What is Tinnitus? Explained by an Audiologist

Tinnitus can be perceived as ringing, whistling or buzzing. Most of the time sounds associated with tinnitus have been described as being similar to cicadas, crickets, winds, falling tap water, grinding steel, escaping steam, fluorescent lights, running engines, and so on.

Tinnitus treatments/management can be divided into two categories: 1) those aimed at directly reducing the intensity of tinnitus and 2) those aimed at relieving the annoyance associated with tinnitus. The former includes pharmacotherapy and the latter include pharmacotherapy, cognitive and behavioral therapy, sound therapy, habituation therapy, and hearing aids.

The most effective approaches are behavioral strategies and sound-generating devices, often used in combination. They include the following:

Cognitive behavioral therapy (CBT). CBT uses techniques such as cognitive restructuring and relaxation to change the way patients think about and respond to tinnitus. Patients usually keep a diary and perform "homework" to help build their coping skills. Therapy is generally short-term — for example, weekly sessions for two to six months. CBT may not make the sound less loud, but it can make it significantly less bothersome and improve quality of life.

Tinnitus retraining therapy (TRT). This technique is based on the assumption that tinnitus results from abnormal neuronal activity. The aim is to habituate the auditory system to the tinnitus signals, making them less noticeable or less bothersome. The main components of TRT are individual counseling (to explain the auditory system, how tinnitus develops, and how TRT can help) and sound therapy. A device is inserted in the ear to generate low-level noise and environmental sounds that match the pitch, volume, and quality of the patient's tinnitus. Depending on the severity of the symptoms, treatment may last one to two years.

When TRT was developed in the 1980s by neuroscientist Dr. Pawel Jastreboff, it was designed to be administered according to a strict protocol. Today, the term TRT is being used to describe modified versions of this therapy, and the variations make accurate assessment of its effectiveness difficult. Individual studies have reported improvements in as many as 80% of patients with high-pitched tinnitus.

Masking. Masking devices, worn like hearing aids, generate low-level white noise (a high-pitched hiss, for example) that can reduce the perception of tinnitus and sometimes also produce residual inhibition — less noticeable tinnitus for a short time after the masker is turned off. A specialized device isn't always necessary for masking; often, playing music or having a radio, fan, or white-noise machine on in the background is enough. Although there's not enough evidence from randomized trials to draw any conclusions about the effectiveness of masking, a trial of simple masking strategies (such as setting a radio at low volume between stations) is recommended.