Tinnitus: Looking Back and Looking Forward

I remember the day I woke up and the tinnitus was gone. It was Christmas time in 1995. After 30 months of living in hell it was silent that morning. The maddening noise would be completely gone for 8 months before recurring in August of 1996. Since then, it would come back perhaps a few times per month for a couple of hours at a time. (Usually at bedtime after a long and stressful day.)

By 1996, my life had taken a massive turn away from selling and into a life of seeing clients with tinnitus and helping them in my role of psychotherapist/hypnotherapist. It was indeed something I never intended to do, but when I “went silent” everyone wanted the answer for their situation. In response to the thousands of phone calls, e-mails, faxes and letters, I started writing articles and posting information about tinnitus relief on my website at Tinnitus FAQ. This article is the first update I’ve made to that information in over three years.

The purpose of this article is to share with you conclusions about tinnitus therapy and treatment based upon my experience with hundreds of clients and thousands of consultations and correspondences over the past six years. It’s not my intention to answer every question about tinnitus nor to give you a new scientific theory. This article tells you what I know is helping people turn the volume down. I’m also going to share with you some speculation as to future research and where more answers may be.

Where does tinnitus originate?

There is still a lot of question as to “where” tinnitus exists in the human body. The initial thought that many people have is that it is in the ear somewhere. There is no doubt in my mind that in some people, this is true. Perhaps otoacoustic emissions from the ear send noisy signals to the brain and that is tinnitus. Perhaps. The truth is, that in some cases that is indeed possible. There is one thing we can be certain about. In all cases tinnitus is experienced in the brain and interpreted by the brain. In other words, like physical pain, tinnitus is interpreted and to some extent generated in the brain. My experience of doing years of psychotherapy and hypnotherapy with people who suffer from tinnitus is that it can and often does go away with the right program, the right treatment plan.

Imagine that there are hundreds of highways in your brain (there are billions, but if you can imagine a map of your country with all of the interstate highways visible, that’s enough to understand this useful metaphor). These highways, when interconnected, form memory and allow you to think and create. There are probably no other thought centers in the body. There are probably no other creative thinking and centers in the body. The neural circuitry, the highways are where it’s all at.

Think of someone you love. Think about them in great detail. What they look like, sound like, maybe how they feel. Just do this for a moment before continuing.

Your “conscious self” just took an off ramp of reading this article to an image or sound or feeling or all three to someone you love. The “driver of your car,” the “you” of whoever you are went from reading this article to someone you love. It literally lit up an entirely different set of circuits and neural pathways in your brain.

Some of these highways have tinnitus “on them.”

Some of these highways do not have tinnitus “on them.”

Those two statements are certain. They are not hypotheses nor are they theories. Those statements are facts.

It’s also interesting to note that there is some evidence that some cases of tinnitus are caused by an instability of the structure of the cells in some parts of the brain.

Using different kinds of hypnosis I can report to you the results of years of experience with hundreds and hundreds of clients. (I am also drawing on case studies by my colleagues like Ron Stubbs, Dianne Olson and others.)

1. In regression hypnosis, when clients are directed to times in their life when tinnitus wasn’t present, almost all clients do not hear their tinnitus while in trance.* This can be for periods of time up to two hours during our session work. During these two hours, most clients are not hearing their tinnitus at all. Their “selves” are driving themselves along highways that do not have tinnitus “on them.” This is consistently true. At least 70% and maybe as many as 90% report this experience.
   
   *Trance refers to a focused state of attention where the client is only attentive to what they are directed to be attentive of. There is nothing mysterious about trance. If you cry at the end of It’s a Wonderful Life with Jimmy Stewart and Donna Reed, you were in trance because you dissociated from the real world and bought into the world of the Bailey’s and the evil Mr. Potter.
2. In regression hypnosis, when clients are regressed to describe incidents of serious events where tinnitus volume is loud and distressing they almost always experienced increased tinnitus and distress. Upon relating these incidents many times in trance, the anxiety and helplessness of the client reduces and often the client experiences little or no anxiety to loud tinnitus while in trance.
3. When clients are “brought out of trance” and are attentive to everything else in the world, their tinnitus tends to be louder (although this is not always true) for an hour or two then remits significantly, often to levels that are substantially quieter than when the client walked in the office.
4. Long term results show significant gains in almost all cases. Now, this is a sticky point here. Clients who faithfully do their homework and practice all of the different focusing and self hypnosis exercises we assign do substantially better than those who fly into town for three days, leave and do nothing at home. Personal responsibility is critical.
5. Meditation for people with moderate to severe tinnitus has proven largely ineffective.
6. Hypnosis that relies on relaxation and calming techniques has almost no value when contrasted to guided imagery. But…
7. Imagery is a distant second place when contrasted to the long term results of the hypnotic interventions of #1 and #2 above.

The Goal of Tinnitus Therapy

We have yet to have a documented case where a client improved dramatically after one session of hypnotherapy or psychotherapy. Generally speaking 15 hours of therapy or more is necessary. This should be obvious as it takes a long time to get those big 8 lane highways in the brain to atrophy into dirt roads that are rarely traveled. That is the goal of therapy by the way. The objective and focus of the therapist is always to a) desensitize the client to the sound of tinnitus and b) to teach the client how to focus on other experiences in life (past, present or future) that do not have “tinnitus on the highway.”

The good news is that most cases of tinnitus, regardless of cause improve with time, with therapy and lots of successfully completed homework.

The bad news is that there aren’t a lot of therapists out there that understand how to work with people who suffer from tinnitus.

More Good News: Approaches that Work

Clients continue to respond favorably to medications like Zoloft, Effexor, and Paxil. (antidepressants)

They also tend to respond as well or better to Xanax and Ativan. (anti-anxiety medications)

Clients have also reported positive results with Neurontin and Klonopin. (anti-convulsants)

In fact, the number of medications that help tinnitus sufferers reduce volume and suffering is so great that it is a shame that the FDA (to my knowledge) still hasn’t approved medications for tinnitus sufferers.

A medication that reduces the fear response will help extinguish the fear response to tinnitus and thus the amount of attention paid to tinnitus. (Thereby shrinking the 8 lane highway into 6 or 4 or fewer “lanes.”) Long-term use of anti-anxiety medication is probably warranted for most severe cases and the resulting fewer suicides and long term positive change will likely supercede the minor side effects and remote possibilities of addiction to said medications.

Those medications that reduce depression, obsession and compulsive behaviors will also continue to help those suffering with tinnitus. The SSRI’s tend to be most effective in my experience but other medications certainly can help as well.

The Osteopath

Many people call and come complaining that their tinnitus is exacerbated by pressure on their forehead, different head positions and teeth clenching. When I hear this I immediately refer the person to an Osteopath.

For some reason, osteopathic treatment (intracranial sacral therapy) still seems to be effective in helping the majority of my clients that report these exacerbating elements. I can’t explain all of the reasons why, though I do have hypotheses. The human body generally responds well touch and feelings of connectedness. Perhaps there is some of this mind/body response in the client’s experience. Perhaps the human body can become so stressed and distressed that it changes brain chemistry. Perhaps the sphenomandibular ligament that connects the area of the ear drum to the jaw is causing some kind of pressure in the ear, like plucking a guitar string.

One client named John was planning to come to Minnesota to work with me a couple of years ago. I sent him to a local D.O. (doctor of osteopathy) and he never needed to fly here because regular treatments by his D.O. were all he needed for elimination of tinnitus. (I’ve had similar situations with clients I did telephone consultations with that I suggested other treatments like Prozac, Zoloft and Xanax.)

Auditory Habituation

Tinnitus Retraining Therapy is a fancy phrase for auditory habituation. I’ve talked with many people who have improved by using sound generators. I’ve spoken with many others that couldn’t stand to have the little noise makers in their ears. What I have found nearly universal in acceptance by clients is listening to classical music, environmental sounds and new age music that both soothes and creates a secondary sound source for attention. Auditory habituation is a “must” in terms of tinnitus recovery and remission.

I strongly suggest all of my clients play music in the background all day long or at least keep a television on. Anything that provides about 50 decibels of sound will do the trick. For the people with severe hyperacusis, they will need to start at 40 decibels and work their way up over time to fifty decibels.

These Usually Don’t Help

As time has gone by, I have seen fewer cases of people improving from any kind of tinnitus sound with Ginkgo. For some time I thought ginkgo might be a significant part of the therapeutic regime for most clients. Today, I suggest clients talk to their medical doctor about ginkgo but I can’t recommend it evangelically as I did 5 years ago.

I’ve also seen very few cases of people improving with homeopathic remedies and acupuncture. None of the bogus drops and mail order “medications” showed any improvement that I could find.

Changes in diet rarely seemed to help anyone in my experience. The same is true for clients who have taken herbal potions and remedies.

The Future

In the long term, “they” almost certainly won’t find a single cure for tinnitus because tinnitus has so many etiologies (causes). Tinnitus is experienced in so many different ways that it seems like aggressive multimodal treatment programs will continue to be in the best interest of the “average tinnitus sufferer.” What these clients will find is that tinnitus can be greatly reduced in most cases through desensitization and alternative attention therapies.

For years I have advocated a multi-modal approach to tinnitus therapy and that has proven to be right on the mark. For the average client suffering with severe tinnitus, I recommend the following in order of importance.

1. Talk to your doctor immediately about starting a fairly long term treatment plan with low doses of anti-anxiety medications like Xanax, Klonopin or Ativan.
2. Talk with the same doctor about starting a fairly long term treatment plan with moderate daily use of SSRI medications.
3. Listen to music or the television all day as background noise. Avoid silence and extremely loud places. If you can’t do this, see an audiologist and buy a pair of sound generators that are comfortable for you to wear.
4. Begin hypnotherapy with someone who has a great deal of experience with tinnitus.
5. Begin psychotherapy with someone who has a great deal of experience with tinnitus.
6. Begin using self hypnosis tapes for alternative attention and focusing practice. Use the tapes every day. (We can help you with this: See our catalog.
7. See an osteopath for 5 sessions. Usually after 5 sessions you know if this is one of the keys for you. Hint: Those clients with the best success are those whose tinnitus is much louder when they are lying down on the floor or in bed.
8. Avoid support groups and other people who want to talk about their tinnitus all day long. Once you have an action plan, avoid others (unless you are a therapist or doctor!) who want to focus on their tinnitus. Tinnitus in some respects, is an “attention disorder.”
9. Start living a life that is rich and filled with the things you love to do, today! If that tinnitus were a wake up call to happiness, today would be the day to answer the call.