Tinnitus is the name given to noises heard in the head or ears. They may be hissing, ringing, rushing or a variety of other sounds.
Tinnitus is extremely common and has been described for as long as humans have been able to document it. Around 30% of the adult population in the UK have heard it at some time, 10% for prolonged periods, and of these people about 4% consult their GPs about tinnitus.
Significant tinnitus distress is far less common, however for an important minority of people it can be loud, annoying, intrusive and life changing.
In most cases, tinnitus is an internally generated sound that the auditory system has tuned into by mistake. Tinnitus management aims to help the auditory system to filter tinnitus out, or habituate to it.
However, it is always important to check that tinnitus is not a symptom of a medical condition, and you should always check with your medical specialist before starting management.
Common causes include:
Stress and anxiety
Low mood state
A traumatic life event
Tinnitus is thought to be triggered when ambient sound within auditory pathways that would normally be ignored is detected.
The auditory system, in common with other sensory systems, analyses sound very carefully for meaning before we become aware of it, and only a tiny percentage of the sounds around us ever reach our conscious awareness.
Our brains use a complex sound filtering system to allow meaningful sounds through and filter out meaningless ones. These filters are influenced by parts of the brain that manage our emotional response and alertness to sound.
This wonderful system is there to keep us safe and happy. So, any sounds that we really love, really hate, or perceive as a threat to our life or life quality will pass through the sound filters even if they are very soft or indistinct.
Tinnitus awareness circles
When we hear sound for the first time we learn its importance, and therefore its meaning to us. Meaningless irrelevant sound is filtered out, but important sound will be heard even if it is very soft. If tinnitus is new, concerning in any way, or associated with something we don’t like then we will hear more of it. It can be a bit of a vicious circle.
There are many approaches to tinnitus management, and numerous mainstream and alternative therapies have been tried.
It is likely that there are many different types of tinnitus lumped together under the term “tinnitus”, so whilst alternative therapies that promote relaxation might work better for individuals whose tinnitus is mainly stress related, they don’t do much to manage the effects of hearing loss and so on.
Scientific reviews looking at a wide range of studies of tinnitus treatment suggest that a combination of managing hearing, sound therapy and psychological management is most effective.
The term “psychological management” here is used to include giving information and advice about tinnitus, counselling, and more intensive strategies such as cognitive behavioural therapy.
Your tinnitus management programme needs to be carefully tailored to your needs.
Ingredients for our perfect tinnitus management recipe
There are several key management ingredients:
Managing hearing loss - if you have a hearing loss we always recommend fitting appropriate hearing aids, or optimizing your existing hearing aids
Sound therapy - this may consist of either wearable or environmental sound generators
Managing the effects of tinnitus - we work with you to identify what effect the tinnitus is having on you, and what thoughts, beliefs and concerns you have about it
Starting habituation - we then start to break these down, allowing you to start habituating to your tinnitus, meaning that you hear less of it
Learning to relax - relaxation techniques can be extremely helpful
Tinnitus management is very much a “whole person” approach – ignoring emotional state and general health issues really isn’t helpful.
The aim of tinnitus management is habituation
Our brains are amazing! When you walk down a street, or go for a stroll in the country, you are surrounded by millions of different sounds, sights, smells and physical stimuli.
However, you are simply not aware of all of these – your brain selectively attends to what is important to you and ignores what it decides is not. It habituates to unimportant stimuli and tunes in to important ones.
Another example - think about the feeling of the socks or shoes you’re wearing right now. You didn't notice them until I mentioned them – that's because you’ve habituated to the feeling – it’s not an important sensation - you don't notice it.
You've habituated to that sensation.
Tinnitus therapy teaches you to habituate to tinnitus. To habituate means to learn not to be bothered by or perhaps even notice tinnitus by retraining your brain not to listen to tinnitus – if this happens the tinnitus sound is filtered out before you hear it.
What stops habituation
If you are worried or concerned about your tinnitus, find it annoying or irritating, your auditory filters will be expert in picking it up and you will hear it more.
This will stop you habituating to it.
How can you promote habituation?
If you start to understand why your tinnitus is there some of the anxiety and concern will go, and you won’t react so strongly to tinnitus. You can then start to identify and change your thoughts and behaviours towards tinnitus and start to habituate.
The vicious circle shown above starts to reverse.
Fitting hearing aids and using sound therapy can help to support this process.
When habituation starts, you will be less troubled by your tinnitus, hear it less and less, find that it is a meaningless background sound, and may even find that it disappears completely.
Most people habituate to their tinnitus on their own, but if this is not happening then tinnitus therapy is extremely effective – the science backs that up.
Your management journey starts here
We provide tinnitus management for both adults and children.
We ask that you see your GP or other medical specialist prior to arranging an appointment with us to exclude any conditions that need medical or surgical management.
The first step is to identify what is going on. We take a careful case history before checking your hearing. It is important for us to understand what effect tinnitus is having on you, how it makes you feel, and if you are suffering from any consequences such as anxiety or depression.
We also ask about the effects of tinnitus on your life quality, including on your sleep.
We then discuss our findings with you, with the aim of giving you a clear understanding of what is, and as importantly, what is not, the problem.
What happens next?
This may be enough, however for troublesome tinnitus we then arrange a series of 5 - 6 appointments over a six-month period with longer term reviews thereafter as necessary. We much prefer to conduct these sessions face to face, however online sessions are also available.
Management tends to consist of frequent initial sessions, followed by an increasing length of time between appointments. The aim is to give you a toolbox that can be used at home, rather than relying just on management sessions.
You will find more information about tinnitus and how to manage it on these links.