New treatment guidelines help sufferers get the absolute best care…

It’s estimated that about one in 10 Americans hears noise—ringing, buzzing, roaring, hissing, whooshing or clicking sounds—when no external sound is present. This condition, known as tinnitus, can be a minor annoyance, or the sound can be loud enough or persistent enough to make concentration, sleep and communication impossible. The torment even drives some sufferers to suicide.

About 20% of people with tinnitus seek medical help. But far too many are told there’s nothing that can be done and they should “learn to live with it”—a hopeless prognosis that only compounds their suffering.

Recent development: A panel of leading experts from the American Academy of Otolaryngology—Head and Neck Surgery Foundation has developed new diagnostic and treatment guidelines, which will help tinnitus sufferers get much better care. What you need to know… 

Determining the Cause

When you see a doctor for tinnitus, he/she should start with a physical examination and detailed medical history to determine if it’s caused by a treatable condition, such as…

• Ménière’s disease. Intense vertigo is the most dramatic symptom of this condition, but hearing loss and tinnitus can be symptoms as well. Diuretics or steroids, taken as needed, may help the disease and relieve the tinnitus.

• Cochlear hydrops. This condition, caused by increased fluid pressure in the inner ear, is like Ménière’s disease but without the vertigo. It can often be cured by reduced intake of salt and use of a diuretic, taken as needed, to eliminate fluid, which in turn alleviates the tinnitus.

• Temporomandibular joint (TMJ) syndrome, whiplash or head or shoulder muscle injury. These issues can activate nerve signals that the brain interprets as sound. Physical therapy, chiropractic treatment and/or orthodontia may help these problems and the tinnitus.

• High blood pressure. Elevated blood pressure alters the inner ear chemistry to cause tinnitus in some people. Effective treatment of hypertension may stop the tinnitus.

• Anxiety and depression. Tinnitus aggravated by anxiety and depression may be alleviated by therapy for these conditions.

• Excessive earwax. Removal of the wax stops the tinnitus.

• Medications. Most commonly, nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve), can cause tinnitus and should be stopped if suspected. Note: Low-dose aspirin (81 mg), often used for heart health, is not known to cause tinnitus.

What a physical exam should include: A hearing test (audiometry). Hearing loss is common with tinnitus, and a hearing aid sometimes makes it better (see “Sound therapy” below).

More advanced tests like magnetic resonance imaging (MRI) are usually not required. But when tinnitus and hearing loss are limited to one side, such tests may be needed to rule out a benign tumor on the acoustic nerve—a rare condition known as acoustic neuroma.

Many tinnitus cases, however, are “idiopathic”—there’s no identifiable underlying disease.

Treatments That Help

The expert panel approved the following two therapies for idiopathic tinnitus. Patients can try both at the same time or do them individually…

• Cognitive behavioral therapy (CBT). This type of therapy aims to alter negative thinking about tinnitus and its effects on your life. When the patient understands tinnitus better (for example, “It’s not my fault”), it takes away some of the mystery and reduces associated distress. To find a CBT therapist, go to the website of the American Tinnitus Association.

• Sound therapy. Just as the ticking of a clock in a quiet room becomes inaudible when there’s traffic in the street outside, background sound can reduce or relieve tinnitus. This masking effect is the simplest form of sound therapy. To mask the tinnitus sound, the patient wears earbuds that deliver white noise, nature sounds or low-volume music. In other forms of sound therapy, enjoyable sounds or music is mixed with the sound that mimics a patient’s tinnitus.

Simply getting a hearing aid to correct hearing loss is also a type of sound therapy—restoring normal perception of external sound often makes the phantom noise much less noticeable.

According to recent sound therapy research, such treatments reduce tinnitus over time, possibly by retraining the brain circuits that generate the perceived sound.

You can develop your own sound therapy program by using apps such as Nix Tinnitus Ear Amp at Bxtel.com ($1.99, iOS)…and Tinnitus Balance at Phonak.com (free, iOS and Android).

Important: Stress does not cause tinnitus, but sufferers will tell you that it can worsen it. Do all you can to keep stress levels in check. Helpful: Counting breaths. What to do: As you inhale slowly, count from one to four. Then, as you exhale, count from one to six. The longer exhale makes this exercise particularly relaxing. Repeat these breaths for about a minute, every waking hour for several weeks, to establish the habit. Then you can use these exercises any time you need to de-stress.

Worth Trying?

The evidence is limited or mixed for the following treatments, and the recent guidelines advise against most of them. But some people report that these approaches help, so you may want to consider trying them… 

• Supplements. Numerous studies suggest possible benefits of supplements for tinnitus. For example, magnesium may improve hearing loss, and alpha-lipoic acid may protect the ears against damage from loud noise or drug toxicity. Also, some research has shown an association between tinnitus and low levels of B vitamins or other nutrients. In practice, some clinicians report improvements in patients who take the supplements described above as well as coenzyme Q10, zinc, selenium and/or other antioxidants that are important for hearing chemistry.

• Alternative and experimental approaches. Acupuncture has been used for tinnitus since the fifth century BC, but scientific reviews have found no conclusive evidence that it works (the panel made no recommendation for or against this treatment). Repetitive transcranial magnetic stimulation (rTMS), in which external magnetic fields are applied in an attempt to change brain function, is now being offered for tinnitus in some clinics, but the FDA has not approved the treatment for this condition and research has not yet shown evidence that it offers long-term benefit.