This is applicable to individuals with a hearing loss. Hearing aids will amplify environmental sounds back into ‘normal’ range. This will allow more sound from the outside environment to enter the hearing pathway. This can partially cover the tinnitus sound(s). This results in the tinnitus sound being less prominent. The use of a hearing aid can also mean that a person has to strain less to hear. This makes hearing less tiring and can also make the experience of tinnitus less exhausting. Some people with tinnitus may have only a slight hearing loss. The use of a hearing aid in such cases may still be helpful in reducing the intrusiveness of tinnitus; it is worth talking to your audiologist about this. Some hearing aids have a built in white noise generator which may partially mask the tinnitus.
Sound Enrichment Therapy
Deliberate use of any sound to reduce tinnitus awareness or reduce the distress associated with it.
Environmental sounds such as a busy street, chatter of an office, desk fan and so on.
CDs and downloads
- Relaxing sounds such as bird song or rainforest sounds.
- White noise/pink noise/brown noise.
Bedside sound generators
- These devices have built-in relaxing sounds which usually include a timer setting to turn off the sound automatically after a set period of time. These can be linked to a pillow speaker.
- These devices are particularly good for night time use when going to sleep, waking up in the middle of the night and waking up in the morning.
Ear level sound generators/White Noise Generators (WNG)
- Produce constant white noise.
At present, there is no drug treatment for subjective tinnitus which is FDA recommended. Some people become anxious or depressed in response to tinnitus and are therefore offered antidepressant medicines. By relieving the symptoms of depression these medicines can help break the vicious cycle between these symptoms and tinnitus distress. Some people are also offered sleeping medicine. These will usually be prescribed by your GP. Some may increase tinnitus annoyance or intensity, and therefore these could be reduced after discussion with your GP.
Mindfulness Based Cognitive Therapy (MBCT) is one of the latest developments within CBT. It uses meditation exercises as a method for helping a person observe their physical, emotional and cognitive reactions to things. This observation can help us to respond more carefully to situations rather than automatically reacting to them. This can help us be less distressed. Learning MBCT skills usually takes a few months of regular practice; most people find the practice enjoyable. MBCT is part of the NICE guideline for the management of depression and is also used in many anxiety clinics. It is also increasingly used in physical medicine and has been used in a number of specialist tinnitus clinics for the past ten years. There is now a growing evidence base indicating that it is an effective way of managing tinnitus for many people.
Some people with tinnitus complain about difficulties sleeping. Not everyone with tinnitus, however, has a sleep problem. Many people with tinnitus actually sleep very well. The link between tinnitus and sleep problems is therefore not inevitable. The sleep problem is more closely linked to the anxiety or depression that tinnitus can cause. Research suggests that when sleep problems are present they are much the same as insomnia when it occurs without tinnitus. It is now thought that when tinnitus and sleep problems are both present the best approach is to focus on treating the sleep problem and that this will reduce the distress and intrusiveness of tinnitus. Medication can help in relieving sleep problems but they should be used only in the short term. The best way of treating longer standing insomnia is to use cognitive behaviour therapy (CBT).
There is a close link between tinnitus and stress. Many people find tinnitus stressful and find that tinnitus is more intrusive when they are stressed. Learning to relax can help to break the vicious cycle. According to the British Tinnitus Association, there are several activities which may help to relieve stress. These include exercise, socialising, changing things in your life which cause you stress (if possible); Other methods of relaxation include breathing exercises, aromatherapy, yoga and tai chi. These things can help you ‘relax’ in a general sense and as a result may reduce the intrusiveness of your tinnitus. “The purpose of relaxation is not to reduce tinnitus, but to deal with the consequences of it” (Andersson & Kaldo, 2006). In a more specific sense relaxation can be achieved by learning progressive muscle relaxation exercises. There is evidence in the scientific literature that these techniques can lead to a reduction in tinnitus related distress and to an improvement in psychological well-being.