Tinnitus

When speaking to our patients about their tinnitus, we often hear the following:

  • "They just told me to learn to live with it."
  • "I am so frustrated. I don’t feel like anyone really wants to help me."
  • “All they’ve told me is to put on some noise and get over it. It’s like they didn’t care.”
  • “I don’t know if I can live like this anymore.”

Tinnitus Definition and General Information

Tinnitus is the perception of sound with no external source. It is a complex neurological condition that involves the hearing, attention and emotion centers in the brain.

Though often described as ringing, it can also sound like roaring, crickets, wind, cicadas, whooshing, a tea kettle, a seashell, or other sounds. It can be steady or pulsing, constant or intermittent, and temporary or persistent/chronic.

Tinnitus is a benign sensation in your body. It is extremely rare that it ever is connected to a life-threatening condition. Tinnitus affects at least 10-15% of the global population. More than 25 million people in the United States are thought to have tinnitus, with about 40% of those feeling that their tinnitus is bothersome. Tinnitus can occur in persons with or without hearing loss, and can onset at any age.

Though there are several theorized causes of tinnitus, it is most commonly thought that tinnitus is the result of increased spontaneous neurological activity in the brain in response to damage to the sensory cells and associated nerves in the inner ear. This damage may result from noise exposure but can also be secondary to medical conditions like hypertension or diabetes, or from medical treatments, such as chemotherapy or high-dose intravenous antibiotics. (which may or not result in a perceptible hearing loss).

The Tinnitus Experience

“I can’t remember ever not having tinnitus. I did not know that it was possible for a person to be in an otherwise quiet room and truly experience silence. I cannot even imagine that. I didn’t know it was abnormal until it was brought up in my Intro to Audiology class!”

Dr. Sarah Curtis, our owner and audiologist, has lived with tinnitus since, perhaps, she was a child. Her tinnitus is constant though it is not bothersome most of the time, especially if there is noise in the environment or if she is very busy doing something.. It sounds like a super high-pitched buzz similar to a field of crickets. She requires a noise generator like a fan to sleep at night. She has normal hearing. The cause of her tinnitus is unknown. It is aggravated by loud noise, stress, and fatigue.

Her experience with tinnitus is not dissimilar from others, but also very unique. In fact, every person with tinnitus experiences it in a different way.

Tinnitus can affect daily activities like sleep, relaxation, and concentration. As stated above, only about 40% of people with tinnitus are bothered by it and most are not bothered by it 100% of the time. There are many people who describe to our audiologists that they can hear their tinnitus if they listen for it or if it is very quiet. Most people hear their tinnitus equally as loud between their ears, but if one ear has more hearing loss than the other, often it is reported that the tinnitus is louder in the ear with more loss.

Tinnitus is most apparent in voids of sound. When there is noise keeping the brain busy, people are not as bothered by their tinnitus, but at night when there isn’t much sound the tinnitus is very obvious. Hearing loss prevents the brain from hearing as much external noise as someone with normal hearing so the tinnitus can become the dominant sound more easily. This is why most people with hearing loss and tinnitus who are properly fit with hearing aids report significant improvement in their tinnitus perception (multiple studies estimate close to 70% report benefit).

Treatment for Tinnitus

The treatment of tinnitus can be very simple for those who are not very bothered by it. Often a simple masking noise as needed can provide relief. For others, more significant changes and interventions are necessary.

Quality, restful sleep is a critical contributor to the ability to cope with tinnitus. When our patients report difficulty sleeping, we prioritize sleep hygiene. Being well-rested improves overall health and well-being, and a rested brain has more capacity to apply coping strategies.

Many patients benefit from mindfulness and/or meditation. These techniques can allow the brain to redirect focus from the tinnitus to something else. This can be as simple as breathing exercises and does not have to be a formal activity.

For those who have anxiety and stress which exacerbate their tinnitus, a referral to and services from a mental health practitioner may be a critical part of the treatment plan. Many patients benefit from Cognitive Behavioral Therapy or other similar interventions. Some also benefit from medical/pharmaceutical treatment (for anxiety, depression, or other conditions) as directed by a physician.

There are also technological interventions for hearing aids.

Low-tech options include sound maskers (freestanding) or masking applications for smart devices. Our favorite apps are ReSound Relief, Widex Zen, White Noise, and Calm.

Hearing Aids can be an excellent treatment option. It is critical, however, that the hearing aids are professionally prescribed and fitted by an audiologist experienced in the treatment of tinnitus. Sufficient but safe volume is necessary for the treatment to be effective and real-ear verification is an essential tool that must be utilized by the audiologist to ensure a truly rehabilitative fitting of hearing aids. Additionally, all major hearing aid manufacturer include tinnitus maskers in their hearing aids, but our audiologists have found that more often than not, patients do not need them. Over-the-counter hearing aids are not appropriate for the treatment of hearing loss in tinnitus patients.

Newly FDA approved, the Lenire tinnitus treatment device is a non-invasive medical device that uses bimodal neuromodulation – a combination of sound stimulation and mild electrical stimulation of the tongue to soothe tinnitus. It is backed by the world’s leading tinnitus and neuroscience researchers. Our practice was selected as a Phase 2 provider of Lenire. With 30 practices added in Phase 2, there are now only 44 practices in the entire United States approved and certified to fit and dispense the groundbreaking device. For more information on Lenire, click HERE.

Tinnitus - Frequently Asked Questions:

  1. Where can I get evaluated and treated for my tinnitus?

    2. It can be difficult to find an audiologist or other healthcare professional trained in and prepared to provide specialized services in tinnitus evaluation and rehabilitation. The good news is that if you’re looking for excellent care in Northeast Ohio, you’ve landed in the right place. Our own Dr. Sarah Curtis is an audiologist specially trained in delivering compassionate tinnitus services.

  2. Is special training required for an audiologist to see tinnitus patients?

    3. Most people with tinnitus are not bothered by it to the extent that they need specialty care. For those who are bothered by it, it is important to seek care from an audiologist who has sought out specialty training and continuing education in providing tinnitus care. Dr. Curtis completed her training as a Certificate Holder in Tinnitus Management (CH-TM) by the American Board of Audiology. Dr. Curtis and Dr. Donovan have both been specially trained in tinnitus treatment with the Neuromod Lenire tinnitus treatment device.

  3. How common is tinnitus?

    4. 90% of people with hearing loss report some type of tinnitus? And that estimates suggest 15% of the general population without hearing loss also have tinnitus. In fact, Dr. Curtis herself has persistent, constant tinnitus with normal hearing! If you have tinnitus, you are NOT ALONE!

  4. Should I see a medical doctor (primary care or otolaryngologist/ENT)?

    5. For most patients an audiologist is the ideal professional suited to care for tinnitus patients. Our Doctors of Audiology are trained to determine if there is need for a medical evaluation. They will take a thorough health history and obtain a list of your current medications. If it appears possible that there may be a medical explanation for your tinnitus, we will insist that you have a medical evaluation, preferably by an ENT.

  5. How do you say “tinnitus”?

    6. Audiologists often pronounce it with a soft “I” in the middle – “tin-IH-tuss”. The general public tends to say “tin-EYE-tuss”. Both are correct!

  6. What are the steps that should be taken in the evaluation of tinnitus?

    7. First, the audiologist takes a detailed case history, discussing the patient’s experience with their tinnitus, and reviews inventories completed by the patient.

    Second, a comprehensive health-centered hearing evaluation by an audiologist must be completed. The evaluation will include some or all of the following:

    • Comprehensive audiometry (air- and bone-conduction tone thresholds 250-8000 Hz, speech thresholds, and word recognition testing)
    • Extended high frequency audiometry (9-20 kHz) may be needed if there is mostly normal hearing on traditional testing
    • QuickSIN speech-in-noise testing
    • Tinnitus Evaluation (tinnitus pitch matching, loudness matching, and determination of the minimal masking level)
    • Measurement of loudness discomfort levels (critical if there is decreased tolerance of environmental sound)
    • Distortion Product Otoacoustic Emissions (DPOAEs) which measure the response of the cochlear outer hair cells. Results may reveal ear damage not apparent on a traditional hearing test.
    • Tympanometry and acoustic reflex threshold measurement are performed when necessary (if there is evidence of possible middle ear hearing loss)

    Third, the results are discussed with the patient.

    Last, a consultation occurs during which the patient and audiologist work together to develop a personalized treatment plan.

    A report of findings will be sent to the primary care physician.

  7. How much does the evaluation cost? Will my insurance cover it?

    8. All patients scheduled for tinnitus evaluation and consultation will be subject to the following fees, payable at the time of visit, with exceptions noted.

    $125: Tinnitus Office Visit Fee*

    $250: Tinnitus Consultation Fee

    $220-$475: Fees for tests performed**

    For IN-NETWORK patients, any co-pays, co-insurance, and deductibles will be due after claims are processed.

    *Only Anthem Commercial and some United Healthcare Commercial plans pay for this fee; all other patients will be responsible for payment on the day of service

    **Only for insurances for which Sounds of Life is OUT-OF-NETWORK; we are IN-NETWORK with Anthem Blue Cross (Commercial and Medicare Advantage), Cigna (Commercial Only), Medical Mutual (Commercial and Medicare Advantage), Summa (Commercial and Medicare Advantage), and United Healthcare (Commercial Only), as well as Medicare Part B. For all other plans, we are out-of-network.

  8. How much does treatment cost?

    9. There is no one-size-fits-all treatment cost. Your audiologist will discuss this with you at your visit

  9. What are some great resources for information on tinnitus?

    10. There are many good sources, but our favorite is the American Tinnitus Association www.ata.org) – this is an amazing organization and their website has fantastic resources

  10. How can I prevent tinnitus?

    11. Preventing hearing loss and ear damage is the #1 way to avoid tinnitus. Using methods to reduce noise exposure (turn down the volume, move away from the noise source, and/or use properly fitting hearing protection) is critical.

    In addition, maintaining good overall health with exercise, a balanced diet, good sleep hygiene, and proper hydration can help to keep your ears, brain, and whole body healthy!

  11. I am not sure I can live with this anymore. What should I do?

    12. If you have thoughts of taking your own life, or harming yourself or others, please call the Suicide & Crisis Lifeline at their new number, 988. www.988lifeline.org The audiologists at Sounds of Life are NOT mental health providers and though our methods may be effective, mental health takes top priority.

    We can help you live in peace with your tinnitus! Call today at 440-579-4085 to schedule!