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In this blog Dr. Hashir Aazh answers frequently asked questions about tinnitus, hyperacusis, and misophonia and noise sensitivity in general. Please feel free to submit your questions via info@hashirtinnitusclinic.com

Does tinnitus affect my hearing?

There is very little evidence that tinnitus impacts hearing loss. Hearing may worsen independently from tinnitus. Some people believe that hearing loss makes their tinnitus worse. See the video below for my research results on this topic.

What kind of masking noise or relaxing noise I should use at nights to help with my tinnitus?

Certainly you are free to listen to any music or background noise that you like. Many people who do not have tinnitus also like to listen to something at nights to relax them. However, if you do this in order to get distracted from your tinnitus, then it is classified as a safety-seeking behaviour which is counter-productive. If you avoid your tinnitus you never learn how to manage it properly. My recent research on tinnitus and sleep shows that the actual loudness of tinnitus is not the key contributing factor to sleep disturbances experienced by tinnitus sufferers. So simply trying to mask tinnitus doesn’t help.

What should I do to get rid of my tinnitus? I’m not sure what to do now. I don’t want to live with this the rest of my life.

There are plenty of options that people have taken in order to get rid of their tinnitus. For example medication, acupuncture, laser, transcranial magnetic stimulation, masking, neck exercises, craniosacral therapy, surgery and many other remedies. There have been anecdotes on tinnitus getting a little better and sometimes a little worse. The bottom line is that to my knowledge there is no “proven cure” for tinnitus at this moment. So any attempt to cure it, although completely natural and understandable, is counter-productive and doesn’t let you to learn how to cope with your tinnitus. How about the alternative of living your life happily and enjoy every moment of your life despite hearing tinnitus? To do this, you may choose to use self-help tools (see https://www.tinnitus.org.uk/), or seeing a specialist who can help you.

Do I need to inform my employer that I have tinnitus?

Some people may fear that if they disclose to their employer that they have tinnitus, they may be discriminated against and their job may become at risk. This is not true from my experience of helping over 10,000 patients with tinnitus. Usually employers are supportive and can offer help with regard to your therapy sessions and flexibility at work and reducing work-related stress in general. Often tinnitus is combined with hearing loss which also need to be disclosed to your employer for health and safety reasons. There are many notable musicians, artists, philosophers, surgeons, politicians, lawyers, engineers, architects, etc who have tinnitus and yet are very successful in what they do.

How do I deal with my friends/ family/ significant others who do not truly understand my tinnitus and/or hyperacusis/misophonia?

Feeling of being understood is very important to all of us. In fact, many schools of thought in modern psychology postulate that the origin of some of the emotional disturbances is the feeling of not being understood and accepted.

However, in everyday life many people, even our loved ones, fail to empathise with our thoughts and feelings. Especially, this is often the case for tinnitus/hyperacusis/misophonia as “hidden” conditions/disabilities. Although it would be very nice if other people could fully understand how you feel, it may not be a feasible goal to achieve. From my point of view, please feel free to agree or disagree, the effective management of tinnitus/hyperacusis/misophonia needs a change from within. So the question that you should ask yourself is “why do I need to be understood by others?” If I am not understood by my loved ones, what would be the consequence? This way of questioning and probing of your own feelings and thoughts may lead to deeper emotions to bubble up to the surface. A wide range of therapies can help you to explore and modify the cognitive process leading to emotions you are experiencing. My recent research published in the American Journal of Audiology and International Journal of Audiology shown that a specialised cognitive therapy approach for tinnitus/hyperacusis/misophonia rehabilitation helped patients to minimise their tinnitus-related distress. When tinnitus-related distress is minimised, tinnitus loses its significance and fades away to the background. Seeing a therapist who can work with you throughout the process could be beneficial. Self-help also has shown to be very successful.

What should I do if my tinnitus is caused by TMJ (Temporomandibular joint) disorder?

TMJ disorder affects movement of the jaw. Tinnitus related to TMJ disorder typically sounds like clicking or grinding noises. TMJ can also be painful especially when eating food or chewing gum. The pain maybe felt around the jaw, sides of your head, or ears. If you feel these symptoms it is very important to see your doctor who can assess you and refer you to other specialists for treatment. Clicking or grinding tinnitus may be related to conditions other than TMJ, therefore, it is important to seen an ENT specialist for full otolaryngological workup. Dentists can help you if teeth grinding is part of your TMJ problem. Relaxation of the muscles around your jaw and face can be very helpful. This can be achieved by reducing stress, general relaxation, massage, or psychological and physical therapies. If the clicking tinnitus still troubles you and you find it difficult to cope with it, then seeing a tinnitus specialist is recommended who can support you in tinnitus management.

I cannot sleep because of my tinnitus. What should I do?

Problems with sleeping are among the most common complaints of tinnitus sufferers. 75% of patients who sought help for their tinnitus from my clinic in the UK had some degree of insomnia. Recent research shows that there is no direct effect of tinnitus loudness on insomnia. Rather, it may be the case that greater tinnitus loudness is associated with increased depression, and tinnitus annoyance, and that these in turn lead to insomnia. This means that for patients who suffer from tinnitus, insomnia may be alleviated if tinnitus annoyance and tinnitus-induced depression are managed adequately, even if the tinnitus loudness remains unchanged. My latest studies show that although various forms of tinnitus rehabilitation only minimally reduced the loudness of tinnitus, the annoyance produced by the tinnitus and depressive symptoms typically improved considerably. Hence, such rehabilitation is likely to reduce problems with insomnia. For more info on my research see https://hashirtinnitusclinic.com/research/

What is the best sound machines that I should use in my bedroom that create some ambient noise to alleviate my tinnitus while sleeping? Or is it better to just play some sort of sound clip from my mobile phone?

Use of background noise in order to distract you from tinnitus, whether it is music from your mobile phone or soothing sounds from a noise generator device, is counter-productive. Use of sound to distract you from tinnitus is an avoidance technique which may be useful in short term but in long term doesn’t allow you to learn how to cope with your tinnitus. The physiology of your body is capable of allowing you to fall into sleep despite hearing a noise, no matter how loud the noise is. People can fall into sleep in all sort of noisy places, e.g., airports, beach, train, etc. Indeed, many people with tinnitus also fall into sleep with no particular problem. So hearing a noise, whether it is tinnitus or an external sound, does not necessarily mean that you can’t sleep. I have studied the usefulness of bedside sound generators from patients’ perspectives. Almost all of the patients who found sound generators to be effective, also rated counselling or education as effective. This makes it difficult to determine whether the sound generators were effective components of the treatment package. In my clinics, we no longer offer sound generators as we believe that such avoidance methods actually delay the progress of the individual in learning how to cope with their tinnitus and how to sleep despite hearing tinnitus. I have seen people who had tinnitus for many years and yet never learned how to cope with it due to their use of avoidance techniques, e.g., sound generators. Sometimes, feeling that you are dependent to sound generators is a source anxiety itself. For more info on my research see https://hashirtinnitusclinic.com/research/

What about hearing aids? I have tinnitus, high tone hearing loss, and hyperacusis. Would a hearing aid, which would fill in the tones I am not hearing, make the brain to stop tinnitus?

Decision about using hearing aids should be made based on the amount of problems that you are experiencing due to your hearing difficulties. So you should have this discussion with your audiologist and decide whether you hearing difficulties and their impact on your life justify the life time commitment of using hearing aids. If the answer is yes, then hearing aids are the right choice for you. A systematic review and meta-analysis of the research evidence showed that hearing aids had a medium-to-large effect on health-related quality of life (Chisolm et al. 2007).

However, if your main motivation for hearing aid is to somehow cure your tinnitus or even mask it then this is counter-productive. Use of hearing aid as a distraction method for tinnitus is an avoidance technique or safety seeking behaviour which may be useful in short term but in long term doesn’t allow you to learn how to cope with your tinnitus. The safety seeking behaviour is even worse if your hearing aid incorporates some masking noises, filtered music, pink noise, white noise, notched noise, etc. In my opinion, use of hearing aids for the purpose of masking or curing tinnitus actually delays the progress of the individual in learning how to cope with tinnitus. Of course hearing aids are proven to be very effective in helping you to hear better and improve hearing-related quality of life, if that’s your aim. So think of hearing aid independent from your tinnitus management.

I have seen people who had tinnitus for many years and yet never learned how to cope with it due to their use of avoidance techniques, e.g., maskers, etc. Sometimes, feeling that you are dependent to a device is a source anxiety itself. For more info on my research see https://hashirtinnitusclinic.com/research/

Tinnitus and hearing loss for musicians

Hearing loss is often associated with tinnitus. Most patients who experience tinnitus also have some form of hearing loss, but not all patients with hearing loss have tinnitus. The strong relationship between tinnitus and hearing impairment probably explains the recommendation that those who develop tinnitus should see an audiologist and Ear, Nose, & Throat specialist for an initial assessment. To complicate matters, some people with clinically normal hearing have tinnitus suggesting that hearing loss per se not be the dominant factor for induction of tinnitus.

Tinnitus and hearing loss can significantly impact the snuffers’ quality of life. The matter can be even worse for musicians as some may be concerned that tinnitus and hearing loss may stop them from enjoying and playing music. Based my clinical experience, same as anyone else, musicians can cope very well with tinnitus if they receive the appropriate support. However, here I would like to elaborate on the underlying mechanism between music included hearing loss and tinnitus. Recent studies show that the extent of musicians’ exposure to amplified music was related to severity of hearing loss and tinnitus. Interestingly weekly hours playing was found to have a greater effect on hearing loss in comparison to years playing.

My recent study which is published in the Journal of the American Academy of Audiology in collaboration with Professor Richard Salvi from Center for Hearing and Deafness, University at Buffalo, USA showed that tinnitus loudness was weakly associated with increased hearing thresholds. One hypothesis is that hearing loss leads to an increase in spontaneous activity in the central auditory system, one of the proposed mechanisms for tinnitus. The increase in spontaneous activity is assumed to be due to decreased in inhibition in the central auditory system caused by cochlear. Relevant to the phenomenon of music–induced tinnitus is the observation of elevated spontaneous rates in the central auditory pathway after noise-induced hearing loss (Kaltenbach 2006). Spontaneous rates start to increase one week post-trauma and continue to increase reaching a plateau after a few months. For more research on hearing loss, tinnitus and hyperacusis see https://hashirtinnitusclinic.com/research/

References

Chen, Y. C., Li, X., Liu, L., et al. (2015). Tinnitus and hyperacusis involve hyperactivity and enhanced connectivity in auditory-limbic-arousal-cerebellar network. Elife, 4, e06576.

Chisolm, T. H., Johnson, C. E., Danhauer, J. L., et al. (2007). A systematic review of health-related quality of life and hearing aids: final report of the American Academy of Audiology Task Force On the Health-Related Quality of Life Benefits of Amplification in Adults. J Am Acad Audiol, 18, 151-83.

Eggermont, J. J., & Roberts, L. E. (2004). The neuroscience of tinnitus. Trends Neurosci, 27, 676-82.

Henry, J. A., Roberts, L. E., Caspary, D. M., et al. (2014). Underlying mechanisms of tinnitus: review and clinical implications. J Am Acad Audiol, 25, 5-22; quiz 126.

Kaltenbach, J. A. (2006). Summary of evidence pointing to a role of the dorsal cochlear nucleus in the etiology of tinnitus. Acta Otolaryngol Suppl, Dec, 20-6.

Kaltenbach, J. A. (2011). Tinnitus: Models and mechanisms. Hearing research, 276, 52-60.

Mulders, W. H., Ding, D., Salvi, R., et al. (2011). Relationship between auditory thresholds, central spontaneous activity, and hair cell loss after acoustic trauma. J Comp Neurol, 519, 2637-47.

Mulders, W. H., & Robertson, D. (2009). Hyperactivity in the auditory midbrain after acoustic trauma: dependence on cochlear activity. Neuroscience, 164, 733-46.

Mulders, W. H., & Robertson, D. (2011). Progressive centralization of midbrain hyperactivity after acoustic trauma. Neuroscience, 192, 753-60.