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 has also been 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. Hyperacusis (sound sensitivity) is present for about 40 % of those who have tinnitus. 

An important fact is that there is no difference in the physical characteristics of the tinnitus sounds perceived by people who suffer from 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; however, it can emerge without any injury to the ear at all. We know that in about 18% of cases, tinnitus can completely resolve on its own. About 9% of people who are bothered by tinnitus will naturally habituate on their own, meaning the tinnitus becomes non-bothersome even if the tinnitus remains. This is very important as many people are told “there is no cure” and believe they will be stuck with tinnitus forever.

Before seeing a doctor for your condition, you may have explored causes and ways to get rid of tinnitus. If it interferes with your quality of life, such as your ability to focus, work, hold conversations, sleep or socialize, it’s time to see a specialist. A routine hearing test can rule out medical issues with the ears that may need to be addressed. Once that has been completed, if you are not bothered, you do not need to worry about tinnitus, as it does not cause damage to your ears. 

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. 

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).

Regardless of the structural issue in your ears, or if there is no structural basis found, most of tinnitus is generated by the brain. Because brains are adaptive, the tinnitus can change, this is called neuroplasticity. As a matter of fact, we often call tinnitus a neuroplastic symptom.

Tinnitus Treatment

Tinnitus can feel overwhelming, but the brain has an incredible capacity to adapt and change. Our approach is grounded in the science of neuroplasticity and is designed to help reduce the impact tinnitus has on your daily life.

Rather than focusing solely on managing symptoms, we help patients understand how the brain and nervous system influence the tinnitus experience and teach evidence-based strategies that support recovery. Through education, nervous system regulation, and personalized treatment, many people find that tinnitus becomes less noticeable, less distressing, and no longer interferes with the things they enjoy.

While tinnitus may not always disappear completely, meaningful improvement is possible. Our goal is to help you regain a sense of control, restore confidence, and support your brain's natural ability to change so that tinnitus becomes a much smaller part of your life.

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 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 individual sessions in which our experts create a plan to address the most annoying aspects of tinnitus. The plan is very individualized and tailored to the experience of each person, depending on where they are in your tinnitus journey. Our treatment approach is guided by many different modalities, such as the principles of Tinnitus Retraining Therapy (TRT), Progressive Tinnitus Management, University of Iowa’s Tinnitus Activity Treatment, Cognitive Behavioral Therapy and tools for chronic pain (such as Pain Reprocessing Therapy). Individual management sessions may include the use of sound generators (also known as maskers), hearing aids, stress management, relaxation training and tools to help you use your brain’s natural neuroplasticity to reduce tinnitus such as graded exposure or somatic tracking. 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

Tinnitus is a complex condition influenced by the auditory system, the brain, and the nervous system. Our approach combines decades of knowledge from Tinnitus Retraining Therapy (TRT) with newer neuroscience and neuroplasticity-based approaches that help reduce the brain's perception of tinnitus as a threat.

A cornerstone of treatment is education. Understanding how tinnitus is generated and why it becomes distressing can be an important first step toward recovery. During your evaluation and follow-up visits, we explain how the auditory system, emotional centers of the brain, attention networks, and the autonomic nervous system work together to influence the tinnitus experience. For many people, learning that tinnitus is a result of normal brain processes, not damage that is actively occurring, helps reduce fear and creates the foundation for lasting improvement.

Treatment is individualized and may include strategies that help retrain the brain's response to tinnitus through neuroplasticity. Depending on your needs, this may include nervous system regulation, changing unhelpful patterns of attention and fear, graded exposure to reduce sound sensitivity or avoidance, and building new experiences that teach the brain tinnitus is a safe, non-threatening signal. These approaches help many patients find that tinnitus becomes less noticeable and less disruptive over time.

Using Sound as a Tool

Sound therapy remains an important part of tinnitus management, but it is viewed as one of many tools available—not the only treatment. Sound can provide temporary relief, promote relaxation, improve sleep, enhance concentration, and make tinnitus less prominent during periods of increased distress. As recovery progresses, many patients find they rely on these tools less frequently.

Sound support may include:

• Tabletop sound machines
• Home virtual assistants
• Pillow speakers
• Headband headphones
• Bone conduction headphones
• Wireless earbuds
• Sound apps on smartphones or tablets
• Hearing aids or wearable sound generators, when appropriate

Not everyone with tinnitus needs a device. Hearing aids are recommended when hearing loss is present and may reduce the awareness of tinnitus while also improving communication. Other wearable sound devices may be helpful for selected individuals, but successful tinnitus treatment does not depend on purchasing specialized equipment. Our recommendations are based on your individual hearing, symptoms, goals, and lifestyle.

Supporting the Whole Person

Although tinnitus is generated by the brain, it is not "all in your head." Tinnitus is a real sensory experience. However, factors such as stress, anxiety, heightened nervous system activation, and emotional responses can significantly influence how loud or intrusive tinnitus feels.

Because of this, treatment often includes strategies that support the health of the entire nervous system. Depending on your needs, recommendations may include:

• Education and individualized counseling
• Nervous system regulation and relaxation strategies
• Stress management
• Attention and concentration strategies
• Sound therapy
• Hearing technology, when appropriate
• Somatic tracking and other mindfulness-based techniques
• Graded exposure to reduce fear and avoidance
• Emotional awareness and processing strategies
• Referral to other specialists, such as ear, nose and throat physicians, behavioral health providers, or your primary care physician when additional treatment may be beneficial

Our goal is to help you build confidence, reduce the impact tinnitus has on your life, and support your brain's natural ability to adapt so that tinnitus becomes less noticeable and less distressing over time.

Biopsychosocial Model 

The biopsychosocial approach addresses symptoms from multiple angles.

• Physical
• Psychological
• Emotional 

We now understand that the brain has a much greater influence over physical sensations in our bodies than we once thought. Rather than focusing only on the physical aspects of symptoms, we consider how multiple factors interact to affect your health and reaction to sounds. This may include current and past life stressors, the impact of symptoms on your life and your thoughts and emotions. Each factor alone may not be enough to create your symptoms, but the interaction of these factors contributes to the course of your symptoms, suffering and healing. 

How We Use the Biopsychosocial Model 

Before you come to the clinic, we collect a comprehensive case history. This includes detailed information about medical evaluations and interventions you’ve received, how your symptoms began, how they are influencing your life now and your current life situations. You will complete a stress inventory about stressful life events that may be influencing your symptoms. The care team will look at the physical, mental and emotional impact of symptoms on your life and provide tools for each aspect. This mind-body approach considers the interaction between your outside and inside worlds in understanding health, illness and health care delivery for you.

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. 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

Websites

• Yonit Arthur, Aud, The Steady Coach
• Julian Cowan Hill
• Association for the Treatment of Neuroplastic Symptoms
• Veterans Administration Progressive Tinnitus Management

Resources for Those Outside of Wisconsin
Below is a list of centers with providers that can see people virtually across the US and internationally. These providers are trained in the same modalities and philosophies that our audiologists use in treating tinnitus, hyperacusis and misophonia.

• Mind Body Therapy Center
• Pain Psychology Center
• The Better Mind Center

How to Make an Appointment

Our providers are licensed in the state of Wisconsin. Healthcare practice is legally determined by the patient's physical location. At this time, we can ONLY work with people who are in the state of Wisconsin. If you are outside of Wisconsin, see our Resources section for more information you can access online and for providers who are treating people outside of Wisconsin.

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 care team members. 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
Alyssa Hazel, AuD, CCC-A 
Kimberly Beres, 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 does not always have a cure, meaningful improvement is possible. With education, personalized treatment, and evidence-based strategies that support the brain's natural ability to adapt, many people experience less distress, greater confidence, and a significant improvement in their quality of life.

Below are excerpts from patients who have shared their experiences with our program.

• “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!”
• “She is by far the best Audiologist I have seen in my 10 years of coping with hearing loss/tinnitus. She's given me hope when others I had seen had told me nothing could be done. I very much appreciate her compassion, intelligence & holistic approach to addressing my tinnitus.”
• “She is an excellent provider. Clearly a master practitioner, she gave me extraordinary attention and great information. I understand my condition very differently than I did before I came in from my appointment with her. I am so grateful for her knowledge and her ability to communicate so effectively.”
• “What a great experience! Listening, explaining, suggesting. I have been plagued by tinnitus for decades and now, finally, have a positive direction and action plan on how to deal with this.”
• “This was by far the best experience I've had. She was very thorough, listened to me and took all the time necessary to provide me with a care plan. I didn't feel rushed, anxious or dismissed at any point during the appointment. I learned a lot about my condition and felt validated by her-Thank you!
• “She is very knowledgeable in her field. She is passionate about her work. She listened to my concerns and gave me some good strategies to help deal with the stress and anxiety I have in dealing with Pulsatile tinnitus.”
• “I cannot tell you how helpful this appointment was for me. It was truly transformative. On the drive home, I felt a peacefulness in my heart that I have not felt since my tinnitus flare-up. I now know there is a path toward healing -- and an opportunity to have a more healthy relationship with my nervous system, which will have all kinds of benefits beyond tinnitus.”