This article is presented in its entirety with permission.
A tinnitus sufferer can't escape the constant sounds, but she can learn to tolerate them.
BY JACQUELINE STENSON
Special to the Times
Many people with tinnitus hear the classic ringing in the ears. For Jennifer Snell, it's more like a maddening cacophony of some of the world's most irritating noises.
"What I have in my head nonstop is the sound of fingernails on metal and the sound of a really high pitched teakettle and the sound of a hiss, like pressure coming through a tiny hole," says Snell, 48, who lives in Redondo Beach with her husband. They're bot retired from the insurance business.
Patients with tinnitus (pronounced ti-NIGHT-us or TIN-it-us) may also hear buzzing, humming, clicking, pulsing and whooshing. The sounds can seem to come from one or both ears, even the whole head, and they can be intermittent or continuous.
Nobody knows exactly what causes the phantom noises of tinnitus, a condition estimated to affect more than 50 million Americans, about 12 million of whom seek help for it, according to the American Tinnitus Association.
Tinnitus is commonly associated with noise-induced hearing loss. Other possible factors include cardiovascular problems, jaw misalignment, some medications, earwax buildup, ear and sinus infections, head and neck trauma and, in rare cases, head tumors.
The Din Within: Jennifer Snell meditates with a CD to help manage her tinnitus. In addition, she takes medications and reads self-help publications, such as Tinnitus: Turning the Volume Down, by Kevin Hogan, and Tinnitus Today, which featured William Shatner, a tinnitus sufferer.
Snell's noises began in her right ear and throughout her head after she had a root canal in January 2002. "That's when my life ended as I knew it," she says.
Not knowing why she was hearing noised that nobody else heard or what to do about them, she holed up at home. "I spent hours sitting in my bedroom closet, rocking back and forth with a heating pad around my head and just crying," she says. "I wrapped my head up and thought that would help."
But the intrusive noises didn't go away.
Suspecting there might be something in her ear, Snell tried in vain to wash it away. "I kept cleaning my ear out with baking soda and warm water," she says.
The noises persisted - and the anxiety grew. "It's like being in your house and the fire alarm goes off and it never stops." says Snell. "It creates an inner anxiety."
Previously she had run five miles a day, participated in 10Ks and worked out at the gym four times a week. But she stopped exercising altogether when the noises began. The intense anxiety also prevented her from driving. She could barely sleep or eat.
Normally weighing 110 pounds, the 5-foot-4 inch Snell quickly began losing weight, eventually shedding almost 20 pounds.
Desperate for relief, she sought medical help but was shocked at what some doctors told her.
"I went to an ENT (ear, nose and throat doctor) who said, 'You'll just learn to live with it' and another who said 'You're probably just going through menopause,'" she says.
Being told there was no help only fueled her anxiety. "I was just in a panic," she says.
Her husband suggested an appointment with his primary care physician, Dr. Robert Glazer in Torrance, who, much to her relief, said there was in fact help.
"Most of the time this is something that at some level you have to get used to and come to terms with," Glazer says. "But it's not that there's nothing you can do about it."
He says it's important to first rule out any suspicious underlying factors, such as tumors or uncontrolled high blood pressure. With no signs of such problems in Snell, he prescribed an anti-anxiety medication and sleeping pills, and referred her to a therapist for what turned out to be a yearlong course of biofeedback and hypnosis to help her relax and learn to cope better with the noises. When the sleeping pills didn't help, Snell switched to the antidepressant Elavil, which she says helped her finally get some rest.
She also went for massages to aid relaxation. And because silence can turn up the phantom noises, she began using low background sounds, such as the television and New Age music, to help mask them. At night, she uses a sound box that plays audio of ocean waves crashing, streams babbling and the wind blowing.
There is no single cure-all for tinnitus, no pill or surgery that promises a quick fix. Like Snell, many patients combine various treatments and self-help measures. Additional approaches include tinnitus retraining therapy (a method that uses sounds and counseling to help "retrain" the brain to block out the noises), acupuncture, hearing aids (for people with hearing loss, to bring back ambient noises that help mask the tinnitus), antiseizure medicines and antihistamines.
Today, Snell is still taking the Elavil and the anti-anxiety medication Xanax. She also practices self-hypnosis and meditation at home and continues to rely on white noise around the clock. She limits herself to one cup of coffee a day, because caffeine is believed to worsen tinnitus.
She's now much more at ease. The noises in her had haven't gone quiet, but she has gradually learned how to cope with the tinnitus and minimize its interference with her life.
"I began to view it more as regular noise - like hearing wind chimes or a car down the street - and that took away a lot of the fear," she says.
Snell has resumed many of the activities she enjoyed before the tinnitus started, such as running every day and training at the gym.
Some activities require adjustment. She can't go out to dinner at busy restaurants because loud noise aggravates her condition. So when she dines out, she goes earlier, when it's quieter. And with the help of earplugs and special headphones to block loud background noise, she can even accompany her husband to some USC football games.
Some days are better than others for Snell. But the condition doesn't control her life anymore.
"Now I pretty much view this as a truck going by outside," she says. "It helps me to realize it's just noise, and it's there."
Where to get help
See the FAQ (Frequently Asked Questions) below.
American Tinnitus Association. For information about tinnitus and listings of healthcare providers in your area, go to www.ata.org or call (800) 634-8978.
National Institute on Deafness and Other Communication Disorders. For information about this and other conditions, go to www.nidcd.nih.gov.
Los Angeles Tinnitus Group. A support group that meets the third Saturday of the month (except July, August and December) from 10 to 11:30 a.m. at 200 UCLA Medical Plaza, Room 206A. Contact Nelly Nigro at (310) 474-9689.
Self Help for Hard of Hearing People. For a list of local chapters, call (301) 657-2248 or go to www.shhh.org.
Tinnitus Treatment and Therapy FAQ
The Tinnitus FAQ for February, 2013 (Frequently Asked Questions)
by Kevin Hogan
Tinnitus. If you have been looking for a tinnitus cure, tinnitus treatment or therapy, you've obviously arrived here to determine what works and what is not likely to work.
I've been in your shoes. I know how hard it is.
Before we begin:
Beware of anyone touting a singular and/or literal "instant" cure for tinnitus because those situations (where tinnitus remits quickly) are not the norm. There is *nothing* a person can take to make tinnitus go away today. It is a process and typically it is not an easy one.
The good news is that people who suffer from even the most serious tinnitus can dramatically improve. Many will achieve remission. There is plenty you can do to bring yourself toward silence but do remember there are no "tinnitus remedies" or "tinnitus cures," so save your money and avoid ANYONE who tells you otherwise.
If you want to know how important the cause of your tinnitus is to the process of tinnitus reduction or remission, that will be addressed below as well.
(The correct spelling for tinnitus is not tinnitis, tinitis or tinitus).
What follows are common tinnitus related questions I have received in the mail and by e-mail from tens of thousands of people over the past 18 years.
I think you already know that this FAQ is not to be taken as medical advice. Please see your medical doctor for medical care!
Feel free to print out this Tinnitus FAQ and bring it to your physician to share ideas and treatment options. Do not underestimate what your physician can do to help you if she wants to.
Warning: The internet is littered with pages that claim I endorse their program, product, herb, supplement or approach. The *only* organization I endorse is the ATA. I do not endorse cures, herbs, supplements or miracles. I do not endorse any approaches other than what we've developed here over the last 18 years. If you want to confirm whether I personally endorse a specific consultant, by name, you can email me the individuals name. My lack of endorsement doesn't mean the person might be valuable to you, I simply don't have evidence they are doing work which will be valuable. When I do, I'll give them my endorsement.
Everything in this FAQ assumes you have moderate to severe tinnitus. Therapy for non-intrusive (not bothersome) tinnitus that is mild to moderate is very different than what is considered here.
"Kevin, I really appreciate your Tinnitus-focused web site with really well-written articles in helping people understand how this comes about. I really do appreciate the great knowledge you have shared. Thanks to your articles, I was able to gain hope that my Tinnitus problem could be turned around, as I didn't realize the apparent contributing factors. Thank you again!" Simon Richards
Can I get cured from tinnitus, too?
That's the #1 question I see. It depends on what you mean by "cured." In my experience, if cure means "silent," near silent or significantly improved, then yes, almost everyone can ultimately improve.
The word "cure" is very final in it's feel. I won't use that word because it can sometimes, mislead. Be wary of those who boast tinnitus cures as they are not telling the truth. In interviews I've been taken out of context. There is NO instant cure for tinnitus. Don't let anyone kid you.
Some people do achieve silence. Some won't. It's often difficult to know in advance who will accomplish what. There are factors to help predict silence, but I still get surprised as people improve dramatically when I thought they might only improve by half, even with time.
Silence for you? Maybe. Perhaps half of my long term clients reported tinnitus remission over time. Usually a great deal of work, time and effort, goes into remission. (Medical doctor invested in the patient, a therapist invested with the patient... etc.)
100% noise elimination/remission is certain for some people. As time goes on and strategies/therapy is more refined, the percentage of clients reporting silence at similar time intervals in the past is growing.
There is a caveat: Tinnitus can be like a cold or the flu or a backache. It can return. Don't fret. It can be short lived IF you move quickly upon the return visit.
Happily, almost everyone can significantly improve from where they are today.
How did you get better?
Medication (anti-anxiety and anti-depressants), osteopathy, hypnotherapy, habituation, sleeping position, self hypnosis,
wearing a splint for my TMJ, and *major* lifestyle changes which someone wrote somewhere was "stress reduction." That is absolutely not a lifestyle change.
Had ANY of these been left out of the equation, I would never have gotten well.
Lifestyle changes include the activities and actions you do each day. Those activities will change when you begin to work on eliminating tinnitus. It has nothing to do with stress reduction. Stress reduction is something that is unlikely to happen for awhile. You will change behaviors, where you spend your day and night, how you spend your day and night. You'll change what you do in your spare time. You'll be very surprised that almost EVERYTHING that helps get people well is counter-intuitive.
Some of this is covered
in detail in the book which was revised in its fourth edition in 2010. For the first time I worked with a co-author who agreed to share some simple case studies that followed the model of therapy I've developed over the last 18 years. I've personally worked with a handful of proteges. They've developed great skill and their work is effective.
I didn't always have a handle on tinnitus. I did an awful lot of things that didn't work...tens of thousands of dollars of treatments and therapies that didn't work.
What was the most important part of your healing process?
Severe tinnitus is torture.
Support from my wife was important. It was no easy process in the early 1990's and it's not easy today even if results are more predictable. You will be looking for a "support person" in your life. You'll need at least ONE.
Xanax and Zoloft; (there are better meds than Zoloft today but it was as good as it got in 1994...) and an osteopath with critical training in specific manipulations. Self hypnosis was crucial and helped the habituation process...and frankly, was far more successful than I thought possible.
If I had to pick one aside from support and the major upheaval of lifestyle changes, it would be Xanax... but all were very important.
People who "try" only one or two pieces of the Tinnitus Puzzle to move toward remission with little more than guesswork rarely, if ever, get well.
Lifestyle changes, refer to changes in what your behaviors and thinking processes, often as they relate to tinnitus, and, in the specific actions you do in the course of your business day. These kinds of big changes are best understood in a series of teleconsults where you learn specifically what to do each day and how to do the processes you will learn.
Processes differ from individual to individual.
One singular example of a lifestyle change would be to begin to almost never "listen" to your tinnitus, simply be aware that it is there. There is a learning curve here and these things are done all day, all week, all month, all year. The changes make or break the probability of remission and they are typically learned behaviors. Sounds easy but it takes patience, effort and endurance.
When you begin the process of getting well you literally move to a lifestyle of thinking about things "outside of yourself." Sounds odd, but that is a factor in getting well. These kinds of "lifestyle changes" are overlooked by just about everyone, but without adopting them your chances at improvement are small. Very small. The way you "go through" your daily life ultimately will determine whether you will experience silence again.
You can take all the meds you want, the lifestyle factors are as important as the medications, they are not an option. One or the other will not cause remission. You need both.
Getting well is like putting a jigsaw puzzle together. It usually works. It takes time and effort.
What is tinnitus and why can't anyone seem to help?
Tinnitus is any noise or a set of sounds heard that is generated in the ear, hearing system, or brain.
Most people I've worked with who experience severe or moderate tinnitus that is generated in the brain even when the original cause was loud sound, ototoxic drugs or tinnitus that was predisposed from depression, anxiety, panic disorder, etc.. If you haven't figured it out yet, everyone from medical doctors to alternative practitioners look in the ear for tinnitus.
Far more often than not..."it's" not there.
You can spend a fortune of time and money on lots of tests. (Some you absolutely need.) Most of the time you will learn nothing and be sent on your way with the message, "there's nothing we can do, you'll learn to live with it."
They look for the hearing loss...and it's very often not there either...
That's a fine place to start at square one. In most cases, the noise simply isn't being generated in the ear. It's not being generated from there and it's a waste of time after a few things are ruled out to keep looking in an empty box and hoping to find something.... That's why they tell you that nothing can be done. Had they known to look in the right place they would have found it.
The majority of the time it is in the brain. About 1/3 of the time there is a physical trigger in the neck/head region. Sometimes both of the above factor into complex cases.
ENT's have told you for years, "There's nothing I can do, you'll have to learn to live with it." The reasons there is nothing THEY can do is because they currently aren't yet prepared to deal with problems that occur in the brain.
And...by the way, tinnitus is NOT a significant brain malfunction. More often than not it is best thought of as persistent memory (most cases in my experience) much like phantom limb pain.
"Kevin, I very much connected and enjoyed reading your book Tinnitus: Turning Down the Volume. I greatly appreciate all your diligence in regard to helping the tinnitus sufferers! I wish you the best and just want to thank you for your wonderful work and making it available for us suffering with this most challenging problem. I am looking forward to a full recovery. I wish you the best and hope that you continue to enlighten the tinnitus sufferers with your brilliant findings and continue to be successful. You are brilliant!" Marya Morrison, Dunedin FL
Just now scientific researchers are catching up with what was in Tinnitus: Turning the Volume Down, back in the first edition in 1996. Tinnitus is a neurological/neurobiological/etc. issue....and only a tiny minority of the time is it also an issue that relates to an eardrum, hammer or anything in the ear...If people followed our protocol in the 1990's, they are fine or as close to "fine" as you can get in life, today.
When you LIVE with severe tinnitus your motivation is much greater to find solutions than when you STUDY tinnitus.
All that said, remember that the people I've worked with over the past decade are people who experience mostly severe tinnitus. The majority of people I've worked with have contemplated suicide and are severely anxious, panic driven or depressed. I only speak from my personal experience and the thousands of people I've worked with. And remember, I've not had experience with people that have mild tinnitus. My work was with those suffering on a moderate to severe level.
This is important because I believe mild tinnitus often is the brain simply filling in from a hearing deficit at certain and often specific frequencies. This is the volume of tinnitus most frequently researched and studied in labs. But my office wasn't a lab.
The perennial question is whether I will begin doing therapy again someday. As of today's date, I have not, but it's always possible in the future. I will probably take a few more teleconsults in 2013, then that will be it again for awhile.
There's always someone with a compelling story. I have trained four talented colleagues in the U.S. who can help at the level of therapy and work with you with lifestyle process changes on the telephone or skype.
Anyone who treats severe tinnitus as a disorder of the ear when testing shows nothing dramatically wrong with hearing (i.e. total deafness), will indeed fail in helping the person who suffers.
Can hypnosis cure my tinnitus?
Not with the practitioner on the street. They simply have no training or experience.
Hypnosis with the tinnitus skilled, results focused, and EXPERIENCED therapist (4 or 5 in the USA?) in conjunction with a well designed management and reduction program just might do that, but hypnotherapy isn't magic. Most people associate hypnosis with "relaxation," or "suggestion."
Forget it. You're going to relax with 80 db going off in your head?
Hypnosis as 98% of practitioners were taught hypnosis is 100% useless in helping someone who suffers from tinnitus.
Never see someone because "they are local." There are only a few with a proven, rock solid track record. A few others who knew what they were doing became overwhelmed and burnt out.
Therapists (M.D.'s, husbands and wives...) aren't trained for tinnitus. (Who is?) Sometimes people who do hypnotherapy for a living think that hypnosis will magically turn down noise, today...Rarely, does it work that way.
Unfortunately most therapists in any field, have no significant experience in helping people with tinnitus short or long term.
The Good News: There are studies that have been duplicated several times that
note that over 69% of people using (long term) well designed self hypnosis programming experience long term significant reduction in tinnitus volume. I took that research and first stubbornly used it to help myself get well, then made available to the public just such a program. (After 18 years, in 2013, I just expanded this program as well, creating two new videos at Christmas.)
But why would we only utilize one modality to get well from something as devastating as persistent tinnitus?
Whenever possible, think multi-modal. If self hypnosis and knowing what to do step by step in your journey back to silence, is of interest to you, yes, I did create The Tinnitus Reduction Program and there is info at the bottom of the FAQ.
Special Note: You don't need to be a guinea pig to test anyone's treatment method. If you do single track therapy you will come to me in two years telling me how much you regret it. I see this in my email every single day.
Can you comment on a combination of Neurontin and Klonopin for Tinnitus?
It appears that Neurontin combined with a benzodizapene will help the majority of people with tinnitus. Abraham Shulman conducted a study with good follow up that had decent results. And when it comes to research, I trust everything he publishes. My belief is that some dosage of Neurontin combined with a low dose of Klonopin perhaps (0.25-0.5 mg three times per day) might cause significant improvement in the majority of people who suffer.
Whether the long term results will be as good as those of Xanax alone I certainly don't know. I have had clients report positive and negative results. If Xanax didn't have the desired outcome after say, six months, I probably would be very supportive of this Neurontin/Klonopin regime as a back up plan in the realm of medication for treatment.
Can you recommend a doctor/therapist locally here in my country, city, state?
I used to make recommendations. I sent people who suffer to famous clinics with names anyone would recognize. All I got were a bunch of hurt tinnitus sufferers. So no, I won't recommend someone, especially "locally" or "near you." If you and I talk on the phone, I'll show you how to talk with Medical Doctors so they can help you.
Too many medical doctors chose not to prescribe the medications that help most and instead of trying to save a life they felt it better to not write a life saving prescription.
Tinnitus is not a sore throat that anyone can help you with. It's the most complex issue a person can suffer from because there is essentially no external data in the textbooks or journals to work from... and the distress levels are often maddening.... Just about everyone I referred to therapists and doctors in the 90's wrote back and told me after a couple of months that they were making no progress. Their doctor/therapist wouldn't help or didn't know what to do. Worse: A lot of people blew thousands of dollars for nothing.
Now I tell people:
DO go see your doctor. She CAN help you. ...She may not know what to do because she simply wasn't trained in tinnitus reduction work. If you have severe tinnitus, prepare to travel for a three day session, perhaps with someone I've trained and coached. So please, don't ask me for a local referral. Go see someone with a proven track record. Talk to your medical doctor FIRST.
If you have a tumor or other physically observable cause, you need to get that taken care of FIRST.
Read this FAQ. See your doctor ask her for help. Take the FAQ to your doctor. Ask your doctor to visit this page. I've worked with a significant number of physicians, internists, audiologists, ENT's, even nurse practitioners, and other great people. If they (or anyone) give you the cold shoulder, go to another doctor who will do everything in her power to help you. No one but you is inside of your head. If they experienced what you are experiencing I promise they would treat you differently.
Therapists, doctors, whoever...no one knows what severe tinnitus is like until they have had it. So for the most part, ...sorry to say...they will possibly give you marginal advice...not because they are bad people, they aren't. They are simply not taught about tinnitus relief that works.
Ask them to help you and YOU take control of your therapeutic tasking and future. It's your life and believe me, if they haven't experienced this...they have NO CLUE what it is like to be in YOUR HEAD.
I have tinnitus: what should I do?
If you've had tinnitus less than two years, you need to see your doctor for an MRI. I have seen cases where a people "became" deaf due to incorrect medical treatment. I am not a big fan of CT scans (radiation, esp. for younger people, but if you've had tinnitus less than two years and you can't afford an MRI, then a CT scan is an option. An MRI will reveal more about the brain to the astute professional though, so, I'd opt for an MRI. Either test will find a tumor and anyone who has been in this business has seen the results of what can happen when an MRI is not given and the worst case happens.
Call me overly protective of you...my clients, or promoting "unnecessary tests," I won't see or TALK to ANYONE who hasn't ruled out tumor with 100% certainty. 1 for every 500 or however many people I've seen in the last 12 years is too many. Don't worry, the MRI will almost certainly come back negative and you will feel great once it's over!
Then have a blood chemistry performed. Are you diabetic? Are you hypoglycemic? Is there an imbalance we need to be aware of? See if getting this area of your life in balance reduces tinnitus volume. There's always a chance that this is the case.
Find out if you are zinc deficient or anemic. Zinc deficiency
does happen sometimes among elderly clients but has never occurred in one of
my under-50 clients. I'm not a mineral expert, just find out and if you're
in need of supplement, ask your medical doctor what to do. Beware: There's a lot of supplements on the market that have too much zinc or other metals that can CAUSE tinnitus. Only take zinc if your doctor tells you that you are deficient and need to.
Rule of thumb: If you take a tinnitus miracle cure pill or supplement or remedy, and you aren't a chemist, stop it. Save me the trouble in two years. It is so easy to make tinnitus WORSE and that makes my job a lot more challenging.
No diet, drink, herbs, supplements or vitamins are going to help your tinnitus improve.
Get an audiological work up and spend some time with your ENT.
It makes complete sense to get checked out thoroughly. Find out where your hearing
loss is, if you have any. About half of my clients have some minor
hearing loss. (I'll be frank: I see no correlation between hearing loss and moderate to severe tinnitus OR hyperacusis. None.) Never assume your tinnitus is being generated in your
Get all the tests you need. It's your life and your
hearing and your suffering. I wouldn't pay a lick of attention to anyone
who says, "Oh it doesn't matter, it probably isn't X". Nonsense, find out
what it IS.
Note on measuring tinnitus volume: If your audiologist simply uses her equipment that she uses for giving you a hearing test she can plot your tinnitus on the same graph as your hearing is reported on. There are a few audiologists who measure tinnitus with a "Celsius" thermometer instead of using "Fahrenheit." Let them do as they will but after they have their "threshold" measurement ask them to do you a favor and find your tinnitus on the graph for YOU.
Do you work in silence or in an extremely loud environment? Both are going to wreak
havoc on tinnitus. Too quiet, you need to
add sound until your daily environment is around 60dB plus or minus. Same
with your nightly environment. If you're a farmer or a construction worker
or in an occupation where you are exposed to 85+dB noise all the time, start
wearing ear protection now.
NEVER stay in silence for extended periods.
Whistle if you have to. The brain must have alternative auditory stimulus
if at all possible to help expedite your tinnitus to reduce in volume and
distress. If you are deaf, and a lot of my clients are, then you must learn
to do external focusing and self hypnosis, regardless of medications.
How does someone become a client of yours?
You can try and get an initial teleconsult with me (or more likely, someone I have confidence in) to put you on track. Sometimes this 90 minutes is what someone needs to get the information and right approach that will change the rest of their life. The therapist I suggest you speak with will look at where you have been, are and what you can do now, and with who. In some cases they'll do a follow up or two with someone if necessary. Specifics that you can't get in a FAQ. I've trained a couple of people whose results are essentially equal to my track record. In all likelihood, I will encourage you to speak with them in a teleconsult. I'm not currently taking longer term clients.
What do you think of masking therapy?
It's fine. I suggest a "habituation" approach that involves pleasant music in contrast to "masking". There are days when masking is very attractive but on whole, habituation is probably a better route in my opinion.
What do you think of vinpocetine for tinnitus reduction?
Possible. Certainly not necessary to go this route prior to the work we will do, but it is an option. There are no studies but I have had some positive anecdotal reports from clients.
What do you think of the Zoloft study where everyone improved and many had remission from just Zoloft?
15 years ago I began to encourage people to look at Zoloft. In the medical community no one paid attention...not for a DECADE. THEN they started to figure it out... It's a logical choice because of it's anti-obsessional, anti depressive, and slight anti-anxiety effects. When the study showed everyone improved, I had no explanation, as that is very rare indeed. My personal experience with my clients with SSRI's in general and Effexor has been excellent.
That said, perhaps in only 5% cases will an SSRI by itself outside of use with anti-anxiety medications will cause significant reduction.
On a scientific note, anytime you see ALL people getting well...
realize there might be a sponsor for the study with a vested interest. In this case, yes, Zoloft (and similar) is an excellent choice, but ALL...is not my experience and I've worked with more clients than perhaps anyone in the United States.
What do you think of habituation for tinnitus and hyperacusis?
Habituation means, that the tinnitus no longer bothers you in any way. Remission, if it's going to happen will happen AFTER habituation.
Habituation is an obvious necessity for EVERY person that has
tinnitus. My definition of habituation might be different than others though. People who fail in TRT habituation that have come to see me
failed because they not surprisingly didn't want yet another sound of tinnitus in their ears/head. There are a lot more ways to habituate tinnitus than with a pair of Starkeys.
Pleasant classical music, environmental sounds and babbling brooks pumped
into my head 24 hours a day for two years did me a world of good. That's where I
suggest most people start. And please don't think other kinds of auditory stimulus won't help, they will. My experience simply has been best with what I've noted above. There's no reason your favorite music at a sensible volume level wouldn't be helpful. The exception here would be music that favors bass. The broadest spectrum of sound is always desirable.
The vast majority of people won't need more than an iPhone and medication to simply habituate.
Habituation is more difficult but by no means impossible when the person has
hyperacusis. Hyperacusis is VERY beatable. Most people recover with little sensitivity later. Interesting, though hyperacusis starts as more difficult to deal with (from my point of view as consultant), it tends to yield first.
What do you think of neuromonics?
I don't. It seems to have identical results that I've experienced with using iPods and mp3 players. Why not use the iPod/mp3 player for the same period and see if that does the trick. (It probably will.) You can always utilize more expensive therapies later. I like to stick with what I know works.
Should I have the ______ surgery for my tinnitus?
Before doing anything that can give you permanent tinnitus...do the things that work. Except for tumor removal, I have never seen a client that needed surgery, experimental or otherwise, for tinnitus alone. It simply is a risk that is not likely necessary.
I wouldn't let anyone with a knife or needle near my head to "treat" tinnitus. Other things you bet. You have to dig all the way to the superior auditory cortex to get to the tinnitus for most people....
What do you think of Xanax? Will it get rid of my tinnitus? Does Xanax cause tinnitus? Can you really get addicted to it?
Did you know that your doctor can't prescribe Xanax to treat tinnitus? No can do. Xanax is a wise choice for treating anxiety or panic disorder, which can be easily *caused* by tinnitus. Make sure you get that straight. Don't ask your doctor for a medication she can't prescribe for the wrong problem...Xanax (alprazolam) is for anxiety. Ask a good question and you can get a good answer. Ask a bad question and your Doc really can't help you...
For me, Xanax was a miracle drug. It saved my life. (Me and thousands of others.) Took several months to "kick in" for me personally. For most people I've worked with it takes about 1-3 months, and that makes sense. If a person has severe tinnitus or hyperacusis and
there are no contraindications, it's the most logical starting point. One study shows about 3/4 of people using Xanax experience almost a halving in the noise volume at the end of the third month of usage. That's faster, on average, than any other option you have right now. It mirrors my experience with clients....
I've *read* stories of addiction, devastation and destruction. It's all very dramatic. I've simply never seen someone become addicted to the low therapeutic dose in 17 years over thousands of clients. If you have profound tinnitus, Xanax (and medications like it) will probably save you from something far worse than the remote possibility of addiction.
Xanax may or may not directly cause tinnitus to reduce in volume. What appears to happen is Xanax reduces the fear response and causes the body to be calm (or even tired). That calm "state" or "response" is conditioned to the tinnitus and eventually there is no need for the brain to attend to the sound. It becomes background and more often than not, the volume comes down as a secondary and not a primary effect.
I wish alprazolam would have been a consideration for the brother of one of my clients. Both had severe tinnitus. Their doctor wouldn't prescribe Xanax, the noise became so horrifying the man committed suicide. The woman (my client) went to bat for herself and worked with another doctor and me. Today she is almost completely silent. The risk of addiction is essentially zero... the danger of suicide for many is ever present.
As noted earlier, Xanax without a support system, especially friends, family, medical... will help, but be realistic. The human animal needs connections with others and tinnitus takes time...and compassion. Addiction: As soon as my first client in 12/13 years has experienced it, I will announce it here.
Caveat: Whenever a doctor prescribes a medication to be "taken as needed," then you DO have the birth of potential addiction. Xanax and similar medications, should be taken regularly and consistently so addiction doesn't happen. You smoke cigarettes and drink wine when needed...you become addicted to that stuff...don't do it with prescription drugs. Use them on a specific SCHEDULE.
Does Xanax cause tinnitus?
Xanax does not cause tinnitus. It has a negative tinnitus effect. In clinical trials for panic disorder, for example, 7% of people who take Xanax report they had tinnitus vs. 11% taking a placebo. Effectively this means that the brain is just as able to create a nocebo as it is a placebo effect. Xanax in low and consistent doses is a safe and effective starting point for your tinnitus reduction program.
Anyone who tells you Xanax causes tinnitus, benefits from you continuing to have tinnitus. You can't get tinnitus from taking benzodiazapenes.
I read in a new book that Xanax (benzodiazapenes) reduce brain plasticity and reduce the effectiveness of habituation (TRT).
Not only is that not accurate, I can't imagine how you could prove such a thing!
Xanax (alprazolam) will cost you a grand total of $100 for the first year, if you require it for that length of time. Even if you use the medication for two years before your tinnitus is remitted or much quieter, that's under $200!!! Generators will run you about $3000. Generators sound like many people's tinnitus and actually can cause more harm than good.
Xanax/Klonopin/Ativan helps most people get dramatic reduction in volume and sometimes remission, without further treatment. Not profitable for "providers"...and it will give you your life and sanity back. People who haven't had tinnitus cannot comprehend this. I've read authors who think they know what they are talking about...and haven't a clue.
Whenever you see someone try and scare you that an inexpensive, virtual side effect free, and proven method for reducing and/or eliminating tinnitus and the distress it causes is terrible...ask what their motivation is for causing the fear first...THEN figure out what's in it for them if they succeed in scaring you.
Reality: Anti anxiety medications (including Klonopin, Ativan, Xanax, etc.) help most people. They don't interfere with any successful therapy. Period.
Jack Vernon says only Xanax XR helps in reducing tinnitus, that alprazolam is not as effective. What is your opinion?
Xanax XR is very possibly a more efficient option. (it's time released so you only take it once daily, can reduce headaches, etc.) Alprazolam vs. Xanax XR overall, very little difference if any will be seen as long as the alprazolam is taken consistently every 8 hours. Now, if a doc has you on alprazolam just once or twice per day, that's a different story. You'll get headaches and tinnitus fluctuations.
Side Note: Jack Vernon falls into the category of one of the few people I
trust in this most unusual of fields...
What about anti-depressants?
I think after Mark Sullivan, I was the first person to wave the anti depressant flag. Of course! In my opinion, an excellent choice for moderate to severe tinnitus
suffering, if there are no contraindications. Some people say to start with
Pamelor, but I would disagree and go with the SSRIs like Zoloft, Paxil, Effexor, Celexa or Lexapro. Please read that last sentence again. I've had a lot of email from people who didn't get it right the first time.
my clients have experienced tinnitus elimination with Prozac. But, prozac
may have a small tinnitus side effect for a few people that is larger than placebo, granted not
significant, but I'm conservative. I would begin with Zoloft or Lexapro, but I am not an MD. MD's have no problem prescribing anti-depressants because they are not "tracked" thus you will have no problem here.
I no longer consider Pamelor because of significant side effects. The vast majority of my clients who have used tricyclics do get
benefits from the tricyclics and even more from the SSRIs... and of course you don't use them at the same
BUT Pamelor also has more impressive side effects than SSRI's and say, Effexor which is very helpful and has few side effects.
Antidepressants probably don't cause tinnitus to go down by themselves. It appears two things happen with people taking these medications. First the "anti-OCD" effect of the medication seems to cause people to "quit checking" their tinnitus. Secondly, the medications do succeed in reducing depression which can be profound...and allow the person to return to normal life as quickly as possible.
NOTE: For most people that are going to improve, tinnitus will INCREASE when you take an antidepressant for the first day or two or maybe even week or two. It comes back down. (You can try and keep the volume up by attending to it and avoiding the other things necessary to cause reduction!) This means the medication is doing it's job in the brain. Don't become upset when the volume increases. Assume it will. A helpful metaphor: The medication is "plowing snow from the highways" in your brain. It takes time to clear paths so they are neat and clean. Give it a few days. I remember these few days myself...they drove me nuts and weren't easy...and they were worth every second.
What do people experience when they take anti-depressants and anti-
Some people experience a locational change in their tinnitus. (That's the first very good sign I look for, by the way.) Some people
experience a temporary increase in volume, which we would expect, and now I
simply let the MDs I work with know that this is actually likely and also
almost certain to be temporary (1-3 days). Anti-anxiety's most common side effect seems to be
drowsiness in my clients. Antidepressants most common side effect seems to
be sexual reduction of pleasure which happens to about 4 in 10 of my
What is most important is how it changes the brain in the long term. Antidepressants will reduce the amount of obsessing and compulsive checking to see if tinnitus is louder, quieter, different...or just to listen. I suggest measuring your tinnitus five times daily. Other than that, put attention externally. If you do this you are on the right road. Anti-depressants are likely to be a CRUCIAL piece of getting well. Get past the first 1-5 days of increased noise (if there is any) and you win. Be stubbornly patient.
Tinnitus is causing me disability. I can't function. Will you help me get compensation for medical purposes?
No. You want to get back to work or to some other work as quickly as possible. (A few days at most.) The people who get well from tinnitus are the people who are most grossly absorbed in major projects that require "spinning a lot of plates." This is part of the lifestyle changes we talked about earlier...
What about ginkgo biloba?
My rule of thumb is this: If you have tinnitus that varies in volume
during the day or is pulsatile, you may want to try ginkgo for a few
months. Like the medications, IF it is going to help, it will take time to "kick in." You will in essence never know whether it helped or not! You might wait two,
three months even before results begin. You should know there is no actual evidence to support ginkgo as a therapeutic tool for tinnitus.
What about biofeedback and relaxation techniques?
Biofeedback is useful in stress reduction
and there is evidence that shows that biofeedback, while less effective
than hypnosis, is more effective than Elavil in tinnitus reduction. For people with mild to moderate tinnitus, relaxation oriented self hypnosis is very helpful. Most people with severe tinnitus can't come close to relaxing which is why I developed the Tinnitus Reduction Program. (See below for details.)
What about acupuncture?
Not proven to help. (Though good for headaches according to recent research.)
What about other herbs? Miracle cure pills?
Not proven to help. Save your money.
What about vitamins and minerals?
Magnesium and zinc may help people deficient in these areas. Calcium might help. (It helps a lot of things believe it or not!) There is some
reason to believe that B-Vitamins can help us cope with stress better. For most: Highly over rated, very expensive, and very likely won't help.
What about ear drops, and all of the remedies sold on the internet?
You mean the scams? They are ALL scams. Want a list of tinnitus scams? Type in tinnitus at google and look at the right hand column. All but two that I looked at today were a rip off. PLEASE save your money. If they have a remedy, they must have a double blind placebo study. Ask for it. (It doesn't exist.) Don't ask for testimonials. Ask for a double blind placebo study performed by an independent group. Again, there are none. Period.
What about chiropractic?
Maybe...For tinnitus, I would advise you to see a Doctor of Osteopathy (D.O.)
A D.O. may not know it but they were probably trained specific therapeutic manipulations that help a significant number of people with tinnitus. The problem is they don't know that they know.
What about psychotherapists?
Same as hypnotherapists. Most are great people that just don't have the laser beam specialized knowledge to help tinnitus sufferers.
What about medical doctors?
Most are just not knowledgeable about how to help tinnitus sufferers. I can't tell you how many times I've read a letter from a physician stating that the patient's tinnitus has no medical basis and therefore, there is "nothing more I can do". This is all preposterous. The medical doctor is one signature away from most people being 1/2 as loud in 90 days. There are MANY medications that can help you. Your medical doctor isn't obligated to work with you and you aren't married to your medical doctor. Become a proponent of getting well and seek the help of those who will help you. (Ask your doctor to stop off here for 10 minutes! Good doctors will take the time for you.
If you don't like your therapist or doctor, dump them. You need someone who will help you long term. Tinnitus isn't a sore throat or an ear ache. It's work. If they help you, keep them. Your M.D. should be knowledgeable, willing to learn FROM YOU... what you are learning and that you are willing to perform some trial and error. Treating tinnitus isn't just science. There's quite a bit of artistry in the long term process. It isn't just hypnosis or Xanax or TRT. It's a long term relationship in a lot of cases...in most cases.
Jack Vernon of the ATA told me...do you agree?
Jack Vernon is the person who talked with me 16 years ago. Jack and I have spoken only that one time. Jack is very knowledgeable about tinnitus. His approach is somewhat different in some respects. In others, we are very similar. If you have talked with Jack, follow his recommendations... Great human being. And "different" is not a synonym for "bad."
I've been thinking about suicide.
If a person has severe tinnitus and is suicidal, they should see a
psychiatrist or medical doctor, get treated both therapeutically and pharmacologically, then email me after the above
criteria have been met. This is my most common client. I've been where you are. It stinks. Remember: You will improve if you do those things that lead to improvement.
How did you come to know so much about tinnitus when the rest of the world seems lost?
I had severe tinnitus for 2.5 years, finally figured how to get better with the unwavering assistance of Chris Coleman, Director of Hope for Hearing in California and others...Today I have no tinnitus. (I only do therapeutic consultation work with people who have tinnitus, and those consultations are coming to an end.)
My LONG TERM experience from beginning to elimination or substantial reduction with tinnitus sufferers is second to only a very few: I
work with some of the most severe cases of tinnitus sufferers in the United
Why write the book?
It's not possible to answer the stacks of e-mails and letters each day any more. Now someone can go to Amazon.com and for next to nothing get the basic answers I would give. Please, read the book first, then e-mail. Your questions will be much more fine tuned after reading the book. (You're going to waste $10,000 on scam approaches if you haven't already, please, spend $20 or go to the library for heaven's sake.)
Do you hate getting all the e-mails?
No, I hate not being able to help and answer everyone personally. I spend 1-2 hours daily corresponding with whoever I can get to in the email box. It is not possible to do more, so forgive brevity if I can respond to you. People
aren't "bothering me." I do get down because I am not a non-profit
organization with a staff of people to answer all the inquiries. Sometimes it makes literally me cry when I have to
choose between my kids and my e-mail. I will always try to help but you need to be patient. Please do read the book and take advantage of the Tinnitus Reduction Program and begin your self therapy as soon as possible.
Please do not email before reading the book. It answers most questions most people have for me that aren't answered in this FAQ.
Please read the book prior to a teleconsult. It will save an enormous amount of time (and your money). If you want to get started in a logical fashion, start with the videos in The Tinnitus Reduction Program below. It's very inexpensive and will save you a significant amount of money in consultations. In all probability I will refer you to a colleague for a teleconsult and future therapeutic work.
WHO SHOULD OWN THIS PROGRAM?
Anyone with tinnitus who would like to reduce the volume of their tinnitus through the use of six self-hypnosis CDs, along with other strategies presented in the program.
The Tinnitus Reduction Program has helped thousands of individuals reduce the distress associated with tinnitus. In most cases, when individuals utilize the Tinnitus Reduction Program as part of a multi-modality approach to tinnitus reduction, they experience long-term improvement.
"I had meant to write before as I have had your program from July now. They have been wonderful and saved my sanity. My tinnitus is greatly reduced and my Meniere's under control. I return to your CDs as I find them excellent and I use them every night to go to sleep with. Thank you." Anne Clarke
Your CD/DVD program includes at least three hours of up to date information about how to reduce the volume and distress of your tinnitus. This portion of the program is updated regularly.
In addition to what is working in the area of medicine, tinnitus retraining therapy, and other modalities, you will receive self hypnosis CD's specifically designed by Kevin Hogan which assisted him in the elimination of his tinnitus. The first two DVD's in the program include the most up to date information about tinnitus relief you can get. Now, you can utilize the same program as part of a multi-modal effort in reducing your tinnitus volume.
Kevin Hogan is a psychotherapist specializing in hypnosis, who didn't stop with just one possible way to experience silence. A multimodal approach is the only way to assure your success in reducing your tinnitus volume and the intense emotional distress that comes from the tinnitus. If you are sick of hearing that "nothing can be done" and "you'll have to learn to live with it," this is the starting point.
The program includes the new revised edition of, Tinnitus: Turning the Volume Down which includes the latest developments in reducing tinnitus and hundreds of citations for further research.
Tinnitus Reduction CD/DVD Program and the book, Tinnitus: Turning Down the Volume
100% Lifetime Money Back Guarantee. After you have used this program and the information in it, for six months, you will have a record of specifically how much quieter you are then than now. If you don't think this program lived up to it's billing, return it for a full refund. And, If a CD or DVD EVER skips or breaks, we will replace it FREE!
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