Managing Your Tinnitus: What to Do
and How to Do it
Tinnitus Education
Tinnitus Education: Outline
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What is Tinnitus?
 Why is tinnitus a
problem?
 How we hear vs. tinnitus
hearing.
 Sounds of tinnitus
 Is there a cure?
 How many people have
 Methods to eliminate
tinnitus?
tinnitus or reduce its
loudness
What causes Tinnitus?
 Prescription Drugs
How can Tinnitus affect
you?
 Use of Sound
 Tinnitus can affect
 Methods to manage
concentration
tinnitus
 Tinnitus can cause
 Cognitive-Behavioral
emotional reactions
Therapy
 Tinnitus can disrupt
 Mindfulness Based
sleep
Therapy
What is tinnitus?
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TIN-i-tus is a ringing, humming, buzzing, or other
chronic noise that is perceived that does not have an
outside source. This sound can occur from one or
both ears, or within the head.
In the U.S., 50 million people have experienced
tinnitus at some point and 10 million people visit
physicians for this problem
How we hear vs. tinnitus
Sound waves in the air become transformed into signals
that the brain recognizes as sound. With tinnitus there
are NO sound wave vibrations that cause nerve fibers
to activate. In most forms of tinnitus, it is thought that
nerves fire on their own. The brain perceive these
signals as sound
Figure 1
What Causes Tinnitus
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When we get hearing loss, we lose some cells in the
inner ear that sense sound. The brain cells that do
the function of hearing, however, do not die. This
causes an increase in activity in the brain cells that
do the function of hearing.
Tinnitus is caused by a combination of this increase
in activity and usually one of the following factors:
 Stress
 Anxiety
 Fatigue
 Poor sleep
 Depression
What Causes Tinnitus
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Factors such as stress, anxiety, depression, poor
sleep, etc. cause some changes in the brain that
makes the brain more aware of the tinnitus
Since tinnitus is affected by emotional factors (e.g.,
stress, anxiety, depression, etc), management of
tinnitus requires managing any of these co-existing
issues
This includes, sleep management, stress
management, etc.
Sounds of Tinnitus
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Patients with tinnitus often report sounds of:
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Ringing
High pitched tone
Hissing
High tension wire
Buzzing
Sizzling
Crickets
You can hear more
than 1 sound
How can tinnitus affect you?
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Tinnitus can affect a person’s life in a variety of ways
Some of the main effects are:
 Concentration difficulties
 Emotional reactions
 Disrupted sleep
The onset of tinnitus can be life-altering
Tinnitus can affect concentration
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The sound of tinnitus can disrupt work and tasks that
require your attention
The chronic sound of tinnitus is unpleasant and
cannot be eliminated
 Some people differ in their ability to ignore
sounds. For some, it is easy to ignore, but for
others it can be challenging
Tinnitus does not make it difficult to hear, but it can
disturb with focused listening
Tinnitus can cause emotional reactions
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Tinnitus is a chronic noise and can become irritating
Emotional reactions to tinnitus have been reported to
cause:
 Depression
 Anxiety
 Anger
 Frustration
 Worry
People with previously existing anxiety and
depression are more prone to chronic tinnitus
The goal of tinnitus management is to manage these
reactions to tinnitus.
Tinnitus can disrupt sleep
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Many tinnitus patients have reported sleep problems
Tinnitus can make it hard to fall asleep and returning
to sleep after waking up in the middle of the night
The worse your sleep is, the worse your tinnitus will
be the next day
Tinnitus can cause you to become sleep deprived
and make it harder to normally function during the
day
Why does tinnitus become a problem?
1. Many people with tinnitus report that “it came out of
nowhere.” Tinnitus is a different sound and it can be
annoying by focusing on it.
2. It can be perceived as a threat and keep our
attention. It can create fear that it is a serious medical
condition or a psychological disorder. There are often
reports of “going crazy” or “having a tumor”.
3. There are different reactions to tinnitus. The sound of
tinnitus may disturb one person, but not another.
4. Tinnitus can be annoying because the sound is
persistent. There is a loss of “peace and quiet”.
Why does tinnitus become a problem?
5. Tinnitus can trigger negative memories if the onset of
tinnitus was associated with a traumatic event.
Traumatic events can include stressful experiences,
severe sleep disturbance, combat, head injury, or
explosion.
6. Tinnitus is an unwelcomed sound and can be more
irritating if it is louder. Those with a higher sensitivity of
tinnitus appear to be most bothered by it
7. The more attention given to tinnitus, the more it
becomes problem. It may affect you lifestyle.
8. Tinnitus can cause a lack of control. People with
tinnitus feel like it is uncontrollable or escape it.
Is there a cure?
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Curing tinnitus means that the sound that you hear
would be eliminated.
 Unfortunately, there is no cure for tinnitus yet.
There are available treatments to manage living with
tinnitus. These treatments can:
 Reduce its loudness
 Reduce the person’s reactions to the tinnitus
Reduce Its Loudness
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There are many ways to try treat tinnitus, but there is no
proven cure
Some ways to reduce its loudness are:
 Prescription drugs
 Use of sound
 Hearing aids
 Masking
 Generic Masking
 Table-top noise generator
 Music
 Customized Masking
 Sound therapy customized to the hearing and
tinnitus profile
Prescription Drugs
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There have been many drugs used to treat tinnitus,
but most are based on a trial-and-error process.
The drugs used are designed to manage other
tinnitus-related problems such as
 Depression
 Anxiety
 Mood disorders
 Lack of sleep
With this method for treatment, it must be
approached with great care due to potential side
effects.
Use of Sound
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Hearing aids
 Hearing aids can assist in tinnitus management since
they allow more sound to reach the brain to reduce
the perception of tinnitus, they increase background
noise, this allows you to hear soothing and interesting
sounds, also they can make difficult listening
situations less stressful.
Tinnitus Masking
 This treatment method can give the perception that
tinnitus is eliminated or reduced in loudness. This
method can give the patient a sense of relief from
tinnitus.
Reduce Reactions to Tinnitus
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Reducing the reactions to tinnitus is a way of
management. This approach of treatment can help
you better cope living with tinnitus. This includes:
 Psychological approaches
 Cognitive-Behavioral Therapy (CBT)
 Mindfulness Based Therapy
Cognitive-Behavioral Therapy (CBT)
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CBT combines helping patients change how they
think about their tinnitus to help them feel better with
everyday activity changes
CBT was initially used to treat depression, anxiety,
and chronic pain.
It is now used to psychologically manage tinnitus by
reducing negative reactions to tinnitus.
Mindfulness Based Therapy
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Mindfulness based therapy is used to acknowledge
thoughts of tinnitus in a nonjudgmental way and living
in the moment.
It is used to accept tinnitus by becoming aware of it.
Can Tinnitus be Cured?
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“Cure” = eliminate or reduce the tinnitus
No cure yet – research underway
It can’t be cured, but you can learn to manage your
reactions to it
Tinnitus Management
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There are 2 components to tinnitus
1. The sound that you hear
2. The reaction you have to the sound
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To help Manage your tinnitus, you need to address
both components
1. Using sound to help reduce the perception of the
sound
2. Manage your reaction to the sound that you hear
Goals of Tinnitus Management
(All Methods)
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Emotional reactions are reduced
Stress is reduced
Little if any attention is given to tinnitus
Tinnitus does not affect any life activities in a major
way
Further help is not needed or wanted
These goals can be reached even if the sound of
your tinnitus doesn’t change!
Sound Therapy
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What is it?
 Sound that helps reduce the perception of tinnitus
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How can it help?
 By giving you a sense of relief from tension and
stress caused by tinnitus
When can it help?
 Any time your tinnitus bothers you
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Sound Therapy
Things to Remember
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Sound therapy is more soothing to some people, and
less soothing to others
The goal of customized sound therapy is to direct
more sound to areas of the brain that are thought to
be responsible for the perception of tinnitus
Music therapy is the combination of sound therapy
and relaxing music
This allows you to listen to music while the sound
therapy is playing in the background
Martha
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When Martha reads at home, she listens to music
therapy
The sense of relief she feels from the music makes it
easier for her to concentrate
This an example of using music therapy
Background Sound
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What is it?
 Any sound that is neutral (not soothing and not
interesting)
 For example like the sound of the air conditioner,
dishwasher or talking of others in a restaurant
How can it help?
 Reduces contrast to make it easier to ignore your
tinnitus (we’ll explain!)
When can it help?
 Any time
Imagine a Lit Candle in a Dark Room
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The candle is the only light in
the room
There is sharp contrast
between the bright candle
and the dark room
The candle naturally attracts
a lot of attention
Turn on the Lights!
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This is the same lit candle, but
with the lights on
The contrast between the
candle and the room has been
reduced
The candle is just as bright as
before, but attracts less
attention because now there is
other light in the room along
with the candle
Same Candle –
Different Backgrounds
This same idea works for tinnitus…
Imagine “Tinnitus”
in a Quiet Room
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The tinnitus is the only
“sound”
There is sharp contrast
between the tinnitus and
the quiet room
The tinnitus naturally
attracts a lot of attention
Turn on the Sound!
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Same tinnitus, but in a
background of sound
The contrast between the
tinnitus and the quiet
room has been reduced
The tinnitus is just as loud
as before, but attracts less
attention because of the
background sound
Same Tinnitus –
Different Backgrounds
Tinnitus Contrast Activity
Let’s try it!
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click icon to play sound
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Spend a few moments listening to your
tinnitus in quiet
Then, with the background sound turned on,
notice the reduced contrast
Reducing contrast makes it easier to ignore
your tinnitus
Background Sound:
Things to Remember
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Tinnitus is less likely to get your attention when you
add background sound
You might not notice background sound helping you
right away—that doesn’t mean it’s not helping you
Using constant background sound over weeks or
months can help you get better at ignoring tinnitus
Never use sound that is irritating or annoying to you
to manage your reactions to tinnitus
Janet
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Janet keeps a tabletop fountain running on her desk
The background sound from the fountain makes it easier
for her to ignore her tinnitus
This is an example of using background sound
Interesting Sound
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What is it?
 Sound that keeps your attention
 Sound that involves active listening
 Some examples include talk radio, audio books,
interesting music, dynamic speeches
How can it help?
 Shifts your attention away from your tinnitus
When can it help?
 When you do not need to concentrate on
something else
 When you want to relax or sleep
Interesting Sound:
Things to Remember
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We’re all different!
 Some sounds (e.g., talk radio) are more
interesting to some people, and less interesting to
others
Your job is to find sounds that are interesting to you
It might take time and patience to find the sounds that
are most interesting and helpful for you
Never use sound that is irritating or annoying to you
to manage your reactions to tinnitus
Patrick
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Patrick talks to his friends on the telephone to keep
his mind off of his tinnitus
This is an example of using interesting sound
To help you come up with
ideas for choosing sounds…
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You can use
 Environmental
 Music
 Speech
Environmental Sound
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Sounds of nature
 Moving water
 Beach sounds
 Forest sounds
 Animals
 Wind
 Storms
and more…
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Manmade sounds
 Masking noise
 Electric fan noise
 Shower sound
 Aircraft noise
 Wind chimes
 Traffic noise
 Radio static
and more…
Music
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There are many styles of music
We all have our preferred styles
Any music that is neutral or pleasant can be used to
manage tinnitus – as long as it is not too loud
Speech
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Speech can be used as part of your plan to manage
tinnitus
There are many kinds of speech, and we react
differently depending on the type of speech and the
situation
Some examples:
 Talking on the phone
 Listening to an audio book
 Listening to a lecture
Nine Combinations of Sound to
Manage Reactions to Tinnitus
You Have Now Finished This Module
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Next let’s take a closer look at an example
Bob
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Listening to talk radio helps Bob get his mind off of his
tinnitus at night
 This helps him get to sleep
This is an example of using interesting sound
Tip: It’s best to NOT use the TV for this as the flashing
images can prevent you from falling asleep
Won’t Interesting Sound
Keep Me Awake?
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Interesting sound can be a powerful way to get your
mind off of your tinnitus
 This helps some people relax enough to fall sleep
 It might not be helpful for others
Be open to using sound in surprising or unusual ways
to manage your reactions to tinnitus!
Another Sleep Challenge for Bob
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Listening to talk radio helps Bob get to sleep when he
goes to bed at night
However, he wakes up in the middle of the night and
has trouble getting back to sleep because of his
tinnitus
He does not like to listen to interesting sound in the
middle of the night
What did Bob do?
Bob’s Solution
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Keeping a fan running all night long reduces the contrast
between Bob’s tinnitus and the quiet of his bedroom
The reduced contrast helps Bob stay asleep all night long
This is an example of
using background sound
Develop a Sound Plan That is Easy to Do
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Your first Sound Plan should be easy to do and
practical for you
Use sounds and devices that you already have
As you try the Plan, you will learn what helps the
most
You will get ideas about how to improve your Plan
Write Down Your Sound Plan
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What will you use for background sound
_ _ _ _ _ _ _ _ (examples include Sound therapy,
fan, fountain, etc.)
What will you use as an interesting sound
_ _ _ _ _ _ _ _ (examples include audio book, talk
radio, Music therapy, etc.)