Tinnitus Treatment: A New Understanding Brings Hope For Tinnitus Relief and Your "Cure"

by Kevin Hogan

(This article is excerpted from the book, Tinnitus: Turning the Volume Down (Revised & Expanded)

Tinnitus, "the noise," is running through your brain on hundreds of highways called neural pathways. These neural pathways are roads between brain cells. The "intersections" in the brain’s highways are called synapses.

These intersections don’t actually touch each other. The open space between the cell arms is called the synapse. The highways are made up of axons and dendrites (which you really don’t need to know all that much about). One cell (neuron) sends information to another cell by sending an impulse from one cell to the next via a neuro-transmitter, much like a cellular telephone call. The phones aren’t connected by wires. We’ll talk a little more about these neurons and neurotransmitters in a moment.

It is also useful for you to understand about how people get depressed, feel stressed or become panicked or experience anxiety, and, how all of this relates to tinnitus.

Research into tinnitus suffering shows that what we call SPADE (an anacronym I coined in 1995 to consist of at least one of the following: stress, panic disorder, anxiety, depression, and/or emotional challenges) tend to predispose people to tinnitus (and of course other somatics as well). SPADE is a significant set of variables in determining who will experience suffering from tinnitus and who will not. SPADE is most likely a significant variable in who experiences tinnitus after exposure to loud noise or other physical stimuli. The emotional part of our brain, it appears, is critical in both the experience, suffering and relief from tinnitus.

There may be a stigma that goes with this line of thinking. If we acknowledge an emotional component to the onset and later suffering of tinnitus, we acknowledge that it is at least tangentially something that could be mistaken as a "mental illness." Because such terms are useless in the healing process, we will not concern ourselves with such labels. You can call anxiety a "brain cold" and "depression" a case of the "mind flu." The name doesn’t matter, getting better does. Our objective will always be the reduction and/or elimination of tinnitus. Period.

Tinnitus suffering is positively correlated to all the elements of SPADE.

For now, consider the insidious relationship between brain chemistry and stress, stress and depression, and all of these emotional states and tinnitus.

In SPADE, "the first factor" seems to be stress.

In 1993, Dr. G. W. Brown wrote that he discovered 84% of a large sample of depressed patients had experienced severe stress in the preceding year compared to 32% of control subjects. Drs. Anisman and Zacharko have suggested that the depletion of certain neurotransmitters (e.g., of dopamine, serotonin, and norepinephrine) that are associated with stress may leave an individual sensitized to subsequent stress and thus less capable of coping with it. They view the inability to cope effectively with stress as a major predisposing factor in depression. (Biopsychology, 1997, Allyn and Bacon Press)

Important studies involving patients with tinnitus reveal that depression precedes a significantly large numbers of tinnitus cases. People not suffering from depression develop tinnitus that produces suffering less regularly.

Therefore for at least a significantly large percentage of the patients suffering from tinnitus, we know that many were predisposed to tinnitus by depression and before that severe stress. Further, we know from various drug studies that anti-anxiety medications (Xanax) and anti-depressants (Pamelor) have been showing to reduce tinnitus volume in a significant number of patients. (76% and 43% respectively compared to 4% for a placebo.)

Anti- convulsants like Klonopin have also been shown to be successful in reducing tinnitus in large numbers of patients. Klonopin is regularly prescribed for individuals who suffer from anxiety, epilepsy and/or related seizures. Anti- anxiety and anti-depressant medications in general seem to help tinnitus sufferers reduce tinnitus volume and distress in significant numbers.

The beneficial effects for tinnitus reduction and distress reduction by these medications offer us our first clues as to the causes and potential elimination of tinnitus.

For many people with tinnitus, negative emotional experiences play a pivotal role in onset, suffering, and later, relief from tinnitus. Severe tinnitus challenges the emotional stability of even the most resilient individual. Tinnitus is far more than a simple hearing disorder. Tinnitus is a complex intermingling of deficient brain chemistry, phantom auditory perception, cell receptor damage, and/or negative emotional experiences (among other variables). Tinnitus sounds may be similar from person to person, but the cause, onset, volume and experience of that tinnitus can be very different. One modality of reducing tinnitus may work for some but it is becoming clear that a multi-modal approach to tinnitus reduction is going to be indicated for most individuals. (Effective therapy normally can include some or all of the follwing: auditory habituation, medication, osteopathic treatment and hypnotherapy.)

Stress, depression, panic disorder, and anxiety are like fertilized soil for a farmer. The farmer planting the crops can be likened to the physical stimulus that causes the tinnitus and makes it persist (grow) when in most people, without the fertile soil, it only lasts a period of time. Once the tinnitus is "planted" in the brain of stressed or depressed individuals, it grows and soon plateaus in volume.

The brain initially becomes aware of this noise and initially does not like the noise. The part of the brain that probably detects the potential negative impact of this noise is the amygdala. It does this by comparing the sound of the noise to other noises the brain has experienced in the past then determines whether action should be taken or not against the sound. (Unfortunately the amygdala cannot help us take action at reducing the noise.)

As the brain becomes accustomed to having the noise around, the noise is accepted as part of the daily experience of life. Tinnitus is often perceived as a threat to survival and the amygdala demands that it be found when the conscious mind notices it is "not there." (Have you noticed that when you awaken from a nap your tinnitus volume increases? For many, this is your brain’s way of trying to keep you alive. The tinnitus is as persistent as breathing and like breathing it will make sure the noise is detected if the brain has the tinnitus correlated to a survival issue in one manner or another.)

The brain does not think that tinnitus is "good." It simply is a survival issue. An intruding sound has been detected and a "sound loop" is created in the neural pathways that keeps the tinnitus perception intact. Long after the physical stimulation for the tinnitus is gone (a loud concert for example), the tinnitus persists. The brain continues to find the noise. This is what is meant when it is said that tinnitus is psychosomatic in nature even though the tinnitus onset was physical. Psychosomatic means that their is a significant emotional cause or relationship with a physical medical problem. In tinnitus, this is often but not always the case. You will soon discover that this relationship works to your advantage when you begin your daily regimen to reduce tinnitus volume and distress. Tinnitus in many people is like a paradoxical memory. With skillful therapeutic intervention, the brain can sometimes "forget" the tinnitus. Sometimes the forgetting is for minutes or hours. Sometimes the forgetting is for days or years. This is good news for the sufferer.

The continuation of noise (persistent tinnitus) is often not "necessary." If there is no evidence of significant sensorineural hearing loss, then the probability of tinnitus remission is significantly increased. The brain can be re-wired and re-programmed to stop playing the endless looping of tinnitus tapes. (Those with sensorineural hearing loss can also experience remission of tinnitus, but in our clinical experience, it is less often.)

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Tinnitus FAQ's

• 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 13 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... 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, 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 States.

• Why write the book?

It's not possible to answer 20-30 e-mails and letters per 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 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 Tinnitus: Turning the Volume Down (Revised & Expanded)

If you'd like to read an excerpt from the book, click HERE

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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