Hope for Those with Tinnitus

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By Keynote ContributorLouise HartSenior Audiologist at Action on Hearing Loss

By Louise Hart, Senior Audiologist at Action on Hearing Loss

Having been an audiologist for many years now, often the first comment made by members of the public when discussing tinnitus is “I know there is nothing you can do about it and I just have to learn to live with it”.

It is so frustrating to hear this time after time, because – contrary to public opinion - it’s not true. Although our knowledge and understanding of tinnitus still has a long way to go, in the last few years research has improved its grasp on tinnitus, and as such we are heading in a more positive direction for sufferers.

There are also interventions that we know work, and because of this increased knowledge we are starting to understand why.


What is tinnitus?

Tinnitus is a medical term to describe the perception of noise either in one ear, both ears or in the head, when there is no corresponding external sound.  In the UK there are approximately 600,000 people whose tinnitus has a significant negative impact on their quality of life and health.

When we suffer from a malady, it is normal for us to want to know what the cause is. Like many other health issues the answer to this is never simple. There are many different trigger factors for tinnitus other than the obvious age and noise exposure, for instance ear disease, head and neck disorders, circulation issues, certain medications, and even stress can trigger the onset of tinnitus.


What causes tinnitus?

So what exactly happens in the ear or the brain? At the moment there are several different theories as to where tinnitus may start, how it may start and what processes or parts of the brain may be involved in its maintenance.

As an organization we are funding research at the University of Newcastle to try and delve into the possible different strata of states that we presently think tinnitus may have.

Robert Sweetow (PhD) gives a great explanation of the present theories of tinnitus origin:

  • ‘Disruption of auditory input (e.g., hearing loss) and resultant increased gain (activity) within the central auditory system.
  • Decrease in inhibitory (efferent) function.
  • Over-representation of edge-frequencies (cortical plasticity).
  • Other somatosensory influences (Cervical disturbances, TMJ, etc.).
  • Extralemniscal neurons, particularly in dorsal cochlear nucleus and AII area, receiving input from somatosensory system.
  • Association with fear and threat (limbic system-emotional brain) and increased attention related to limbic system involvement.
  • Widely distributed gamma network.
  • Dysfunctional gating in basal ganglia or thalamic reticular nucleus.

One of the newest theories is that our brain has lost its normal ability to block or tune out a negative sensory signal. There is a linked network of brain structures that is involved in emotion, behavior, and long-term memory acts as a gatekeeper to keep the tinnitus signal from reaching the auditory cortex. Robert Sweetow once again gives a good technical explanation:

Sensory information then enters both the auditory and the limbic systems through the medial geniculate nucleus (MGN) and before the signal is processed, it travels through the thalamic reticular nucleus (TRN), which evaluates whether or not it should be passed on."

"There is a significant loss of volume in the medial prefrontal cortex (mPFC) in people with tinnitus/ and or chronic pain. This structure projects into and activates the TRN. If the volume loss creates a loss of neurons, the mPFC and TRN will malfunction.”

Put simply, damage to this system probably affects the perception of sensory signals in such a way that either tinnitus or chronic pain can develop and carry on in a self-perpetuating loop. It’s no surprise that stress may have big impact on these loops and could possibly be one of the factors involved in the transition from mild to severe tinnitus.


Tinnitus interventions

As there are so many possible factors engaged in the emergence and maintenance of tinnitus, it is no surprise that the interventions that work best are multimodal. To help a patient with persistent distressing tinnitus, a tinnitus therapist and/or team will use the following methods, some of which are related to sound enrichment and others to how to change our perceptions.

Where there is a hearing loss then we know that hearing aids often help. The reason for this is two-fold. Firstly, less stress is being put on the auditory pathway as the individual is then not straining to hear. Secondly, the contrast between the internal sounds and external sounds is diminished.

The second useful method is sound enrichment. This can be done in many ways, from the use of environmental sounds, such as water lapping to music. Having these sounds consistently in one’s normal environment helps mask the tinnitus, but also reduces the contrast between the tinnitus and quiet.

For some sufferers it may be necessary to also wear a device that gives either a white noise, or another noise, that they find helps divert their brain from the tinnitus. This white noise can be switched on by the audiologist in many hearing aids, NHS or private, or a device can just have the white noise only.

However, with any sound enrichment the sound must be set just below the level of the tinnitus. It is very important to get the brain to actively choose the sound it listens to rather than just mask out the distressing tinnitus.

Lastly as discussed in our explanation of tinnitus origin our brain chooses what it listens to and gives sounds emotional meanings, in this case strongly negative feelings to the tinnitus sound. Factors like stress decrease our ability to cope with these feelings.

Many individuals with tinnitus have found that cognitive behavioral therapy (CBT) and mindfulness have been instrumental in giving them back some quality of life. CBT addresses these negative perceptions and tries to get the individual to understand how these thoughts affect their emotional and physical states.

Many sufferers question whether CBT actually works when it comes to tinnitus, but research has shown that it definitely improves how people cope with the condition. CBT has long been used in pain management and there is research there to indicate its effectiveness, as both pain and tinnitus use the same neural pathways in the brain it is no surprise that it works for both..

Mindfulness, like CBT, is increasingly being used to help improve health outcomes, and like CBT research is accumulating on its benefit, so much so that some prestigious universities now have it as part of their syllabus.

Mindfulness is ‘the practice of bringing one's attention to the internal and external experiences occurring in the present moment, which can be developed through the practice of meditation’. Although this can initially be disturbing for the tinnitus sufferer, over time it can be effective in reducing the effects of stress on tinnitus and vice versa.

Tinnitus research

At Action on Hearing Loss we also fund biomedical research into how tinnitus is generated and into possible new treatments. There are already drug treatments for some types of tinnitus being tested in clinical trials.

However as tinnitus is so complex in its origin and system involvement, it is unlikely that we will find a single drug cure. Researchers are also looking at breaking the neural network by stimulating the vagus nerve which is involved in the transmission of efferent information in our body.

With all this in mind, please, if you are dealing with a tinnitus sufferer don’t say ‘nothing can be done’ because that’s just not true.  All that does is make the journey back for the tinnitus sufferer more difficult and longer; instead, reassure them that help and advice is out there, and that in time they can learn to live with their condition.

About Louise HartLOUSIE HART

Louise has worked in audiology for the last 23 years. She trained in Australia and worked for Australian Hearing, specializing in dealing with those with tinnitus and complex hearing loss.

After moving to the UK, Louise spent the next 10 years at Brighton working with complex adults and BAHA patients, along with being involved with Southampton University on its BSc supervision program and being an external assessor for BSc students.

At present Louise works in two roles, working for both for Action On Hearing Loss and Sussex Healthcare Audiology, which provides AQP services mainly in Sussex and Surrey.

Action on Hearing Loss is a patient representative body and her role there is public, health policy and information facing. Her role in Sussex Healthcare Audiology is to ensure that even a small provider can provide good quality care, and with this in mind she has been involved in the IQIPS accreditation of her service.

Both these roles fit in with her belief that good quality care should be provided to all and that both the patient/client and audiologist can work together to get the best outcome.

About Action on Hearing Loss

Action on Hearing Loss helps people to confront deafness, tinnitus and hearing loss to live the life they choose.  Action on Hearing Loss enables them to take control of their lives and remove the barriers in their way. Action on Hearing Loss gives people support and care, develop technology and treatments, and campaign for equality.

Further Reading

Disclaimer: This article has not been subjected to peer review and is presented as the personal views of a qualified expert in the subject in accordance with the general terms and condition of use of the News-Medical.Net website.

Last Updated: Jun 16, 2019


  1. Tonetwisters . Tonetwisters . United States says:

    Hmmm ... I wonder if Ms. Hart has tinnitus herself? Probably not. It's great that she cares enough to work in this field, and I sincerely hope that something IS coming that will turn down the "crickets." However, this misery is not "easily lived with." And the more loud sounds you are around, or the more prescription drugs you take, the louder and more intense this racket becomes. Trust me, it is an irritating condition upon which all other health issues are made worse than they otherwise would be.

    • Tom Gugliotta Tom Gugliotta United States says:

      ...they will just do what they can with a little grant money they can get.  Audiologists are the least qualified to do this research.  They know nothing about the brain, which is where the noise originates.  Most audiologists just want to take you for a ride with their stupid hearing aids and noisemakers that don't work.

  2. patricia webb patricia webb United States says:

    Have tinnitus for 10 yrs. Got it right before husband got really sick and I had had throat surgery which no one associates with anything. Have spend thousands of dollars on the Neuromonics device which I was assured would greatly help me. My husband had died by this time and I was trying anything. A lot of acupuncture, chiropractic. Am on meds. now for anxiety and to sleep. It's a lonley world when you are alone and don't hear much encouragement.

    • Tom Gugliotta Tom Gugliotta United States says:

      I went through a period of PTSD.  During that time, it could have been the stress or the antidepressants the doctors were pumping into me just to shut me up.  Over the course of a week, I developed hyperacusis and then tinnitus.  They hyperacusis is gone now but the hissing and ringing in my right ear and head have never stopped.  That was almost 17 years ago.  I too spent thousands on hearing aids, acupuncture, chiropractic and useless herbs and vitamins.  Anyone that could make a buck took advantage of me.  I just don't understand why drug companies aren't researching this.  There is a gold mine to be had if there was something that worked.

  3. Val M. Smith Val M. Smith United States says:

    I'm here because some webpage I found myself on had one of those infomercials for " a cure for Tinnitus. It's one of those infomercials that drones on and on for far too long without giving a hint about what they will say at the end. Instead I did a search and found myself here. I decided to join one of the forums and here is the first place I came to.
    My 2 cents might be the same no matter what malady we human beings have. What that is has to do with an unwillingness of most doctors to listen ( No pun intended )
    In the old days doctors listened very closely to what patients had to say realizing that the patients were giving real time feedback. Now most doctors I know listen with a half ear and half brain. One could hold the cure for all illness's in their hand and most doctors will only be interested in how high one's cholesterol is.
    In another forum I found 3 doctors who had their own sub forums. They were last answered in 2014. Maybe they just lost interest?

  4. Peter Maitland Peter Maitland Australia says:

    I underwent a Industrial Hearing Test 17 years ago. I had this test to see if I had suffered any hearing loss because I used to work in heavy industry. I had no ringing in my ears at all before the test. The VERY NEXT MORNING I woke up with a horrible noise in my ears. This screeching/ hissing/ shooshing noise continued for four days. I was going crazy. After four days this noise suddenly stopped. However, I noticed after that, that on quiet mornings when I awoke, I could hear this noise in the background but not as loud as it was before. I just put up with it as it was only audible on certain days and only very low.

    Anyhow, 12 years passed and I was handed a free hearing test brochure from a friend at another place that I worked for. I forgot about the prior test.

    You guessed it. Silly, silly, silly, silly me had another Industrial Hearing test.

    The next morning I woke up in extreme distress. The noise in my ears was excruciating and I rang up this company and said, 'what have you done?'. They denied that they were the cause.

    My ears have never stopped this incessant noise. I have now been going through this rotten Tinnitus for 5 years now. I had to leave work over it.

    Some people can put up with it, but these people only hear the noise now and then. I do not say that these people have Tinnitus. They just have a little noise in the background.

    REAL TINNITUS sufferers know the difference. Some have committed suicide over this.


    It is not normal to pump high and low frequency noise in your delicate ears. This audio test should be outlawed.

    ENT specialist wont be in this, because they make lots of money from these tests.

    Some people have this test and don't notice any difference but some like myself are affected differently. I wish that I never had this rotten test. I should have remember when I had that first test 17 years ago.

  5. Suzan Lee Suzan Lee United Kingdom says:

    All this come in the end  there is no cure snd you have to live with it
    CPC and TRT all they teach you how the live with it...all drug trial in the come to conclusion no change...one think i find helpfull accepting and stop looking for treatments...

  6. andrew bailey andrew bailey United Kingdom says:

    I’ve suffered with continuous tinnitus since May 1996. I’m a retired builder, my damage was done by a workmate cutting through a steel Lintol with a sthil saw. Unfortunately I had my back to him and didn’t think to have put my ear muffs on. So now in my 22nd year. What I hear every minute of every day is a very loud hissing noise in both ears. On a scale of 1 to 10 it’s around 5 for pitch, but on the same scale about volume it would be 10. For me it’s just a bug bare these days, I don’t allow it to spoil my life, I guess it’s a sink or swim situation, I was determined never to give in to it. For me, it’s as bad now as it was 22 years ago when it came on and never left me, but over time, I guess I’ve habituated to it. It’s just a matter of getting used to it. So to everyone out there that’s suffering! take it from me, it does get easier, because over time we build up some tolerance. Aweful though it is, I’d rather have this than to be deaf or blind. Just stay positive, and remember, the glass is half full and never half empty.

    • Donna M Donna M United States says:

      Thank you andrew for the positive and honest heads up on this issue. I have had tinnitus for only a little while { maybe I shouldn't say only a little while, because even only a little while seems like an eternity and it sucks } going on 2 years now. Mine happened at a band practice right before I had a chance to put in my earplugs that we all always used to wear. And the band started up to jam and there went my ears, the loud music did me in. And it's sad, because the thing that I loved the most, music, and being the lead singer, and performing live onstage, ripped my heart out that day. Now I have nothing to do with music at all. I'm gun shy now and can't be around loud music or anything loud for that matter. I pray about it everyday, and put it all in god's healing hands, and pray, god gives doctors the knowledge to find an outright cure, or the knowledge to at least find us some relief and a way to lower the noise and the speed of it all. I also have a hissing sound in both ears andrew. And it's funny { not really } that you use the volume level on a scale from 1 to 10 to describe the loudness that you hear, as I do the same when I talk to people who I find that have tinnitus. My hissing level is about a 7 and the volume is about an 8 or 9. None of it though is any good. So I'm trying to do my best in dealing with it. But it's hard brother, no denying that. God bless you andrew, and I sure do pray that god grants us all who suffer, a cure from this dreaded affliction. May god bless you always andrew.

      • roger bartholow roger bartholow United States says:

        Hey Donna I'm so sorry to hear about your tinnitus experience.I fell victim in a similar way being a lead vocalist myself I was getting ready to lay down my vocal tracks for a demo and when the music track came  on it was set to full volume I didn't stand a chance having headphones on. Im going on a year now since the music died.You are so right about dealing with that part of the journey.I wish for you nothing but the very best.Lets hope for 2019 to be the year of the tinnitus breakthrough.There are alot of new and exiting things going on worldwide in the research side of tinnitus .Hang in there Donna...Roger

  7. Chester Laid Chester Laid Netherlands says:

    The only real problem in this article is the phrase " don't say nothing can be done" there is nothing that can be done literally.
    Meditating or relaxing meds or whatever external means to help coupe with tinnitus gives varius degrees of relief but never enough to say that something can be done.

    We are waiting for hard intervention by the medical world not these ambigious phrases we know already.
    Every person or organization will tell us to practice mindfullness because that is how a person can handle a harsh situation but it does not fix the situation.

    anyone will do some of the above always so these articles are what actually drains our energy al the more when  thousands of these articles all say the same....
    We know already for gods sake pls just stop it with the feel good articles that are empty to begin with..
    I want to give credit to the person who wrote this and say thank you for caring but the situation drags this negative mention out of me for the reasons stated above...

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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