Breakthrough tinnitus therapies focus on treating the brain

If you have tinnitus, you know how annoying it is to be the only person in the room who “hears” an unwanted sound, such as ringing, buzzing, hissing or roaring. Up to 50 million Americans are bothered by this condition.

Latest thinking: Even though tinnitus is often associated with age-related hearing loss, researchers are now discovering that the telltale “ringing in the ears” and other sounds are probably generated by abnormal activity in the brain regions that are responsible for perceiving auditory sound.

What role does the brain play in tinnitus? It is now thought that because of hearing loss, the brain’s auditory system does not receive the sensory input it expects, so the brain compensates by activating brain cells (neurons) to create a perception of sound. Another reason: Tinnitus is also commonly linked to long-term exposure to very loud noises, which may alter brain function in a way that leads to the unwanted sounds that characterize the condition.

Good news: Fortunately, a number of recent therapies now offer new hope to tinnitus sufferers.

WHAT WILL WORK BEST FOR YOU?

What works for one tinnitus sufferer won’t help everyone with the disorder. Simple steps you can try on your own…

Review all medications you’re taking. More than 200 medications can cause temporary tinnitus in some people — even aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin). Prescription drugs that have been linked to tinnitus include diuretics (water pills) and certain antibiotics and cancer medications. If medication is the culprit, stopping or changing the drug usually eliminates symptoms.

Important: If you believe a prescription drug may be causing tinnitus, consult your doctor before decreasing the dose or discontinuing it.

Eliminate caffeine. Caffeine in all forms (including coffee, many teas, some sodas and chocolate) makes tinnitus significantly worse for many people.

Try vitamin B-12. Although the research is mixed, some people have found relief by increasing their intake of certain minerals (such as magnesium or zinc) or B vitamins (especially vitamin B-12) according to the American Tinnitus Association. If you would like to try this approach, talk to your doctor for advice on the supplement (and dosage) that would be best for you.

Get checked for earwax. Ask your doctor to check your ears for earwax — wax buildup commonly causes tinnitus.

Override the sounds. Besides masking the sounds, this can also reduce the brain activity believed to trigger tinnitus. For example…

  • Background noise, such as music, a humidifier, a fan or a white-noise device, can be especially helpful at night if your tinnitus makes it hard to fall asleep.

  • A hearing aid or cochlear implant (an implanted electrode and external electronic receiver for people with too much hearing loss to benefit from a hearing aid) may help reduce tinnitus symptoms in people with significant hearing loss.

    • NEWEST TREATMENTS

    If the strategies described above don’t relieve your tinnitus symptoms within three to six months… or if your tinnitus is in only one ear (possibly indicating an underlying condition such as a benign tumor) or symptoms are bothersome enough to interfere with daily activities and/or sleep, consult your primary care doctor or an otolaryngologist (ear, nose and throat specialist) for an evaluation.

    The physician may refer you to an audiologist (a health-care professional who specializes in hearing loss, tinnitus and balance disorders) for advice.

    If you would like to try one of the breakthrough therapies described below, consider consulting an otolaryngologist or audiologist at a tinnitus treatment program at a university-based medical center (these therapies are typically not covered by health insurance)…

    Tinnitus retraining therapy (TRT). Counseling and sound therapy (whereby patients hear steady, low-level background sound, often from in-ear sound generators) help make people unaware of tinnitus.

    This therapy is currently being studied in a large clinical trial. Several smaller studies have reported success rates of about 80%. To find an audiologist trained in TRT, contact the American Tinnitus Association (800-634-8978).

    Music therapy. Music is used in at least two tinnitus treatments…

  • Neuromonics Tinnitus Treatment involves the use of an FDA-approved prescription device that plays music (through earphones) embedded with sound that is customized to the person’s tinnitus sound frequency. The device can be worn during most activities and is designed to help “retrain” the brain so it filters out the disturbing sounds associated with tinnitus.

    • There is no independent research on this treatment, but a study conducted by the device manufacturer found that 91% of tinnitus sufferers experienced an improvement of at least 40% in symptoms after six months. To find a provider, contact Neuromonics, Inc. (866-606-3876, www.Neuromonics.com).

  • “Notched” music therapy uses a form of tailor-made music modified to remove the sound frequency of the individual’s tinnitus. This targets the part of the brain associated with tinnitus. In a recent German study, notched music was found to reduce tinnitus symptoms after 12 months.

    • Acupuncture. In a Brazilian study conducted on 76 tinnitus patients, acupuncture was found to provide immediate reduction in tinnitus symptoms, but the research is mixed on the long-term efficacy of this therapy.

    Hypnosis. Among 49 tinnitus patients who were introduced to hypnosis and taught basic methods of self-hypnosis, 35 completed the therapy and experienced relief from tinnitus symptoms after five to 10 sessions, according to research conducted at the University of Liège in Belgium.

    Biofeedback. Some patients have benefited from this therapy, in which monitoring devices are used to give immediate feedback on involuntary bodily responses, such as breathing. This helps patients have some control over negative physical reactions that often accompany tinnitus, such as increased heart rate.

    Medication. The drugs below, which are now being evaluated to reduce tinnitus symptoms, are designed to treat other conditions but can be prescribed by doctors “off label” for tinnitus treatment.

  • Acamprosate (Campral) is used to treat alcohol addiction but has been shown to help some tinnitus patients.

  • Tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressants may help relieve severe tinnitus, with possible side effects including dry mouth and constipation.

  • Alprazolam (Xanax) is an anti-anxiety medication that appears to improve symptoms temporarily in some patients but hasn’t been shown to offer long-term benefits. Possible side effects include nausea and drowsiness.

    • ON THE HORIZON

    Another potentially promising treatment is transcranial magnetic stimulation, in which a weak electric current is sent through the brain. A small magnetic coil is placed on the scalp — in this case, near the brain’s auditory cortex. Current from the coil stimulates neurons in the targeted area. Studies have shown significant reduction in some patients’ tinnitus symptoms, and this therapy is now regularly used in Europe.

    Transcranial magnetic stimulation was recently approved by the FDA as a treatment for depression. At this point, it’s available to tinnitus sufferers only through clinical trials. To learn more, consult the National Institutes of Health Web site, www.ClinicalTrials.gov.