Managing Tinnitus (Ringing in the Ears)

Tinnitus refers to the perception of sound in the ears or head that is not produced by an outside source. It is a symptom, not a disease. While tinnitus is often associated with ringing in the ears, people experience tinnitus symptoms in different ways. It is also described as hissing, roaring, buzzing or static. Tinnitus can be constant, can vary in intensity or may come and go. It can range from high to low-pitched, tonal or multiple tones, can pulsate and may be perceived in one or both ears or in the head.

Facts About Tinnitus

About 60 million or more Americans experience tinnitus of some type. Studies show that 10% to 15% of adults experience constant tinnitus, and about 2 million people are seriously debilitated from their tinnitus. It interferes with their ability to function day-to-day. For about 75% to 80% of people, it is not bothersome. An important fact is that there is no difference in the physical characteristics of the tinnitus sounds perceived by people who suffer with it and those who are not bothered by it. Tinnitus tends to increase in prevalence with age and is most commonly associated with hearing loss. It does not go away by itself.

Before seeing a doctor for your condition, you may have explored causes and ways to get rid of tinnitus. If it is interfering with your quality of life such as your ability to focus, work, hold conversations, sleep or socialize, it’s time to see a specialist. Tinnitus will not go away by itself.

Myths About Tinnitus

Be aware that there is a fair amount of misinformation about tinnitus.

Myth 1: Tinnitus will make you go deaf.

Although tinnitus is associated with hearing loss, it doesn’t cause hearing loss or deafness. The opposite is true: Hearing loss is typically the cause of tinnitus.

Myth 2: Tinnitus interferes with your hearing.

Tinnitus won’t affect your hearing, although it may affect your ability to focus and your attention span. Tinnitus may seem worse if your hearing loss increases because outside sounds will no longer help in covering up your tinnitus.

Myth 3: Dietary changes can help.

Reducing your intake of caffeine, alcohol, salt or otherwise restricting your diet will not change tinnitus. Although some people may relate temporary increases in tinnitus to some of these substances or foods, diet is not the underlying cause of tinnitus and elimination will not cure it.

Myth 4: Medications and supplements can help.

They won’t. There are no effective medications or supplements for tinnitus, including prescription medications and over-the-counter remedies. This includes products marketed specifically for tinnitus relief that are available in most pharmacies. Save your money, because they don’t work.

What Causes Tinnitus

Ninety percent of tinnitus cases are associated with hearing loss, and in most cases, tinnitus is not a sign of something serious like an underlying medical condition. Tinnitus is most often a benign condition, meaning that the presence of tinnitus does not cause physical harm to the ears or body, and tinnitus will not cause hearing loss or damage the ears.

To date, there is no known cure for all types of tinnitus, and it is rare to experience total reduction of tinnitus sounds through medical intervention.

In addition to hearing loss, causes of tinnitus vary and may be linked to the following:

• Ear canal conditions: Infections like swimmer’s ear or impacted ear wax or other debris in the ear canal.
• Middle ear conditions: Infections, a perforated ear drum, stiffening of the middle ear bones (otosclerosis) or spasming of muscles in the middle ear (myoclonus/tensor tympani syndrome).
• Inner ear conditions: May include damage to nerve endings like sensorineural hearing loss, damage caused by noise exposure, Meniere’s Disease (a balance disorder) or benign tumors such as acoustic neuromas, which develop on the vestibular nerve leading from your inner ear to your brain and affect balance and hearing.
• Injuries and other problems: Head injuries, neck issues, temporomandibular joint disorders or TMJD (jaw misalignment), reactions to certain medications, thyroid issues or blood flow issues near the ear (pulsatile tinnitus).

Tinnitus Treatment

Tinnitus treatment is about managing the condition and learning how to cope with it. While treatment won’t cure tinnitus, there is a difference between no cure and no help. Our goal is to help patients understand and gain control over their tinnitus, rather than tinnitus having control over them. We hope to help patients progress to the point where tinnitus is no longer a negative factor and to help them resume enjoying life as much as possible.

We will develop a personalized tinnitus management plan for you that you can practice at home. Educational counseling helps people understand tinnitus generators in the brain and how the body responds to distressing tinnitus. Specific tools are outlined and reviewed in detail.

What to Expect During Tinnitus Treatment

When you make an appointment with our audiologists, you can expect the following.

Psychosocial Evaluation

Each patient will complete a packet of questionnaires and history to assess individual needs and factors affecting their perception of tinnitus and sounds.

Comprehensive Hearing Evaluation

A hearing evaluation determines if hearing loss is present. It also helps us rule out potential medical issues related to tinnitus that would require further evaluation with an ear, nose throat or other specialist. Your hearing status allows us to recommend hearing aids to improve issues related to impaired communication. Often, determining the physiological basis of tinnitus and fitting you for hearing aids can be the best course, especially for those with milder forms of tinnitus and hearing loss that can be helped with hearing aids. Your hearing evaluation can be completed at any Froedtert & MCW audiology clinic. Evaluations completed by an audiologist outside of the Froedtert & MCW health network will be accepted as long as they are no more than six months old.

During the evaluation, an audiologist will perform a complete hearing test, which may include extended frequency range testing to determine whether hearing loss or damage to the auditory system exists. A detailed discussion with you ensures that you have a clear understanding of your hearing acuity and what affects and generates tinnitus. We will also discuss the various origins of tinnitus, including the most likely cause of your tinnitus.

Other assessments may be included based on individual needs such as:

• Referral to other specialists: Referrals may be necessary depending on the outcome of the initial tinnitus management appointment.
• Optional tinnitus management sessions: Depending on the responses to your questionnaires, tinnitus-specific management strategies may be needed. We offer group and individual sessions in which our experts review a sound therapy plan to address the most annoying aspects of tinnitus. The plan is guided by the principles of Tinnitus Retraining Therapy (TRT). Individual management sessions may include the use of sound generators (also known as maskers), hearing aids, stress management and relaxation training or referral for counseling. Depending on the severity and nature of your tinnitus, only one or two or perhaps several of these management options may be recommended.

Insurance

Assessments are billable to most insurance carriers. Your insurance carrier may require a referral. However, please be aware that management consultations are never billable to insurance. You are responsible for payment at the time of your appointment. See the Tinnitus Management Appointment Agreement form for details. You must review it, sign it and return it to our clinic before scheduling your appointment.

Tinnitus Management Options

Our audiologists are trained in and practice the basic principles of Tinnitus Retraining Therapy (TRT). TRT is based on the principle idea that non-hearing systems play a significant role in troublesome tinnitus. Therefore, a key component in tinnitus management involves comprehensive education and counseling, with emphasis on teaching the basic functions of the auditory system and the brain in reference to the perception of tinnitus. In particular, we’ll cover the brain systems that deal with emotions (limbic system) and the nervous system that controls all body functions and triggers the "flight or fight" reaction (autonomic nervous system).

The auditory (hearing) pathways play a secondary role. According to this model, the annoyance of tinnitus is determined by the limbic and autonomic nervous systems. It should be noted, though, that it is the limbic and nervous system responses that result in the annoyance felt by the person with tinnitus. For the most part, the actual volume or pitch of tinnitus doesn't matter.

To understand how tinnitus emerges, it is helpful to understand how sound is processed in the pathways of the brain that process sounds (auditory pathways). This is the basis of habituation — retraining the brain to filter out sounds and classify tinnitus activity as an unimportant signal. Decreasing negative reactions to tinnitus is a primary goal of the therapy.

In addition to education and counseling, tinnitus management usually includes sound therapy. Although there are no cures for tinnitus, there are several options to use sounds that can produce relief. This can be done through a variety of sound-generating devices you may already have, such as:

• Table-top sound machines
• Home virtual assistants
• Pillow speakers
• Headband headphones
• Bone conduction headphones
• Wireless earbuds
• Sound apps on smart devices (tablets or smartphones)
• Wearable/custom fit devices such as hearing aids or sound generators

Although negative psychological or emotional reactions are associated with distressing tinnitus, it isn’t “all in your head.” Tinnitus is a real problem – it is not imagined. Almost all patients indicate that stress or tension makes their tinnitus worse. Since stress is highly correlated with tinnitus increases, stress management and nervous system regulation strategies are often used. Research tells us that when relaxation strategies are used with sound therapy, patients experience improvement faster.

Other relief techniques may involve medications to help control anxiety, depression or insomnia. We recommend that you contact your primary care physician for prescriptions, as our audiologists are not medical doctors and cannot prescribe medications.

Because concentration and focus are some of the highest ranking issues with tinnitus, ways to improve attention in the presence of tinnitus is a common goal of management. Sleep is often disrupted by tinnitus and when necessary, specific sleep strategies are reviewed to make sure high quality sleep is restored.

Other management options include:

• Tinnitus coaching
• Counseling
• Stress management
• Relaxation therapy
• Habituation therapies
• TMJD treatment
• Acupuncture
• Physical therapy

Individual Sessions for Distressing Tinnitus

To participate in a one-on-one session with a tinnitus expert, you must first complete a comprehensive hearing evaluation.

These sessions are for people with mild, moderate or severe tinnitus distress, multiple tinnitus-related issues and/or sound sensitivity issues. Additional individual sessions may be scheduled as appropriate. You can complete the comprehensive hearing evaluation on the same day your individual management session is scheduled.

Hearing-related issues are identified and addressed based on the comprehensive hearing evaluation. The purpose of working with a tinnitus specialist one-to-one is to address multiple tinnitus-related issues such as sleep disturbance, focus/concentration issues and emotional well-being. Other issues of hearing loss or sound sensitivity can also be addressed.

Our tinnitus specialists are trained in using multiple tools to address all possible related issues. If hearing aids have been recommended, you can work with a tinnitus-trained professional to ensure the appropriate style and features are available to maximize your hearing and reduce tinnitus-related issues.

Each individual management session is scheduled for 90 minutes. The cost is $180, which is not billable to insurance. Payment is collected when you arrive for the scheduled appointment.

Hope for Tinnitus Patients

Experiencing distressing tinnitus issues can be extremely upsetting and even life-altering. Our goal is to approach each person as an individual. We want to understand your specific physical, psychological and emotional needs and get you on the path to healing.

The audiologists who work each day with people struggling and suffering with these conditions do so because they have a passion to help others restore and improve their lives. Our program provides relief, improvement of quality of life and hope. Even when a cure is not possible, healing is always possible. Hope is very much alive.

Are You in Crisis?

If you're considering suicide, or have thoughts of suicidal ideation, call a suicide hotline or go to the nearest emergency room for immediate help. The National Suicide Prevention Lifeline is available 24/7.

• 1-800-273-8255
• Crisis Text line: Text HOME to 741741

Resources

Handouts

• Mental Health
• Sound Therapy

Our Tinnitus Videos

• Sound Therapy
• Program Video

Websites

• Joey Remenyi Seeking Balance
• Bruce Hubbard (Cognitive behavioral therapy)
• Veterans Administration Progressive Tinnitus Management

How to Make an Appointment

Because everyone’s tinnitus and sound sensitivity is different, it is essential that we gather information about the specifics of the conditions you are dealing with to ensure we schedule you for the correct assessments and with the appropriate providers. After we receive your completed forms, we will review them and contact you to schedule an appointment. Typically, you may expect a call within a week of the date the completed forms are received.

For your convenience, you can fill all of this out online and submit the form here. The form allows you to upload your records and answer questions about the impact tinnitus has on your life.

Tinnitus New Patient Form

If you prefer, you can download a PDF of the intake form and fill it out. You can fax or mail the filled-out form to the number and address below. We do not support e-mailing your form.

Return Forms

• Fax: 414-269-8157
• U.S. mail: Froedtert Hospital Audiology, 9200 W. Wisconsin Ave., Milwaukee, WI 53226

More Information

For more information about services, doctors or clinicians with the Tinnitus and Hyperacusis Program, please call 414-805-8569, or e-mail us at [email protected].

Tinnitus Specialists

Our team is made up of audiologists who specialize in evaluating and managing tinnitus. We have been helping people since 2008. Our audiologists have extensive training and many years of experience with people who experience a mild to severe disturbance from tinnitus. They continually develop their skills and remain current on the most evidence-based practices.

Marcia Dewey, AuD, CCC-A
Kayla Sanders, AuD, CCC-A
Ann Smith, AuD, CCC-A
Kasey Gillmore, AuD, CCC-A

This team collaborates with others who treat disorders that can contribute to tinnitus or make it worse. These specialists include:

• Ear, nose and throat specialists (otolaryngologists) who treat disorders of the ear
• Tinnitus counselors who provide cognitive behavior therapy (CBT) and stress relief
• Dentists who treat temporomandibular joint disorders (TMJD)
• Physical therapists who help people improve neck and jaw issues

Our audiologists provide education, management techniques and tools to gain control and relief of symptoms and the strong reactions associated with tinnitus.

What Our Patients Say About Their Tinnitus Treatment Results

Although tinnitus can’t be cured, with therapy and management techniques, its impact can be reduced. Below are excerpts of what some patients have said about their results.

• “I felt like there was a rock on my chest, and I was drowning. I feel like the rock has been removed, and I have hope.”
• “Basically, for three days straight I could not hear any tinnitus. I cannot express to you how nice that was.”
• “Something amazing has happened with my right ear. For the last 24 days, there has been a 40% to 50% reduction in the tinnitus. It has dropped to a considerably lower level and stayed there. I wasn't expecting this, given that I had tinnitus in my right ear for the last 23 and a half years.”
• “The 19 good days were almost twice as much as I had done previously … In January, having just three bad days in August would have been almost unimaginable.”
• “I’m doing GREAT now … I can't describe the state I was in. You are one of God's angels.”
• “Thank you for taking the time to help me with such an unknown situation.”
• “It has been weeks since I have had a problem with the tinnitus, and static noise is greatly diminished.”
• “I am noticing a definite improvement.”
• “What would I do without you and the program you created at Froedtert? I am not alone in this … solely because of you.”
• “Meeting this provider was literally a lifesaver. She listened, acknowledged my feelings and my journey and spoke to me in a compassionate way. She is so knowledgeable about sound sensitivity and happy to say that after six months. I have finally found ‘my people!’ Thank you!”
• “Excellent care; information about tinnitus very reassuring, easy to understand.”
• “She was very professional and focused on my situation. Very personable.”
• “She was amazing — so detailed on what was going on. I learned a lot!”
• “She is the best doctor I have seen, ever.”
• “The provider answered all my questions and didn't rush me. She always treats me with respect.”
• “The doctor spent a lot of time with me making sure I understood what is going on with my ear. Her descriptions and explanations are perfect. I never felt like something I said was irrelevant or unimportant. She has a gift of putting a person completely at ease. It was a treat to have her as my provider.”
• “She was kind, empathetic and professional. I couldn't have asked for a better audiologist. I'm so happy to have her help with my tinnitus.”
• “The doctor and her student were competent, knowledgeable — explained everything in detail.”
• “She is an amazing audiologist. She always listens and has up-to-date resources. She spends quality time and answers all questions and is willing to discuss all options and treatments. She goes above and beyond to inform about latest research and options. She is amazing!”