My Recovery from Tinnitus and the Research no one wants to talk about, that I Uncovered, and Still Matters to You.

by Kevin Hogan, 1996/2018

The noise turned on at 80 dB and I needed relief now. I knew what tinnitus was, because just a few weeks before, I had experienced some head noise that was loud for several hours but faded. I knew the noise was called tinnitus because I had looked it up in Britannica. I didn’t know anything else about it. This time, at 2 AM, August 1, 1993; the 80+ dB noise was relentless. It woke me up out of sleep. I turned on the TV and then turned the volume all the way up. I put a fan on by my head on high. I couldn’t stand the head noise and the external noise didn’t cover the internal noise in any significant way. It didn’t go away and I was despondent. I called my physician when his office opened. He recommended calling the American Tinnitus Association for information and then scheduled an appointment to see me. The ATA told me there was a medication called Xanax that could reduce the noise and did in most people that used it. This was the beginning of my new life. Life with tinnitus, which eventually went away, but only after reading over 1,000 abstracts, papers and articles, and several serious reflective days where suicide was strategically planned. Life, late that summer, was something I felt I could no longer contribute to…

Xanax

…I once used street drugs in college and had learned how incredibly stupid that was. When the doctor told me Xanax may be habituating, I was torn between dealing with the drug or the noise. The noise was 80dB and the research was clear:

76% of individuals using Xanax gained relief by more than 40% volume reduction in their tinnitus. It would take 8-12 weeks for the drug to make an impact.(1)

…76% is most people…but I was not comfortable with the odds. Never having been a lucky person, I figured myself as part of the 24% with no change. I started the prescription and felt groggy. The next step was to take some time off of work and go to the library. The inter-library loan librarian was inundated with my request for hundreds of articles, journals, books, periodicals, that I was finding may contain information. We found phone numbers of the few specialists in the United States and I called them. A few treatments were having success. Most were not. Those treatments that were having success looked unpleasant.

Seldane

The end of August is upon our small family of three and our new motorhome is sitting waiting for me to get healthy so we can take a vacation. Driving it though is exacerbating the sounds in my head. My new theory of my cause for the tinnitus is that I’m having allergies. I quit eating various foods, stay away from electromagnetic frequencies, and decide that leaving for vacation just might do the trick. I read a study that shows that says:

60% of individuals who use Seldane experience some reduction in the volume of their tinnitus.(2)

The study wasn’t all that well done, as far as I understood it, at that time, but I decided to talk to the doctor. He agreed it was worth attempting. 30 day trial prescription. Still taking the Xanax with no effect….

We take 10 days off and drive to Cape Cod from our Minnesota home. We love Cape Cod and some of our best experiences in life have been there. Knowing from my hypnosis education how important the environment is to you on a psychological basis, off we go….to Cape Cod and still ringing in the high 70’s. It was on this trip, as I sat by one of my favorite spots, alone, attempting to meditate and pray, that I first seriously decided that life wasn’t worth participating in for me. I was seemingly useless to my wife and daughter. I felt as if the world now revolved around my noise. Everything was out of perspective. Over 30 days into the Xanax and 10 into the Seldane. All I felt was tired and depressed.

My wife talked me out of suicide, thank God. The depression and chronic fatigue continued. We were now home and money was running thin. Time to go back to work. Ironically, I continued to help individuals with chronic illness improve their conditions, but I was getting nowhere.

Pamelor; Stress, Anxiety, Depression and Panic Attacks

We discontinued the Seldane and continued the Xanax knowing it could still take weeks for it to “kick in.” I had gotten the name of a Dr. Mark Sullivan out east. He had done some research on Pamelor as a treatment for tinnitus. I remember thinking that ..Pamelor helped about 40% of individuals to reduce their tinnitus.(3)

A simple math equation reminded me that between the three medications listed above, my chances were over 95% that at least one would be helpful!

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Pamelor also seemed to be a logical choice as I had been experiencing a great deal of stress, anxiety and depression for sometime, before the onset of tinnitus. The tinnitus simply made everything worse. The research I had been reading at that time clearly indicated that I was not alone. In fact, most people with tinnitus, experienced,

….stress (4), panic disorder (5), anxiety (6), depression (7) and/or emotional problems (8) before the onset of their tinnitus. (SPADE)

The encouraging news for me was that tinnitus wasn’t simply an “ear phenomenon.” There was a reasonable correlation between emotional distress, which is very treatable and tinnitus which according to most professionals, was not. In fact, the relationship between what is called subjective tinnitus and (S.P.A.D.E.) was the norm for most clients I would later work with. Another interesting paper I came across noted that once an individual had tinnitus, he became far more likely to acquire other somatics (pains and illnesses) than someone without tinnitus.(9)

This was the first link that I made that hypnosis actually may be a useful treatment for tinnitus. Many of my clients whose illnesses and pains seem to expand into more somatics, were generally excellent candidates for elimination of chronic illness via hypnotherapy. I began to investigate….but my tinnitus was still in the 70+ dB range and the hyperacusis I experienced was becoming more frustrating to deal with every day.

Then sometime in October, the Pamelor was prescribed by my doctor. The tinnitus immediately skyrocketed back into the 80’s and it moved around my head. It was very scary. I called the doctor and asked to be taken off and he explained to me the neurological impact of Pamelor in the brain and its likelihood to decrease the volume. I agreed to continue but I was scared. Then a few weeks into the new prescription, the Pamelor completely eliminated my tinnitus. It kicked in with the Xanax and the tinnitus was almost completely gone. The Pamelor days would be short though as the side effects mounted. Dry mouth, fatigue, very high blood pressure. The doctor said we couldn’t continue with the Pamelor. I protested of course. I didn’t care about the side effects, compared to the benefits I was receiving from the medication. Silence was wonderful, even at the price I was paying fo r it. No matter, Thanksgiving came and the Pamelor went. Zoloft, a substitute was prescribed in its stead. The tinnitus returned, into the 60’s range most days. The side effects were gone, but the noise had returned.

Hypnotherapy works?

Christmas came and went. We sold the motorhome. I couldn’t drive it, so it didn’t really matter. I was busy with clients and my research but I was only finding case studies until early in 1994 I began uncovering reams of hypnotherapeutic research. The research explained that tinnitus needed to be treated like phantom pain (10) (11). I had done that many times. That would be easy. Tinnitus would yield to traditional modes of regression.(12) Tinnitus could be blocked at the cortical level by hypnosis in half the cases. (13) Tinnitus could be alleviated by self hypnosis tapes designed for tinnitus reduction if they were carefully designed by the practitioner, in over 69% of cases. (14) Essentially, I determined that over 80% of people should gain benefit through hypnotherapy, reducing the volume and/or the emotional impact that went along with it. I liked my chances and began practicing self hypnosis at night in lieu of the temazapam I had been taking for sleep. It took about six weeks to really become effective at habituating to the tinnitus for sleeping, which was my worst part of the “day.”

Occasionally on a bad day during this habituation process, I took a temazepam for sleep, but that was the exception and not the rule. The hypnotherapeutic tapes and self hypnosis that I practice succeeded beyond my wildest dreams. I habituated the tinnitus. It was one year later. The sound was in the 40’s and 50’s on many days, but it rarely mattered. By 1994 years end, the tinnitus began to permanently habituate. During all of 1995 and 1996, the tinnitus would return home and remind me that it still new where I was but the noise never bothered me again. Occasionally noise would come above threshold, maybe 20dB. I decided to come off the Xanax first and then the Zoloft. Except for a few very annoying days of letting the body re-adjust itself to being medication-free, the process was a complete success. The tinnitus did not increase after eliminating the medications. I was, in effect, cured.

During 1995, my work with clients from all over the country was in full stride. The phone calls, faxes and e-mails never stopped, and don’t to this day….and now the research that has been released in these last two years has validated my earlier speculations about tinnitus. In fact the important papers released in 1995 and 1996 are among the most important ever. They essentially prove that hypnosis and other cognitive therapies like biofeedback are the most likely road to success for most individuals with tinnitus. (The caveat being that hypnotherapy and biofeedback are practitioner dependent for success, and that drugs are not. You MUST have a qualified hypnotherapist and not someone who has little or no understanding of tinnitus.)

When I wasn’t working with clients, I accelerated my extension work in psychology. I was figuring out that the easiest way to get tinnitus to return was to not have a very occupied mind. It worked.

Staying Current for my Clients

Here are just a couple of the most recent exciting research findings that have appeared on the “tinnitus scene.”

What I learned in 1995 was that tinnitus in many clients is a recursive loop of memory, or put another way, is enmeshed into their memory and conscious awareness. This may indicate that hypnosis may indeed be able to block the tinnitus below the cortical level and from awareness, and at worst we could teach the client to create new perceptions that would allow the conscious mind to be filled with other stimuli and not the tinnitus. The theory and experience was validated when I read an unrelated study by Dr. Abraham Shulman which discusses where tinnitus is located in the brain. I merged his work with SPECT analysis(15), and my experience with hypnotherapy into a successful therapeutic regimen, and, it has indeed proven excellent results.

I also discovered that a biofeedback study (which is simple relaxation and manipulation of visualized images to reduce stress) again proved that most people can control their emotional response to tinnitus with proper practitioner guidance. Biofeedback became popularized over 25 years ago when it was deemed useful to measure the client response to altered states of consciousness. It was discovered that most people can reduce their stress level through electronic monitoring. Biofeedback is generally considered to be a useful sub-field of hypnotherapy and it is always encouraging to see positive results for tinnitus sufferers that are taught biofeedback monitored relaxation techniques.(16)

This is just the tip of the recent tinnitus research iceberg. In the next issue of Hearing Health, we will specifically discuss what the profoundly deaf can do for their tinnitus reduction, and, we will insert self hypnosis instructions specifically designed for the hard of hearing with tinnitus.

Notes:
1. The Xanax study was reported in Arch Otolaryngology Head and Neck Surgery. 1993:119:842-845 by R. Johnson, B. Brummett, A. Schleuning. The double blind placebo study showed 76% of individuals using Xanax had a volume reduction of 40% or more. The control group showed only 4% improving. Side effects were minimal and the study lasted only 12 weeks. Improvement for most began after 8 weeks on Xanax at 1.5 mg. per day total.

2. Seldane-study unavailable to author at press.

3. Pamelor-In a personal conversation with Dr. Mark Sullivan, my understanding was that he was currently working with nortriptyline with tinnitus sufferers and was experiencing a fair degree of success. Further, in the biofeedback study, cited in number 16 below, it was found that 27% of patients improved using Elavil, a close “cousin” to Pamelor.

4. Stress- A. Shulman in the SPECT study, noted in 15 below, notes that, “the stress factor has been linked to cortisol accumulation resulting from a defect in its control of the hippocampus. Its accumulation has been linked to changes in mood which, over time, progress from anxiety to depression. The tinnitus patient may develop a memory not only for normal auditory stimuli but also, paradoxically, for the aberrant sound, that is tinnitus.” Hundreds of studies cite excessive stress as related to tinnitus annoyance and suffering. Numerous studies cite excessive stress as highly correlated with tinnitus onset.

5. Panic Disorder-56% of individuals with panic disorder experience tinnitus as well.

6. Anxiety-J.Cicocon, F. Amede, et.al., in Geriatrics, Feb. 1995, pp. 18-25, note that, “Subjective tinnitus is more common and may be due to peripheral or central auditory pathology, a metabolic abnormality, or anxiety/depression.”

7. Depression was reported as prevalent across the lives of 62% of tinnitus sufferers vs. 21% of a control group by Griffiths, Katon, Dobie, Sakai, Russo, in the Journal of Psychosomatic Research. Vol. 31, No. 5. pp. 613-621, 1987. (Current depression was reported in 48% of tinnitus sufferers vs.. 7% of the control group.)

8. Emotional Problems-In the same study noted in (7), the researchers noted that the number of psychosocial problems and thus the resulting disability experienced was significantly greater in the tinnitus group compared to the controls. The authors was conclusion that treatment needed to attend to both the tinnitus and the depression when present. Common challenges facing tinnitus sufferers in at least half of all cases include clinical depression (75%), insomnia (56%), adverse effects in lifestyle (93%) and sexual difficulties (52%).

9. Somatics- J. Russo, W. Katon, et. al, noted in Psychosomatics, Vol. 6, 1994, pp. 546-56, “the results revealed that the number of lifetime medically unexplainable symptoms were significantly, independently, and positively related to increasing numbers of current and past anxiety and depressive disorders…and the “worry-pessimism” and “impulsiveness,” subscales…were positively related to the number of medically unexplained symptoms. The results suggest that somatization is associated with current and past history of psychiatric illnesses and harm avoidance in this sample of medical patients.”

10. Phantom Limb Pain treatment by Dr. Milton Erickson was treated using identical hypnotherapeutic application as his case study tinnitus client, noted in his text book Hypnotherapy, with co author Ernest Rossi, Irvington Publishing, 1979.

11. Pawel Jastreboff, in the British Journal of Audiology, 1993, pps. 7-17, noted that, “in the vast majority of cases tinnitus is a phantom auditory perception, perceived exclusively by the patient…(and among the problems tinnitus brings-)…extremely strong imprinting of the tinnitus sound on the patient’s central nervous system.”

12. Dianetics, Hubbard, L., 1950, Bridge Publishing.

13. Crasilneck and Hall, in their text of Clinical Hypnosis announced that 50% reduction in symptoms can be achieved, “probably through blocking awareness at a cortical level.” Supporting this theory, is the text, Hypnosis: Current Clinical, Experimental and Forensic Practices, edited by Michael Heap: “Hypnosis appears to be a natural choice of….treatment for tinnitus, not only as a relaxation method but also as a means of modifying or even blocking sensory awareness…There are a number of comments and reports in the literature concerning tinnitus sufferers.”

14. G. Brattberg, at the Sandvikens Hospital in Sweden did a longitudinal study of patients using a self hypnosis tape after just one session of hypnotherapy with a client. 69% cited improvement, regardless of cause. Three patients of the 32 studied announced a cure. Most were sleeping better, having significant improvement in critical lifestyle areas. Numerous other studies support Brattberg’s findings.

15. A. Shulman, A. Strashun, et al. discussed at the Triological Society, 1993, NY, that, “SPECT results of brain demonstrate for the first time the in vivo significance of the organacity of brain for a central type tinnitus…auditory function can be considered to involve multiple neural networks reflecting various attributes of hearing…It can be speculated that a short term memory is established for tinnitus in the medial temporal lobe memory system which becomes stored in associated areas of the neo-cortex. A paradoxical memory for tinnitus may cause the tinnitus to become clinically manifest as a severely disabling tinnitus.”

16. L. Podoshin, Y. Ben-David, et. al., researched the differences of tinnitus in both resting and active situations for their patients. 43.5% of biofeedback patients experienced improvement at rest and 24% during activity, outperforming those using the drug Elavil.