Chapter Ten reviews the use of sound therapy, including hearing aids and background sound to help tinnitus sufferers. While not all patients require hearing aids, those who do often report that hearing aids help their communication and provide some degree of tinnitus relief. Background noise or environmental sound is appreciated by those individuals who observe that tinnitus is less noticeable when other sounds are present. We often encourage patients to discover on their own the benefits of using sound to interfere with their tinnitus. If a person with tinnitus learns from experience that they get to sleep more easily on rainy nights than on quiet nights, then they may capitalize on that observation by using sound generators that mimic nature sounds or small waterfall devices to recreate the comforting sound produced by rain. Others will discover that a fan placed in the bedroom at night provides enough sound. In those cases when hearing loss is severe enough to make fans or other sounds inaudible, patients may turn to devices with external speakers that can be placed comfortably under their pillow. Many patients find that trying to cope with tinnitus without the use of environmental sound gives new meaning to the term, "suffering in silence."
Chapter Eleven discusses the healthcare professionals who can assist your efforts to manage the effects of tinnitus. Audiologists, otologists and psychologists are most often consulted; other professionals such as acupuncturists have had success working with patients who suffer from tinnitus. This book is not intended to replace a visit to your healthcare professional as your tinnitus might be a symptom of some other treatable disease. Patients should be encouraged to take advantage of opportunities to access the expertise of many professionals who can help. Tinnitus management is facilitated through interprofessional care and it is important for your initial caregiver, usually an audiologist or otolaryngologist, but perhaps a primary care physician, to identify appropriate referrals to other healthcare providers who would bring clearly-defined roles to the practice of tinnitus management.
Chapter Twelve discusses the variety of medications and dietary supplements that have been used by patients to reduce tinnitus severity. Many individuals report that some drugs and/or supple-ments have helped them. Unfortunately, at present none are widely accepted as a reliable treatment. Another complicating factor presented by non-prescription supplements is that their composition and doses are not regulated in the US. Manufacturers and retailers of dietary supplements and herbal compounds do not conform to the same Federal Drug Administration guidelines as the prescription drug makers. Therefore, occasional extravagant claims can be made about their potential to cure or reduce tinnitus without supporting evidence. Tinnitus also may be an early indication of an adverse reaction to a prescription or over-the-counter medication. If you noticed that tinnitus developed or worsened when your medications were changed, then it's important to discuss your options for medications or supplements with a physician.
Chapter Thirteen reviews hyperacusis, which often occurs with tinnitus. Loudness hyperacusis describes the experience that common sounds of moderate intensity are perceived as excessively loud. This often is accompanied by powerful emotional responses of annoyance and fear. Some even experience pain from sound exposure. These abnormal perceptions of sound loudness occur in 25-50% of patients seen in tinnitus clinics, and it displays its highest prevalence among patients with severe tinnitus. Patients with 'fear' hyperacusis often report that they must curtail activities that involve groups of people or noisy areas. At times, they feel the need to avoid previously-enjoyed places, organizations or entertainment sources in order to maintain a sense of control over their sound environment, and to avoid lashing out at friends and family members. Unfortunately, the more a person withdraws from social situations, the harder it becomes to adjust to the bothersome sounds and restore social ties. Hyperacusis often complicates the manage-ment of tinnitus as it subjects the patient to a second layer of discomfort. However, there are some emerging treatments. Many patients with hyperacusis have reported benefit from listening to low levels of background noise. The reliance upon sound therapy may be counterintuitive because of the aversion the patient has to many sounds. Nevertheless, the use of sound as a therapeutic element can promote desensitization and produce positive results that generalize to many aspects of a patient's life.
Conclusions
You might be reading this book for a number of reasons. Perhaps you feel emotionally drained or irritable because of the persistent nature of the tinnitus sound that you hear. You might have difficulty hearing or lay wake at night trying to get to sleep with a cricket sound in your head that won't go away. Or you just can't focus adequately when you're reading because of the ringing. If any of these problems sounds familiar, you are among the millions of patients who report suffering from tinnitus.
If you're reading this and you don't have tinnitus, but rather it is your spouse, other family member or friend who is affected, then this book is for you too. Most people who know someone with tinnitus want that person to feel better and to function the way they once did. You can be helpful by understanding and by providing support and encouragement. In this way, the isolating aspects of tinnitus can be minimized, and perhaps some of the emotional strain reduced.
It is typical for individuals with tinnitus to search for information on the Internet, in health journals or even glossy magazines found in the grocery store checkout area. Far less typical is the tinnitus sufferer who seeks help from an audiologist or physician. Despite its high prevalence only 7% of the patients followed in a large-scale study contacted a physician for help with the disorder (Davis, 1995). A patient's understanding that there's no simple cure may exacerbate the problem. Tinnitus is often characterized by the patient as an isolating condition perhaps because its persistence reinforces the belief that their sensory environment is corrupted, or somehow different from that of their peers. The tinnitus sufferer often searches for solutions or assistance on their own because they believe that nobody else understands their situation. An Internet search starting from scratch can be helpful, but can also lead to discouraging dead ends and, even worse, suggest false hope in a myriad of 'cures' that carry one guarantee or another. Read this book to deepen your understanding; it can help equip you to ask your healthcare provider the right questions.
Your need for knowledge, understanding, and relief can start here with this book, however these pages are not a reasonable substitute for an evaluation provided by an otologist and audiologist. If you've heard the statement, "there's nothing that can be done about your tinnitus," then you're listening to the wrong person. The implication of this statement cuts to the heart of why this book was written. The fact that there is no cure yet demands your active participation in shaping a strategy, uniquely your own, that helps you experience relief. We have seen, first-hand, evidence of patients who suffered terribly learn over time to manage their tinnitus problem without experiencing a 'cure' or the elimination of their tinnitus. There is no reason that you cannot join them.
References
Andersson G, Baguley DM, McKenna L & McFerran D. (2005). Tinnitus: A Multidisciplinary Approach, London: Whurr Publishers.
Baigi A, Oden A, Almlid-Larsen V, Barrenas ML, et al. (2011). Tinnitus in the general population with a focus on noise and stress—a public health study. Ear & Hearing, 32 (6): 787-789.
Cima RFF, Maes IH, Joore MA, Scheyen DJWM, et al. (2012). Specialised treatment based on cognitive behaviour therapy versus usual care for tinnitus: a randomised controlled trial. Lancet, 379: 1951-1959.
Davis A. (1995). Hearing in Adults, London: Whurr Publishers.
Davis A & Rafaie EA. (2000). Epidemiology of tinnitus. In Tyler R, (Ed.) Tinnitus Handbook, San Diego: Singular Publishing.
Erlandsson S. (2000). Psychological aspects of tinnitus. In Tyler R, (Ed.) Tinnitus Handbook, San Diego: Singular Publishing.
Jakes SC, Hallam RS, Chambers C & Hinchcliffe R. (1985). A factor analytical study of tinnitus complaint behavior. Audiology, 24:195-206.
Kreuzer PM, Landgrebe M, Schecklmann M, Staudinger S, et al. (2012). Trauma-associated tinnitus: audiological, demographic and clinical characteristics. PLoS ONE 7(9): e45599. doi:10.1371/journal .pone.0045599
