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There is no cure and no specific treatment is efficacious for noise/ringing in the ears/head; however person can opt from many options available. In some cases it can be quieted with treatment of underlying cause. In majority of sufferers there is no serious pathology and reassurance is all what is needed.

‘Nothing can be done and you have to live with it’ is to be avoided and patient should be assessed and investigated properly by otolaryngologist, audiologist and neurologist if required, to find any treatable condition. 

Manage treatable conditions:-

• Stop medicines causing tinnitus.
• Wax, foreign bodies can be removed.
• Treatment of middle ear infections and fluid should be done. 
• Otosclerosis and tinnitus- Surgery and/or hearing aids; surgery may not cure tinnitus and a failed surgery can cause severe tinnitus but correcting conductive deafness (even with poor speech discrimination) allows masking effective.
• Menieres disease- Tinnitus is difficult to treat in non functioning (dead) ear, so decision for destructive surgery should be taken with care.
• Abnormal patency of ET- Mostly seen after weight loss, can be corrected by minor surgical correction (25% silver nitrate or diathermy)
• Surgery for tumor
• Hearing aids for hearing loss 
• Treatment of blood pressure/thyroid disorder/other medical conditions causing tinnitus.
   

General measures and prevention, life style modification-

 Prevention is the best way to ensure no worsening of disease.

• Take care of the body by giving it enough rest, sleep and water.
• Dietary supplements Vitamins A, C, E, and B group and Zinc
• Micro nutrients to prevent noise induced hearing loss
• Support and stress management; taking a positive step in controlling the condition and changing response to it
• Regular exercise
• Decrease intake of salt
• Avoid food with high sugar
• Limit exposure to loud noise, occupational and recreational
• Avoid aspirin, and NSAIDS
• Avoid ototoxic medicine
• Avoid nicotine, alcohol, caffeine
• Take steps to lower blood pressure and cholesterol
• Ginkgo Biloba extract is an effective, well tolerated whilst not effective in every single patient, the proven benefits far outweigh any risks.
   

Medicines-

There is no specific drug designed specifically for tinnitus. There is no active research going on because of high cost and high rate of failure involved in creating a new drug.

Anxiolytics, Carbamazepine, Lidocaine, and intravenous Barbiturates show encouraging results but potentially serious side effects limit usefulness. Relatively low doses may bee effective in tinnitus management.

Patient and clinician together determine right drug considering side effects if it is worth.

Tinnitus Retraining Therapy

Person can be habituated to sound in the environment, so aim is to train the brain to adapt to sound.

TRT has 2 elements- Direct counseling and sound therapy

Sound therapy-

Sound therapy is to be combined with other therapies like counseling to improve effectiveness.

Tinnitus is more noticeable and disturbing when environment is quiet. Person with tinnitus thinks that sound is because of or can cause some serious damage to brain or inner ear. This negative emotional response from our subconscious brain (limbic system) travels to conscious brain-cortex, so person reacts.

In sound therapy instead of treating patient surrounding sound is manipulated so that it becomes less noticeable, here are many ways to achieve the goal such as: -  

• Table top devices-environmental sound machine, water fountain, clocks, fan, radio
• CD based system
• Hearing aids
• Masker
• Combination of hearing aid and masker
• Cochlear implant/electric stimulation

Table top devices;

Devices kept on side of bed such as ticking clock, adjusting radio in between two stations, or fan, may divert attention and make tinnitus less noticeable.

Hearing aids;

If a patient has a hearing loss in the frequency range of the tinnitus, hearing aids may be helpful in covering the tinnitus.

Masker;

The use of masking in the treatment of the tinnitus has mixed success, Patient's perception of the pitch and loudness and the overall intensity of the masking signal should be well understood.

Tinnitus maskers introduce an external pleasant masking sound into affected ear , thereby minimizing or eliminating the perception of the tinnitus.

Cochlear implant;

Cochlear implant may mask tinnitus by ambient sound or may suppress tinnitus by the electrical stimulation sent through the auditory nerve. Some forms of electrical stimulation to the ear can stop tinnitus briefly.

Counseling-

Effective counseling is most critical aspect of tinnitus management. Tinnitus sufferers are anxious and frightened by the presence of tinnitus and need a careful and clear explanation of the nature of the disorder.

It can be quite disturbing leading to sleep deprivation, depression & decreased work efficiency. Most important aspect of tinnitus is distress, irritation and distraction caused by the noise. Person often feels that such noise is a symptom of brain tumor or stroke. Reassurance should be given by E.N.T. specialist, neurologist and audiologist.

Biofeedback

Distress caused by tinnitus is in correlation to degree of attention paid to tinnitus and shifting attention of person to a different signal is bio feedback. It is relaxation technique that teaches to improve coping ability and has 70-90% success rate.

Tinnitus patients have high levels of anxiety, tension, or other symptoms of chronic stress. Biofeedback is quite effective relaxation technique; it teaches person to control certain autonomic body functions such as pulse, muscle tension and skin temperature. Goal is to help person manage stress not by reducing stress but by changing the body reaction to it.

Controversies exist about role of alternate therapies.

Research results have not conclusively identified these treatments as helpful for tinnitus.

• Hypnotherapy
• Control of inhalational and food allergy
• Bio feedback
• Zinc, magnesium and vit-B12
• Herbal ginkgo biloba have mixed result
• Homeopathic remedies
• Acupuncture
• Hyperbaric O2
• Music tharapy

Most important and essential aspect is educating person with respect to nature of tinnitus, keep in mind treat the patient not the tinnitus…

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