Tinnitus Treatment and Therapy FAQ

· 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.

· 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, 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.

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Tinnitus Treatment and Therapy FAQ

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.

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.

Antidepressants probably don't cause tinnitus to go down by themselves. It appears two things happen with 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 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 drove me nuts and weren't easy...and they were worth every second.

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Tinnitus Treatment And Therapy FAQ

· 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 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 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 effective. What is your opinion?

My opinion is I find it hard to believe Jack told you that. What you probably read/heard was that Xanax XR is 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, you bet. You'll get headaches and tinnitus fluctuations.

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Tinnitus Treatment and Therapy FAQ

· What do you think of neuromonics?

I don't know. It seems to have identical results that I've experienced with using iPods and mp3 players. It just seems spendy to me. 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 I become addicted? Will it get rid of my tinnitus? Does Xanax cause tinnitus?

Did you know that your doctor can't prescribe Xanax to treat tinnitus? No can do. It's for treating anxiety 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 is for anxiety.

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.

Xanax doesn't appear to 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 ocnditioned 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.

Don't ask your doctor for Xanax for your tinnitus. She can't do that. Xanax is for anxiety reduction. Read that sentence again. Then your doctor can prescribe safely (for her, not you). Don't ask your doctor to do something that could get them in trouble. Xanax is for anxiety reduction.

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 11 years has experienced it, I will announce it here.

Caveat: Whenever a doctor prescribes a medication to be "taken as needed," then you have the birth of potential addiction. Xanax should be taken regularly and consistently so addiction doesn't stand a chance.

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Tinnitus Treatment and Therapy FAQ

· How does someone become a client of yours?

You can try and get a teleconsult with me (or someone I have complete confidence in) 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. I've trained a protege whose results are essentially equal to my track record. In all likelihood, I will encourage you to speak with her in a teleconsult.

· 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 the Zoloft study where everyone improved and many had remission from just Zoloft?

12 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.

· 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 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 a world of good. That’s where I suggest everyone start, except those who can’t wear headphones for various reasons. 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.

The vast majority of people won't need more than an iPod to 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!

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Tinnitus Treatment and Therapy FAQ

Can you recommend a doctor/therapist locally here in my country, city, state?

I used to make recommendations. I sent people 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."

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), Jennifer Battaglino in NY, and in Tennessee (Bob Bayliss). That's it at the moment. In England, contact Mair Llewellyn at the Tickhill Clinic. My friend Terry Watts in London has experience as well. So please, don't ask me for a referral, except to these people 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 it to your doctor. 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?

1. 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. 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.

   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!

2. 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...

   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. 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....

3. 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.

4. Do you work in silence or in a loud environment? Both are going to wreak havoc on tinnitus. Too quiet, you need to 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.

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· Can hypnosis cure my tinnitus?

Hypnosis with the tinnitus skilled therapist (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?

If that is proposed or 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 Battaglino (NY) and Bob Bayliss (TN) are successfully working with people to this point. These guys (and Jennifer) have a proven, rock solid track record. A few others who knew what they were doing became overwhelmed and burnt out. Therapists (doctors, 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 (of any kind) have no significant experience in helping people with tinnitus short or long term. (One session of suggestion based hypnosis is like taking one Xanax. It will do almost nothing.)

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 11 years I just expanded this program as well.)

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 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 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 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.

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