways, tinnitus is a psychological condition. If the noise is persistently bothersome, you may focus on it too much, to the point where you can suffer anxiety and worsen your quality of life. If this problem occurs, Dr. Newman recommends cognitive behavioral therapy and other forms of talk therapy to help you reframe your perception of tinnitus, accept it, and combat any negative feelings that can exacerbate it.

He also encourages tinnitus patients to stay active and socially engaged, and to avoid "checking behaviors," like overly researching tinnitus on the web, which can keep you tuned in to your tinnitus, not your life.

"People stop doing activities because of tinnitus, and that's absolutely the opposite of what you want to do. One of the worst things you can do is to keep checking on your tinnitus and focusing on it," Dr. Newman says. "It's when tinnitus becomes the 'bad guy' in your life that it really becomes a problem. Patients have to be very patient and motivated to try some of these things. All of these strategies, like cognitive behavioral therapy and sound therapy, are directed at not making tinnitus the 'bad guy' anymore."


Tinnitus explained

Tinnitus is not a disease, but rather a symptom of a problem in the auditory system. People with tinnitus perceive sounds in one or both ears or in their head when no external sound is present. For most people, it's a ringing sound; others characterize the noise as hissing, roaring, or buzzing.


* Use hearing protection whenever you work in noisy environments, mow your lawn, work with power tools, use firearms, play or perform loud music, or attend loud concerts, fireworks displays, or sporting events. Keep music at a comfortable level.

* If you have bothersome tinnitus, seek out a multidisciplinary treatment program that includes an audiologist, dentist, psychologist, physical therapist, and other specialists.

* Seek more urgent medical attention if your tinnitus is accompanied by sudden hearing loss, occurs in one ear, or matches the pulsing of your heartbeat.

* If you have hearing loss along with tinnitus, consult an audiologist about hearing aids, including combination models that have sound generators.

* Sit up and stand up straight. Poor posture may lead to neck problems that can be associated with tinnitus.

* Tell your doctor or dentist if you grind your teeth, have biting/jaw disorders or have suffered a neck injury--all of which can contribute to tinnitus.

* Ask your physician if any foods or beverages (caffeine, alcohol, and sodium are common culprits) or any medications you take may cause or worsen your tinnitus.

* Refrain from using cotton swabs, or Q-Tips, to clean your ears.
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Title Annotation:Speech, hearing, vision
Publication:Men's Health Advisor
Date:Nov 1, 2016
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