Tinnitus Awareness Week ran from February 3rd – 9th 2020. As it comes to a close let’s help shine a light on this distressing condition by defining it and discussing strategies to foster hope. Tinnitus is the perception of hearing noise in your ears when no external sound is present. It has been experienced by about 45 million Americans according to the American Tinnitus Association. Making it one of the most common health concerns in the United States. Tinnitus is not a condition itself, but a symptom of another condition like Migraines, Meniere’s Disease, noise exposure or injury. In many cases an exact cause is never found. It’s often described as ringing, but it can also sound like hissing, buzzing, clicking, whooshing, roaring and other sounds. Tinnitus pitch and volume often fluctuates so it can be present all the time or it may come and go.
Tinnitus Comes and Goes
As someone diagnosed with Vestibular Migraine and Meniere’s Disease I experience tinnitus all day, every day in varying degrees of volume and pitch. At times the noise comes out of nowhere. It is so loud and low- pitched, it sounds like I’m standing next to someone who spontaneously started playing a tuba. Other times it sounds like a high pitched fire alarm squealing so loud it startles me when it begins.
When my Vestibular Migraine and Meniere’s attacks are well controlled, my tinnitus sounds like quiet ringing that I can only hear in a quiet room. That’s what I call my baseline, but I’m one of the lucky ones. Because hearing an unbearably loud noise that no one else can hear, can torture you in unimaginable ways. With no ability to escape it, wherever you go, it’s right there with you. While there is currently no definitive cure for tinnitus, it doesn’t have to be a life sentence of misery. There are many strategies available to help lessen the burden of this distressing symptom.
Tinnitus and Migraines
There is a tinnitus and migraine link. For many with Migraine and/or Meniere’s Disease the intensity of tinnitus comes on stronger during attacks. Attacks seem to carry a volume control with them and when attacks hit, volume is cranked all the way up. Neurology Times reports that people with migraine are at a three times higher risk of developing tinnitus than those without migraine. This may indicate a problem in the central process of the brain rather than in the inner ear. Armed with this knowledge, you can help to minimize tinnitus by gaining control over your migraine and breaking the tinnitus and migraine link.
Strategies to reduce migraine symptoms include:
- Following a Vestibular Migraine Diet– I follow Heal Your Headache diet, but other vestibular migraine diets are available like Charleston and Keto. When it comes to vestibular migraine diets, choose just one diet that fits the best with your eating preference that you are most likely to stick to.
- Supplements- Try supplements with research backing them for migraine prevention including magnesium, riboflavin and ginger. You can learn more about effective supplements for migraine in this post written by our resident dietitian Danielle.
- Consider a preventative medication– Very low dose nortriptyline ended my daily dizziness helping me go from being housebound for months to successfully working full time. As an added bonus, it’s also on the list of medications that might improve tinnitus. This article written by Dr. Hain contains a migraine medication flowchart that does a great job reviewing common migraine medications. Notice that magnesium and a vestibular migraine diet are recommended at the top of the list.
- Medication- Migraine abortive medications and Meniere’s disease rescue medications may help reduce tinnitus when an attack hits. Working to prevent and abort attacks can in turn reduce tinnitus.
- Many more strategies– So many more strategies are available to empower you to kick your attacks to the curb. Here are a few great ideas as outlined in our Migraine Strong Treatment Pie.
What Makes Tinnitus Worse
There are many things that make tinnitus worse including dehydration, insufficient sleep, noise, stress, MSG and CATS just to name a few! No, not the soft, cuddly kitty cats we all know and love. I’m talking about Caffeine, Alcohol, Tobacco and Salt that create the easy to remember acronym CATS. While everyone certainly has different tinnitus triggers CATS are four common triggers that are real risk factors in making tinnitus worse. Caffeine and Alcohol can increase your blood pressure. While tobacco can constrict capillaries and blood vessels and salt affects the amount of fluid released in your inner ear.
Some research suggests low salt intake around 1500 mg per day is beneficial in reducing tinnitus. While other research suggests keeping a steady amount of the same daily salt intake is effective. So play with both ideas to see which one is helpful for you. My tinnitus screams when I consume large quantities of salt so lowering my intake works for me. In addition to CATS I also had to eliminate MSG to turn down the volume of my tinnitus and migraines. MSG comes in many hidden forms in processed foods so get to know the cover words that are often used to represent it.
Strategies to Help Ease Tinnitus
Many people are afraid that their tinnitus will worsen over time. The good news is that according to the American Tinnitus Association, tinnitus does not usually worsen. In more great news it can also be effectively managed using a variety of strategies. Read on to learn more about strategies to help you feel better and help you gain control.
I mentioned earlier that dehydration is a factor that makes tinnitus worse so hydration is a great and simple strategy to try to improve it. Hydration is actually the first line of defense in treating Meniere’s disease in Eastern medicine. Recommendations vary, but the 8 by 8 rule is easy to remember. You can follow this rule by drinking at least 8, 8 ounce glasses of water each day.
If you search you’ll find all kinds of products on the market promising to make tinnitus better. I spent a lot of time scouring the internet, on message boards and in support groups discussing products that work for others and trialing many of them for myself. I think the following products gathered below are worth mentioning and trying.
- Lemon Bio-Flavonoids– This is the supplement I personally cannot be without. They work by widening small capillaries and arteries helping to increase blood flow and reducing tinnitus. For me this supplement works. In addition to quieter tinnitus, I have noticed reduced ear pressure and fullness since beginning this supplement as well. The only caution is it MUST be real lemon bio-flavonoids and not generic citrus bio-flavonoids that are found in many supplements. I use Lindberg Brand found online at Nutrition Express. Amazon sells it as well, but it’s about twice the price.
- Vinpocetine – This one takes many weeks or even months to begin to reduce, and some report, even eliminate tinnitus. A positive side effect is that many report a reduction in brain fog as well.
- Ginko Biloba- Ginko Biloba for tinnitus also works by improving circulation and increasing the permeability of capillaries and vessels. Pure Encapsulations makes a great supplement called Cognitive Factors that combines both Vinpocetine and Ginko Biloba. I use Cognitive Factors in my supplement regimen and am pleased with the results. The John of Ohio Meniere’s Regimen explains each of the three supplements I just mentioned above along with many more.
- Melatonin- It’s currently unclear exactly how melatonin helps improve tinnitus. What we do know is melatonin helps improve sleep. Since poor sleep makes tinnitus worse, many theories point to using melatonin for tinnitus to help regulate sleep and reduce this risk factor.
- Zinc- One small study showed a decrease in loudness of tinnitus by supplementing with 50mg of zinc daily. Melatonin and zinc are two supplements for tinnitus that I haven’t yet tried for myself. I’d love to hear your results so reach out if you have feedback to share.
- Magnesium- In Migraine Strong we often refer to magnesium as a naturally calming mineral, but it has many other benefits. Magnesium helps nerve function, protects the nerves in the inner ear, relaxes muscles and blood vessels and is a powerful glutamate inhibitor. Supplementing magnesium may improve tinnitus by lowering your risk to damage caused by noise. Since Migraine and Meniere’s disease patients are often more sensitive to noise, protecting your hearing between attacks is something to be considered. I use Pure Encapsulations magnesium glycinate, CogniMag and Life Flo magnesium chloride as a lotion, body wash and foot soak as well. Give me all the magnesium!
- CBD- CBD is a fairly new addition to my preventative treatment arsenal. I love it because it helps to relieve minor pain. It also helps me calm down my nervous system making me feel more relaxed and stress free. Reduced stress leads to reduced tinnitus. Many CBD products are available for you to trial and are now so mainstream you can find it at Nordstrom and Sephora. I use Lord Jones CBD lotion.
- Essential Oils- MotionEaze Sickness Relief works indirectly by kicking out dizziness that leads to anxiety. It is made from natural lavender peppermint, Frankincense, Chamomile, Myrrh, Ylang Ylang and Birch essential oils. Directions call for rubbing a drop behind your ear to help ease nausea, dizziness and head pain leading to a more relaxed state. One of our wonderful members of Migraine Strong, Abby Angelico also recommends helichrysum essential oil. She rubs a bit behind her ears to reduce the intensity of her tinnitus.
Habituation is basically the process of training our brains to turn tinnitus into meaningless background noise. Trying this strategy is a MUST! Our brains are amazing and are absolutely capable of pushing tinnitus into the background which means you really can teach your brain to stop paying attention to the sound. Due to the neuroplasticity of our brains we can either cement that distressing neural pathway into our brains by focusing on the torment. Or we can prune out that distressing neural pathway by changing the way we react to the sound. Through intentional practice our brains can and will tune it out!
Just like our brains learn to compensate for dizziness from vestibular migraine and Meniere’s disease, it will learn to compensate for tinnitus as well. So even though we’re told over and over that there is no cure for tinnitus this strategy fills me with hope for successfully managing it.
Masking devices for tinnitus can be worn in the ear similar to hearing aids to help train your brain to habituate. These devices produce an individually programmed continuous tone specific to the frequencies of your tinnitus and over time, encourages habituation and helps you to stop focusing on it. To learn more about tinnitus habituation definitely check out Glenn Schweitzer’s Rewiring Tinnitus blog along with this great article written by Glenn explaining habituation.
Tinnitus can be a huge distraction making it very hard to sleep. A common treatment to help improve sleep in spite of tinnitus is sound masking. Fans, white noise machines and pillow speakers are great tinnitus maskers. I recently wrote a vestibular migraine sleep blog chock full of ideas about how to sleep with tinnitus. Take a minute to look it over to learn more about other helpful tinnitus sleep strategies.
Antidepressants- The Mayo Clinic reports tricyclic antidepressants like amitriptyline and nortriptyline, have been used with some success to help treat tinnitus.
Benzodiazepines- The Mayo Clinic also reports Xanax may help reduce tinnitus symptoms, but side effects can include drowsiness. This leaves Vestibular Migraine and Meniere’s Disease patients in a tough spot since Xanax is one of the benzos not recommended for us. Due to the short life of its effect, it may prompt patients to use it more often and increase the risk of addiction. Plan to talk with your specialist about the possibility of using a different benzo recommended for dizzy patients like valium or ativan best used short term as a rescue.
Medication Caution- Be aware some medications can make tinnitus worse including antibiotics, aspirin, diuretics and other types of antidepressants. The Mayo Clinic put together a comprehensive list of medications that can make tinnitus worse.
People with tinnitus due to hearing loss may find relief with the help of a hearing device. Talk to your ear specialist about helping you find a hearing aid to minimize some of your tinnitus symptoms.
Protecting Your Hearing Between Attacks
Many with migraine and Meniere’s disease experience sensitivity to sound making protecting your ears between attacks important. Tiny hairs in your inner ear move in response to sound waves. Picture sea anemones dancing to the waves under the ocean. Exposure to loud sounds break and bend these delicate hairs preventing them from properly carrying sound to your inner ear. Both long and short term loud noise exposure can cause permanent damage to these delicate hairs and increase tinnitus as a result. When you know you’re planning to attend a function with loud noise protect them from damage by using earplugs. And carry earplugs with you for times you come across unexpected noise.
Tinnitus and Anxiety
Tinnitus and anxiety often coexist so it’s really common to feel anxious when you have tinnitus. Anyone who experiences it knows just how difficult it is to always hear an irritating sound that just won’t go away. But, the volume of your tinnitus doesn’t usually dictate how tormented you become by it. What determines your torment is how much it bothers you. Honestly, the number one thing you can do to improve your tinnitus is to work on controlling your stress response to it. Then work on calming down your nervous system. You can practice calming your stress response through…
- Mindful breathing techniques– Relaxing your body by controlling your breathing can reduce tinnitus symptoms. Breathe in slowly and deeply through your nose. Hold and release slowly through your mouth. Repeat until you feel your body relax.
- Music therapy– Music is amazing for masking tinnitus. It’s such a great distraction and aids in relaxation. It can change the emotional reaction you feel about your tinnitus. Rather than listening to music that is louder than my tinnitus, I like to encourage habituation by listening to music a bit quieter than my tinnitus to train my brain to focus on the music instead of the noise I hear in my head.
- Create a mantra– A mantra is simply words you repeat silently in your head to help bring yourself a sense of calm. I like the phrase, “I am safe, I am calm, I can handle this.” Create any phrase that sounds calming to you.
- Exercise– Regular exercise can help to keep your blood vessels healthy and increase circulation resulting in reduced intensity and volume. It also just improves your overall sense of wellness helping you cope with tinnitus better.
- Meditation– Download apps to help you practice this valuable strategy. I use the calm app, but there are many apps available to help you relax. Migraine Strong members recommend Calm, Calmer, Insight Timer and Headspace. These apps often include progressive muscle relaxation, guided imagery and many more techniques to help calm you down. I seriously reach for my Calm app often. Give the free version a try and if you love it, keep your eye out as Calm often releases coupon codes to purchase it at 40% off.
- Anything that helps YOU feel calm– Massage, acupuncture and even creative and nature filled hobbies can help calm your nervous system. Occupy your mind with activities you enjoy and help to make you feel more relaxed. Those pleasant activities take up so much room in your mind that tinnitus is naturally pushed into the background.
Tinnitus and Depression
If your tinnitus is causing you distress, getting help is crucial. The American Tinnitus Association is there to provide general guidance on tinnitus management. You can reach them at 1-800-634-8978. Cognitive Behavioral Therapy is a great strategy to help manage depression that comes with chronic illness. Tinnitus experts can also help teach you the skills necessary to cope and to begin tinnitus re-framing to change your response. Facebook has many support groups available for you to join filled with people who understand what it’s like to hear sounds no one else can hear. You can also check the online sites like Meetup to search for local support meetings. If your depression feels overwhelming, in the U.S. call the Suicide Prevention Hotline at 1-800-273-8255. If you’re thinking of harming yourself, call 911 immediately.
A Few Strategies I Would Not recommend
When searching for tinnitus on the internet I found a few strategies I wouldn’t personally try. Use caution when considering purchasing devices that promise to cure your tinnitus with techniques like blowing and sucking air into your ear canal. I’m not a doctor, but I do hold a degree in speech language pathology and I personally think you risk injury anytime you place something into your ear canal. I’d also avoid placing your palm over your ear and repeatedly pressing in an attempt to change the pressure in your ear. Please don’t do that. Another silly strategy in my opinion is repeatedly flicking the bone behind your ear to get tinnitus to stop. While it’s unlikely to have any negative effects this really is just a masking technique. There are safer ways to mask tinnitus mentioned above such as listening to white noise or using masking devices.
While there is currently no cure for tinnitus, it is definitely not something you just have to live with. Trying the strategies above in an attempt to get to the point where your tinnitus doesn’t bother you is the key to feeling better. Don’t try everything listed above all at once. Try a strategy or two that sounds the most helpful to you as an individual. If you’re still left with no relief, seek a tinnitus professional. Also realize that hope happens through communication. Share what works for you and keep fighting to end the stigma of invisible illness by telling your story. Then consider posting it in online forums to help others feel less alone. You can visit the American Tinnitus Association at ata.org to listen to sample tinnitus sounds and for more information on tinnitus.
Note- Any medical advice is based on my own personal experience in finding control over my symptoms. Please consult your doctor before trying any new treatments.
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