Health and Wellness

When you Have Tinnitus or Ringing In The Ears

By Eric Harry

Calm Radio is used by both practitioners and patients as a sound enrichment method to avoid silence. To avoid silence while sleeping, you could try Calm Radio's Nature Sounds like Beach Waves channel, White Noise channel or other Atmosphere nature sounds at medium to low levels in the background while you work, at home or while sleeping (using one of the recommended low-tech internet radios from the list below).

White Noise channels

This spectrum is an excellent masker channel for Tinnitus and not unpleasant to have in the background. You can start by finding a volume for the channel to a level just under the sound of your tinnitus, then over several days, try lowering the channel volume slightly. You might find your Tinnitus has also lowered in intensity.

Sound enrichment is an essential part of Tinnitus Retraining Therapy (TRT). Tinnitus Retraining Therapy (TRT) is protocol for tinnitus management that includes sound therapy.

Calm Radio is used as a tool for TRT using our many Nature Sounds like sea waves, rain, wind, whales, wolves, white noises, nature streams, over 60 Nature Sound channels that you can listen to in the background while you work, or relax. Our 4-Track Multimixing technology also allows you to also create and save your own custom mix of different Nature Sounds to suit what works best for you.

The important message here is to avoid silence. Silence can make the Tinnitus sound louder due to the absence of noise. Ear plugs are not advisable. This is the worst thing to do, because it results in an increase of sensitivity in the central auditory system (increase of gain) which makes external sounds louder still. as they worsen the symptoms of Tinnitus making it seem louder.

Reducing Stress

Stress tends to increase tinnitus. Relaxation is a skill many of us are not very good at. You can improve your ability to relax with listening to Calm Radio relaxation channels such as Mantra, Om, Aura, Healing and many more under the Relaxation category.

Minimize stress in your life where possible and learn how to improve how you react to stressful events. Try relaxing with a daily practice of relaxation exercises such as deep breathing or progressive muscle relaxation. Mindfulness meditation can also help you learn to react less to tinnitus and other experiences.

Some people can teach themselves these relaxation and mindfulness-based stress reduction through reading books and listening to audio recordings. Others prefer to learn these techniques with an experienced professional.

About half of people with tinnitus report difficulty falling asleep or getting back to sleep. To avoid silence while sleeping, you could play Calm Radio Nature Sounds in the background, for example our Beach Waves channel is popular.

Ways improve your sleep:

  • Blackout curtains to block out exterior light
  • No lights in the bedroom...masking tape over LEDs on alarm clocks, for example
  • Read a book in bed
  • Avoid news programs
  • Go to bed only when sleepy
  • Go to bed at the same time every night
  • Get up at the same time every day
  • Avoid naps
  • Avoid clock-watching
  • No computer, cell phone or TV in the bedroom (due to electro-magnetic and wifi technology)
  • Keep the room temperature at about 18 degrees Celsius (64.4 Fahrenheit)
  • Limit caffeine, alcohol and nicotine, all of which can cause nervous habituation patterns
  • Let go of the fear of not sleeping
  • Play Beach Waves or other nature sounds at medium to low levels (using a low-tech internet radio)

Resources:

It is essential that the sounds do not mask or block out the tinnitus when present, as it is not possible to habituated to a sound that you cannot hear. Many people with hyperacusis spend a lot of time in silence because of the dislike for external environmental noise. Some resort to ear plugs*. This is the worst thing to do, because it results in an increase of sensitivity in the central auditory system (increase of gain) which makes external sounds louder still. In hyperacusis it is usually essential to be fitted with binaural white noise generators by someone who has been trained in TRT. They are frequently also necessary in treating significant tinnitus. It should be realized to that the wrong kind of sound therapy, for instance, listening to distorted music tapes, or using devices to mask tinnitus completely, can actually be harmful in certain cases.

Commercial devices which produce sounds like the sea or rain can be very useful, but everyone has an individual preference. Just leaving the television or radio on all the time is not really the answer, as this tends to be stimulating or intrusive at times, or to mask any tinnitus that may be present. Where there is a significant hearing loss causing a problem in hearing speech, patients will require amplification with appropriate hearing aids. These must be a properly fitted by ‘best practice’ only and the two ears must be as evenly balanced as is possible.

* Ear plugs should only be worn when noise levels are know to be harmful to ANYONE. If you have been wearing ear plugs a lot, then only stop wearing them gradually over a period of time.

Get a Good Night’s Sleep

About half of people with tinnitus report difficulty falling asleep or getting back to sleep. In addition to avoiding silence throughout the night, make sure that you employ good sleep habits.

Here are some ways to improve your “sleep hygiene”:

  • Avoid screen time 2 hours before bed
  • Have a consistent and relaxing bedtime routine
  • Go to bed only when sleepy
  • Get up at the same time every day
  • Avoid naps
  • Avoid clock-watching
  • Keep your computer and TV out of the bedroom
  • Keep your room dark and the temperature at about 18 degrees Celsius (64.4 Fahrenheit)
  • Exercise regularly and not too late in the evening (about 2 hours prior to bedtime)
  • Limit use of caffeine, alcohol and nicotine, all of which can disrupt sleep patterns
  • Let go of the fear of not sleeping

Diet and Supplements

Diet modifications and use of supplements such as vitamin B, magnesium and zinc have not been shown to be consistently effective in eliminating tinnitus.

Some people are concerned that certain food items such as coffee will worsen tinnitus. This is not usually the case. Taking a two-week break from a certain food or beverage that you believe might be contributing to tinnitus, followed by a reintroduction of the food or drink, might tell you if the food or drink is linked to tinnitus. Keep in mind that sudden withdrawal from caffeine can have its own side effects such as headache and fatigue.

Tinnitus treatment options

There are a few structured therapies designed to help manage tinnitus.

Cognitive behavioural therapy

Cognitive behavioural therapy, or CBT, teaches us to identify and change negative automatic thinking that contributes to unpleasant feelings and reactions. If the first thought that comes into our heads whenever we hear tinnitus is negative (“I can’t hear because of tinnitus” or “I will never be able to relax because of tinnitus”), then we are likely to feel negatively toward the tinnitus. By changing how we think about tinnitus, we change how it makes us feel. CBT has been shown to be very effective in reducing tinnitus distress.

CBT is typically taught by psychologists or clinical counsellors trained in CBT techniques. CBT is not a service typically offered by audiologists but it may be available through a counsellor or psychologist in your community. CBT is also a component of Progressive Tinnitus Management, discussed below.

Tinnitus Retraining Therapy

Tinnitus Retraining Therapy (TRT) is protocol for tinnitus management that includes sound therapy and educational counselling. Participants in a TRT program receive individualized counselling on tinnitus and instructions on how to use sound to lessen tinnitus awareness. In theory, the combination of counselling and sound therapy help to retrain the brain’s neural networks responsible for tinnitus detection. The goal of TRT is to decrease awareness of tinnitus as well as the reaction to tinnitus (tinnitus habituation). Audiologists take a TRT training course to become qualified as a TRT provider.

TRT is recognized by Veterans Affairs Canada and WorksafeBC. Claimants with a recognized tinnitus claim can request coverage for TRT from these organizations.

Mindfulness Meditation

Mindfulness meditation aims to teach individuals bring their conscious attention to the here-and-now, rather than dwelling in the past or guessing about what might happen in the future. The principle behind mindfulness meditation is that all we have is the present, and that the present moment is where we have the ability to change how we respond to what is happening within and outside of ourselves. We can eliminate or reduce suffering by learning to experience our thoughts, feelings, and perceptions — including tinnitus — without judgment or reaction.

Mindfulness-based stress reduction, or MBSR, is a group program that focuses on developing mindful awareness. Typically the course is structured over 8 weeks in groups between 10 and 40 people. MBSR has been used to improve the well-being of people with chronic health conditions as well as people who are generally healthy. Research funded by the British Tinnitus Association is examining the effectiveness of MBSR for tinnitus management, and there is at least one online MBSR course for tinnitus management that has been piloted and shown to have positive results.

Progressive Tinnitus Management

Progressive Tinnitus Management, or PTM, is a “stepped care” approach. PTM recognizes that not all individuals with tinnitus need the same level of care to learn to manage reactions to tinnitus. Some patients require only a hearing evaluation and possibly hearing aids. Those patients who require more care are offered Skills Education, which is provided by both an audiologist and a psychologist. The audiologist teaches strategies for using sound, while the psychologist teaches coping strategies that are based on CBT. Patients requiring even more care receive an in-depth evaluation by an audiologist and a psychologist, and one-on-one counselling sessions as needed.

Sound enrichment

Sound enrichment is an essential part of all retraining therapy. It is not easy to choose the appropriate sound or sounds which should be present in the background throughout 24 hours of the day. The important message is to avoid silence. This is something which is not particularly easy to do for some patients. There are many ways of enriching the sound environment, but it must be with a sound that is not irritating or intrusive itself. The best sounds are those that are like nature. In summer it may be possible to have the window open. Otherwise sounds coming from a large slow moving domestic fan or radio tuned just of the station may be suitable.

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