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Ten tips on managing tinnitus

Otolaryngologist Dr Don McFerran and audiologist Dr David Baguley offer their hints on managing this distressing problem to mark National Tinnitus Week,

Otolaryngologist Dr Don McFerran and audiologist Dr David Baguley offer their hints on managing this distressing problem to mark National Tinnitus Week,

1. At any point in time around 10% of the population experience tinnitus.

Both sexes are equally affected and although tinnitus is more common in the elderly it can occur at any age, including childhood. The perceived sound can have virtually any quality – ringing, whistling and buzzing are common – but more complex sounds can also be described.

2. Most tinnitus is mild.

In fact it is rare for it to develop into a chronic problem of life-altering severity. The natural history of tinnitus in most patients is of an acute phase of distress when the problem begins, followed by improvement over time. But for a minority of patients the distress is ongoing, and they will require specialist support.

3. Tinnitus is more common in people with hearing loss.

Tinnitus prevalence is greater among people with hearing impairment but the severity of the tinnitus correlates poorly with the degree of hearing loss. It is also quite possible to have tinnitus with a completely normal pure tone audiogram.

4. Tinnitus is commonly associated with a blocked sensation.

For reasons that are not clear tinnitus and sensorineural hearing loss can give rise to a blocked feeling in the ears despite normal middle ear pressure and eardrum mobility. Otoscopy and, if available, tympanometry will exclude Eustachian tube dysfunction. Decongestants and antibiotics are rarely helpful.

5. Giving a negative prognosis is actively harmful.

It is all too common to hear that patients have been told nothing can be done about tinnitus. Such negative statements are not only unhelpful but also tend to focus the patient's attention on their tinnitus and exacerbate the distress. A positive attitude is generally helpful and there are many constructive statements that can be made about tinnitus, such as: most tinnitus lessens or disappears with time; most tinnitus is mild; tinnitus is not a precursor of hearing loss.

6. Enriching the sound environment is helpful.

Useful sources of sound to reduce the starkness of tinnitus include quiet, uneventful music, a fan or a water feature. There are inexpensive devices that produce environmental sounds, and these are particularly useful at bedtime. They can be purchased online from the Royal National Institute for Deaf People shop.

7. Hearing aids are helpful.

Straining to listen causes increased central auditory gain and this increased sensitivity can allow tinnitus to emerge or, if already present, to worsen. Correcting any associated hearing loss reduces this central auditory gain and thereby reduces the level of the tinnitus. Hearing aids are useful even if the hearing loss is relatively mild and an aid would not normally be considered. Recent Department of Health guidelines have emphasised the value of audiometry in a tinnitus consultation, and this is the definitive basis for decisions about hearing aid candidacy. If in doubt, refer for an audiological opinion.

In our view, all people who describe tinnitus deserve an audiological assessment. Decisions on when to start using a hearing aid and what sort to use are up to the individual patient and audiologist.

8. Underlying pathology is rare, but be vigilant.

In many cases tinnitus is due to heightened awareness of background electrical activity in the auditory system that is normally not perceived. It can however be a symptom of treatable and significant otological pathology, such as a vestibular schwannoma or otosclerosis. One should be especially vigilant if the tinnitus is unilateral, or if it has a pulsatile quality.

9. There is no role for drugs – although they be used to treat associated symptoms such as vertigo, insomnia, anxiety or depression.

There is also no conventional or complementary medication that has been shown to have specific tinnitus ameliorating qualities and there is anecdotal suggestion that repeatedly trying unsuccessful therapies worsens tinnitus.

10. Self-help is often effective.

The British Tinnitus Association and the Royal National Institute for Deaf People provide excellent information on tinnitus and common sense advice on managing symptoms. Both run telephone helplines as well as offering advice through their websites.

Dr Don McFerran is a consultant otolaryngologist at Colchester Hospital University Foundation Trust and chair of the British Tinnitus Association's professional advisory committee

Dr David Baguley is head of audiology at Cambridge University Hospitals Trust and vice-chair of the BTA's professional advisory committee

Competing interests: None declared

Audiology

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