Tuesday, December 27, 2005

Tinnitus Treatment, Relief and Cure

Tinnitus FAQ
The Tinnitus FAQ (Frequently Asked Questions)
by Kevin Hogan, Psy.D.

If you have been looking for a tinnitus cure, tinnitus treatment or therapy, please feel free to read the all the tinnitus information below to see what is and what is not likely to happen. 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 tinitis or tinitus). For information about tinnitus related programs, see Here. Updated November 5, 2005

These are common questions (some paraphrased or edited) I have received in the mail and by e-mail from thousands of people over the past few 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! Everything in this FAQ assumes you have moderate to severe tinnitus. Therapy for non-intrusive (not bothersome) tinnitus that is mild or mild to moderate is different.

Can I get cured from tinnitus too?
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 improve greatly.

Maybe. About 1/3 of my clients have reported tinnitus remission as of now. Usually a lot of work goes into these kinds of results. (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 slowly growing.

How did you get better?
Medication, osteopathy, hypnotherapy, habituation, self hypnosis, ginkgo, wearing a splint for my TMJ, and major lifestyle changes. This is covered in detail in the book Tinnitus: Turning the Volume Down. By the way, I did lots of things that didn't work. Tens of thousands of dollars of things that didn't work.

What was the most important part of your healing process?
Support from my wife was very important. Xanax, Zoloft and Osteopathy. It was probably Ginkgo that got rid of one pulsatile sound, self hypnosis eventually took the place of sleeping pills and helped the habituation process...and frankly, was far more successful than I thought possible. If I had to pick one, it would be Xanax, but all were very important. And by the way, all the Xanax in the world won't change MOST people's tinnitus long term without a strong support system of family, friends or medical/therapeutic or all.

What is tinnitus and why can't anyone seem to help?
Tinnitus is any noise or set of sounds heard that is generated in the ear, hearing system or brain. Everyone from medical doctors to alternative practitioners look in the ear for tinnitus. That's a good place to start. However...in most cases, it simply isn't there. That's why they "can't do anything." Had they known to look in the right place they would have found it. It's in the brain. 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 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 a persistent memory (in my experience most cases) much like phantom limb pain. Anyone who treats 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?
Hypnosis with the tinnitus skilled therapist (and I have five fingers the names of those people) 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." Forget it. If that is purported, go elsewhere. And certainly don't see someone because "they are local." In the United States, to my knowledge, only Ron Stubbs (WA), Jennifer Battaglio (NY) and Bob Bayliss (TN) are successfully working with people to this point. A few others who knew what they were doing became overwhelmed and burnt out. Therapists 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 (of any kind) have no significant experience in helping people with tinnitus short or long term. (One session of hypnosis is like taking one week of Xanax. It will do nothing.) 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. But why would we only utilize one modality? Whenever possible, think multi-modal. If self hypnosis is of interest to you, yes, I did create The Tinnitus Reduction Program and their 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 hear this...every day.

Do you recommend 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 believe and 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 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 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. All I got were a bunch of hurt tinnitus sufferers. So no, I probably won't recommend someone, especially "locally" or "near you." 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 to work with 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. Locations: Seattle (Ron Stubbs), North Carolina (Elizabeth Nahum) and in Tennessee (Bob Bayliss). That's it at the moment. In England, contact Mair Llewellyn at the http://www.Tickhillclinic.com/ . My friend Terry Watts in London has experience as well. So please, don't ask for a referral. Talk to your medical doctor FIRST.

Read this FAQ. See your doctor ask her for help. Ask your doctor to visit this page. I work with a lot 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. 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.... 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 person became deaf due to incorrect medical treatment. Get a CT scan if you can’t afford an MRI. 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. Both of my clients who had tumors had more typical tests when their tumors apparently were in their infancy. Call me overly protective of my clients, or promoting unnecessary tests, I won’t see ANYONE who hasn’t ruled out tumor with 100% certainty. 2 in 1000 or however many people I’ve seen in the last few years is two too many. Don’t worry, it 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.
Find out if you are zinc deficient or anemic. Zinc deficiency does happen sometimes among my 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.

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 "hearing system." 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.

Do you work in silence or in a loud environment? Both are going to wreak havoc on tinnitus. Lifestyle change number one is indicated. Too quiet, add sound until your daily environment is around 50dB 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 noise all the time, start wearing ear protection now. But 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?
I have not seen clients for therapy(with rare exception) in the last two years. I will not be taking new in house clients next year. You can get a teleconsult with me to put you on track. Set up a teleconsult (email me, please don't call). Sometimes this 90 minutes is what someone needs to get the information and right approach that will change the rest of their life. I look at where you have been, are and what you can do now, and with who. In some cases I'll do a follow up or two with someone if necessary. Specifics that you can't get in a FAQ.

What do you think of masking therapy?
It's fine....I suggest the "habituation" approach in constrast 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 habituation for tinnitus and hyperacusis?
Habituation is an obvious necessity for EVERY person that can hear, that has tinnitus. My definition of habituation is different than others though. People who fail in TRT habituation that come to see me failed because they shockingly didn't like another sound of tinnitus in their ears/head. There are a lot more ways to habituate tinnitus than with a pair of Starkey’s. Pleasant classical music, environmental sounds and babbling brooks pumped into my head 24 hours a day for two years did me wonders. That’s where I suggest everyone start, except those who can’t wear headphones for various reasons. Then you look at generators.

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!

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.

What do you think of Xanax? Will I become addicted? Will it get rid of my tinnitus? Does Xanax cause tinnitus?
For me, it was a miracle drug. It saved my life. (Me and thousands of others!) Took several months to "kick in" for me personally. Five or six. 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 of addiction, devastation and destruction. I've yet to see it in 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.

Could you become addicted? I wish it 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 almost zero, the danger of suicide for many is ever present. And 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 10 years has experienced it, I will announce it here.

Does Xanax cause tinnitus?
Xanax does NOT cause tinnitus. In fact it has a negative tinnitus effect. In clinical trials for panic disorder, 7% of people who take Xanax report they had tinnitus vs. 11% taking a placebo for the same problems. Effectively this means that the brain is powerful at creating problems (nocebo...not placebo effect) Xanax in low 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.

I read in a new book that Xanax (benzodiazapenes) reduce brain plasticity and reduce the effectiveness of habituation (TRT).
Garbage. 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 with fancy degrees 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.

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 SSRI’s 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. Thanks....Some of my clients have experienced tinnitus elimination with Prozac. But, prozac may have a small tinnitus side effect that is larger than placebo, granted not significant, but I’m conservative. I’d start with Zoloft or Lexapro, but I’m not an MD. MD's have no problem prescribing anti-depressants because they are not "tracked" thus you will have no problem here.

Pamelor has a proven track record. (I no longer encourage using it 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 SSRI’s... and of course you don't use them at the same time. BUT Pamelor also has more impressive side effects than SSRI's and say, Effexor which is very helpful and has few side effects.

NOTE: For most people that are going to improve, tinnitus will INCREASE when you take an antidepressant for the first few days 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. 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 weren't easy...they were worth every second.

What do people experience when they take anti-depressants and anti- anxiety medication?
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 MD’s I work with know that this is actually likely and also almost certain to be temporary (a few 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 clients.

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 and you win. Be stubbornly patient.

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, it will take time to "kick in." Two, three months even before results begin. You should know there is no actual evidence to support ginkgo as a therapeutic tool for tinnitus. I am favorable to the use of it because of my personal experience and a few anecdotal reorts from clients. It's expensive. If money is an issue there are better places to invest in your tinnitus reduction. If money is no issue, I would (and did) see what happens over a few months.

What about biofeedback and relaxation techniques?
Biofeedback is a subfield of hypnosis. Who relaxes or can relax when you have severe tinnitus?? I certainly couldn't. Most of my clients can't. 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?
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.)

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 knowledgable, 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 12 years ago. Jack and I have spoken only that one time. Jack is very knowledgable 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...then evaluate in six months. Things aren't going well, drop me an email. We are two different football coaches with winning records... Jack Vernon saved my life...period. My appreciation and respect for this man are eternal. Great human being.

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 call 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.

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 States.

Why write the book?
I can’t answer 20-30 e-mails and letters per day. 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 about 2 hours daily corresponding with whoever I can get to in the email box. It is not possible to do more so forgive brevity when you write. 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 help but you need to be patient. Please do read the book and begin your self therapy as soon as possible.

How can I get a copy of your book Tinnitus: Turning the Volume Down?
You can go to our Store to order it online. You could also special order it from your book store. (Can you believe no one stocks books about tinnitus?) Amazon.com works.

Please read the book prior to your teleconsult. It will save an enormous amount of time (and your money). If you want to get started in a logical fashion, use The Tinnitus Reduction Program below. It's cheap and will save you a ton of money in consultations with me and others.