Jude Liptak, Au.D., is a board-certified doctor of audiology and director of the Colonial Center For Hearing, located in McLaws Circle of Williamsburg.

A Ringing in the Ear: Treating Tinnitus and Hyperacusis Part Two in a Series by Jude Liptak, Au.D. Published: August 2006 Tinnitus sufferers describe the sensation of “ringing in the ear,” even when no external sound is present. Patients with hyperacusis, on the other hand, report an extreme over-sensitivity to sound. Hyperacusis is often accompanied by tinnitus, and in some cases, can occur among people with perfect hearing. There is no guaranteed “magical cure” for the annoyance and intrusiveness of both tinnitus and hyperacusis, but there are a variety of therapies, which, when used over time, can help a patient successfully manage his or her condition. Treating Tinnitus A person’s auditory system normally disregards a majority of auditory signals in the environment, but it’s still able to detect weak yet significant patterns. For example, you may hear your name mentioned through the background babble of a cocktail party. For a person with tinnitus, though, important sounds are ignored while other signals are amplified. Tinnitus is a condition that can affect a person’s quality of life. The hearing system has a natural filtering mechanism, meaning that we usually only perceive sounds of importance or interest. If a person is in a car and surrounded by traffic noise, for example, he or she won’t hear the sound of traffic and instead will detect the remote sound of a police siren. Similarly, a person with tinnitus hears certain sounds above other background noise. Once tinnitus is present, and the emotional and arousal centers of the brain have been activated, a person’s perception of the tinnitus is enhanced, and he or she begins to focus on the ringing. A cycle then begins which makes the sound more and more pronounced. The primary method for managing tinnitus is auditory habituation therapy, which involves retraining the part of a patient’s brain that detects the ringing sensation by stimulating hearing with either low-level noise or amplified environmental noise. An audiologist may use a high-fidelity digital hearing aid or, in some cases, create the same effect by amplifying a sound over a length of time. Whichever method is used, the goal is to remove tinnitus perception from the consciousness and to begin the process of tinnitus habituation, or desensitization to the signature “ringing” sound. Eventually, the patient can gain relief from the annoying ringing. Any management technique is used in conjunction with an intensive counseling program to teach people not to consciously attend to their tinnitus. Through counseling, the patient can gather information about tinnitus, its likely mechanism, ways to adapt, and coping techniques. It’s normal for people to occasionally hear sounds within their ear, so it’s not important that tinnitus be totally eliminated, rather that it be no longer annoying or distressing. Stress management techniques such as relaxation tapes (either instructional tapes or soothing music) or relaxation therapy can help. Treating Hyperacusis The amplifying effect of hyperacusis causes some patients to resort to wearing earplugs, even during normal conversation. Managing the effects of hyperacusis involves two steps: first, weaning the sufferer off hearing protection (e.g., ear plugs, headphones), and second, stimulating the auditory nerves via sound therapy. A patient with hyperacusis should gradually stop using hearing protection. Specialized earplugs are available that can filter loud sounds while still allowing quieter sounds to pass through. Therapeutic noise generators (or hearing aids) are then used in combination with patient counseling, similar to the way tinnitus is treated. Because they can be irritating to the sufferer, both tinnitus and hyperacusis can affect a person’s concentration and overall mood, thus placing strain on personal and professional relationships. Coping with tinnitus or hyperacusis involves explaining the condition to family members and asking them to be more understanding. A lack of understanding from family and friends can add to a patient’s frustration and slow recovery. A patient should ask others to reduce loud noises in the home, at the workplace or other noisy environments. Methods for Treating Tinnitus Sound therapy involves using low-level sounds that blend with rather than cover the sound of the tinnitus. With this approach, the patient’s hearing is stimulated for a minimum of eight hours per day up to 18 months. Therapeutic noise generators create a low-level hissing sound. This noise interferes with pattern recognition, making it more difficult to separate the tinnitus signal from background noise. The auditory pathways adapt to the new level of background activity and the perception of the ringing is reduced. In many cases, these devices can be more annoying than the actual tinnitus. Most audiologists prefer hearing aids. Digital hearing aids offer new solutions to tinnitus management. To treat tinnitus, the patient must wear a specially-programmed hearing aid for a minimum of 8 hours per day to stimulate hair cells (nerve synapses). The hearing aid should amplify the sound frequencies where tinnitus is present, thus eliminating the tinnitus. Assistive Listening Devices (ALDs) are used in combination with some hearing aids to provide additional stimulation of the hearing pathways. These devices can be connected directly into a radio or television, allowing the patient to receive a signal that’s been specifically adjusted for his or her hearing loss. Bedside noise generators are alternatives to wearing hearing aids during sleep. Tinnitus is often most noticeable in quiet situations such as lying in bed at night, so devices are available for nighttime sound therapy. These devices look like small radios and are often called “bedside maskers” or “sound conditioners.”  Most can be programmed to play a number of different sounds (e.g., rainfall, ocean surf). Portable music players such as the Sony Walkman and Apple iPod are alternatives to noise generators; however, they’re not the best approaches for sound therapy. Herbal Therapies Some believe Ginkgo biloba may minimize the effects of tinnitus that are caused by impaired circulation because magnesium phosphate and potassium phosphate (two active ingredients in this extract) have shown results among some patients. However, in a 12-week trial involving 978 people, researchers concluded that Ginkgo biloba extract was no more effective than a placebo in improving symptoms of tinnitus, stating that it “seems to be ineffective in treating tinnitus alone, but it may be effective in treating tinnitus in patients who also have other symptoms of cerebral insufficiency.” Consult your primary care physician before starting any herbal regimen for the treatment of tinnitus.

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