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TINNITUS
If you suffer from tinnitus, your first question
probably is, “Can anything be done about
this noise I hear?” The answer is YES! A
great deal can be done to help. To begin, you
need to understand what it is. I have provided quite a bit of information here to help you understand the condition as well as some options for finding relief. Should you grow impatient reading through all the information, and want to quickly find the option that provides the best results available today, skip down to the section on AnxietyRelief Techniques (ART.)
Tinnitus is classified as a phantom auditory
perception. That is, a sound perceived as
inside your ears or head when that sound does
not exist outside you. Tinnitus is often generated
in the brain, but perceived as being heard
in the ears. People often refer to tinnitus as
a ringing in the ears; however it can
take many forms, including ringing, chirping,
hissing, sizzling, whining noises, or like the
sound of rushing air or the humming of power lines.
It may be high pitched or low, soft or harsh,
faint or loud. The intensity or loudness of sound(sound
pressure) is measured in decibels, abbreviated
as dB. Normal conversation typically measures
between 40 and 50 dB. A home vacuum cleaner or
alarm clock measures between 65 and 85 dB, a coffee
grinder 70-80 dB, a blender 80-90 dB, and a garbage
disposal around 85-95 dB. A tractor, a truck without
a muffler, or shouted conversation measure about
90 dB. Many tinnitus sufferers estimate the noise
inside their heads at between 20 and 40 dB, however
it more often approaches 8 to 10 dB when measured
with an audiometer. A few people, however, experience
tinnitus at 75 to 80 or even 90 dB. This intensity
level may spontaneously vary from time to time,
and in different environments. The majority of
adults with normal hearing experience occasional
tinnitus, described as high pitched ringing in
their ears.
Tinnitus is actually quite common, affecting
20% of all people, and one out of three over the
age of 60. When individuals with normal hearing
are placed in a soundproof chamber, 95% develop
temporary tinnitus. People need some external
sound around them at all times. In the absence
of external sound, the human auditory mechanism
and brain create internal noise while searching
for external sound. I should probably mention
here that I am a board certified Otolaryngologist—a
hearing expert who truly understands tinnitus
and hyperacusis. I also lived with both hyperacusis
and tinnitus for several years. I sincerely hope
that my personal experiences and resulting specialized
knowledge about both conditions will benefit you
greatly. I no longer suffer, and you don’t
have to either. Help has arrived in the form of
Hypnotherapy Institute and Anxiety Relief Specialists,
of which I am the director.
Certain forms of tinnitus can be explained physiologically,
such as when one of the tiny middle ear muscles
spasms, vibrating the bones of hearing in the
middle ear. Or when throat muscles contract that
open the Eustachian tube, or when your temporomandibular
joint(jaw joint) creates a pull or vibration on
your eardrum. An abnormal junction of the skull
base with cervical vertebrae has been reported
to cause tinnitus. Pulsations of a blood vessel
will occasionally be heard inside the head or
ears. The most common and most bothersome form
of tinnitus, however, is known as SIT: Subjective(only
audible to the individual,) Idiopathic(of
unknown cause) Tinnitus.
You may very well ask, “Can I get rid of
this noise once and for all?” In the best
of situations, it will go away completely. In
others, you can reduce the intensity of the sound
AND train your brain to largely ignore it. To
know which situation applies, you first need to
determine what’s causing your tinnitus.
Where do you start? Certainly NOT by visiting
a hearing aid dealer or your family physician,
because neither is equipped to provide an adequate
examination for tinnitus. Begin by visiting a
qualified Otolaryngologist (ear, nose, throat
specialist.) Some causes can be treated and relieved
directly. For example, something as simple as
ear wax(cerumen) touching the ear drum can cause
tinnitus. Some medicines can make your ears ring,
so simply discontinuing the offending medication
will generally make the tinnitus go away. In addition
to obtaining a hearing test, called an audiogram,
your ENT doctor will likely perform more detailed
tests of your auditory/vestibular nerves—called
the eighth cranial nerves. These tests concern
balance as well as hearing, since the two are
closely related. You doctor will probably order
a CT scan or MRI of your head to visualize your
inner ear and surrounding brain areas, especially
if you have tinnitus in only one ear. This study
is to be certain you do not have a rare and removable
growth on the acoustic nerve. An acoustic neuroma
is a non-malignant tumor growing along the eighth
cranial nerve. These tumors often cause tinnitus,
hearing loss, and/or vertigo, and can be surgically
removed. Meniere’s disease also causes tinnitus,
hearing loss, and vertigo, and is treated with
medications and dietary changes. In the vast majority
of cases, after the examination and tests provide
the very important information about what you
do NOT have, you will be told that your tinnitus
is idiopathic (unknown cause) or that it’s
the result of some past exposure to loud noise
that damaged your hearing nerve(s) or inner ear(s.)
The inner ear includes the cochlea, a snail-shell
shaped organ lined with sensitive “hair
cells” that receive sound vibrations and
transmit impulses along your acoustic nerve to
your brain. Your ears receive and transmit sound,
but you actually hear that sound in your
brain.
Examination by a qualified specialist described
above must never be bypassed.
After all tests are completed, however, be prepared
to hear that nothing can be done for your tinnitus.
THIS IS NOT CORRECT. You may
be told, “You’ll just have to learn
to live with it.” THIS IS NOT CORRECT.
Many ENT specialists are sadly uninformed about
the highly effective treatment options available
today for tinnitus. They may be excellent, well-trained
physicians and surgeons, able to correct complex
hearing-related conditions, but training often
glosses over conditions that cannot be readily
corrected with surgery or medications. Your ENT
doctor may have been taught that there was no
effective surgery or medication for tinnitus,
so patients just have to accept it. WRONG!
This is where I come in, along with a few others
across the country who have discovered: YOU
DO NOT HAVE TO JUST LEARN TO LIVE WITH TINNITUS.
A GREAT DEAL CAN BE DONE TO REDUCE YOUR SUFFERING
AND TO QUIET THAT INFERNAL NOISE IN YOUR HEAD!
First you need to understand that you can be
helped. You also need to understand that there
is no magic pill or overnight cure for tinnitus,
and you must become personally involved in every
stage of your therapy. How quickly you find relief
from subjective idiopathic tinnitus(SIT) will
depend greatly on two factors: 1) how much you
want relief, and 2) how enthusiastic you are about
participating in your own therapy. If you follow
my recommendations, the sounds in your head will
either A) go away, or B) improve dramatically.
I will guide you through several legitimate options
proven to help tinnitus sufferers get better.
You do not have to live with this noise
forever, so put thoughts of hopelessness, suicide,
and other such radical measures aside.
Van Gogh cut off his ear to rid himself of tinnitus.
It didn’t work for him, and it won’t
work for you. Severing the auditory nerve will
make you deaf, but not stop tinnitus—this
has also been tried in the past. I know tinnitus
is distressing. It’s downright frightening.
It’s frustrating. It makes you feel powerless
to do anything at all. But it’s also temporary
and fixable.
Several options are available, including:
1) Medications
2) Tinnitus Retraining Therapy(TRT)
3) Hypnotherapy
4) Anxiety Relief Techniques™(ART)
5) Select Combinations of therapies
1) Medications. Anti-anxiety
medications can be helpful; however, in most instances, I find them unnecessary. I also believe they are greatly overprescribed today. Many are also terribly habit-forming and extremely difficult to stop. Anxiety Relief Techniques or EFT are far better options in my opinion. Having said that, Xanax delivers
nearly a 50% reduction in the perceived volume
of tinnitus for more than 75% of sufferers, typically
within one to three months. Tricyclic antidepressants
such as Pamelor and Elavil reduce tinnitus in
about 40% of sufferers. SSRIs(selective serotonin
re-uptake inhibitors) such as Prozac and Paxil
help many sufferers by elevating their levels
of serotonin. Some of the anticonvulsants such
as Tegretol or Primidone have proven approximately
85% effective in relieving certain types of tinnitus.
These are only a few examples. Medications are
discussed in greater detail in my CD program,
along with several other effective therapies.
Please note that all medications have side effects
and/or interact with other drugs or foods, and
some of these effects can be dangerous or even
life-threatening. For this reason, you will need
a local physician familiar with their use to prescribe
and monitor all medications.
2) Tinnitus Retraining Therapy(TRT)
relieves suffering from tinnitus in approximately
85% of trainees, but it works very slowly. I find this length of time unacceptable and unnecessary in my experience. For the sake of completion, I will describe it here, though I no longer recommend it. Developed
in the 1980s by Dr. Pawel Jastreboff at the University
of Maryland, this therapy works through a process
called habituation. TRT consists of two closely
integrated and equally essential parts: A )The
use of sound therapy, and B) Counseling
by a knowledgeable professional. Typically,
TRT requires 12 to 18 months to achieve maximum
effectiveness. To understand how TRT works, you
first need to understand that tinnitus involves
not just the ears, but multiple structures and
nerve pathways within the ears and brain. Sound
is collected by the external and middle ear as
vibration, converted to electrochemical energy
in the cochlea, and transmitted as nerve impulses
along the acoustic nerve to specialized brain
cells called auditory centers in the temporal
lobes of the brain. Brain cells then interpret
these nerve impulses as sound. It’s these
interpretations that determine how you hear the
sound. Even more significant, these and other
centers in your brain determine the relative importance
of that sound. Think about this for a moment.
Your conscious mind can pay attention
to only a few hundred bits of information (stimuli)
at any given instant. There are thousands of bits
of information constantly bombarding you, some
deemed by your mind to be more important than
others. To avoid sensory overload, your conscious
mind chooses to ignore stimuli not deemed threatening,
stimulating, challenging, exciting, rewarding,
essential to your survival or well being, etc.
That is, your brain ignores things it considers
unimportant, so you remain unaware of
them until something changes to make them become
important. Some of these bits consist of visual
(sight) stimuli, others are kinesthetic (touch,)
olfactory (smell,) gustatory (taste,) and auditory
(hearing.) The relative importance of the stimuli
changes constantly, so the degree of attention
you grant them also changes.
A new stimulus will always be noticed
and evaluated by our brains as to whether it presents
a threat or warns of danger. Your mind learns
to ignore any recurring stimulus that it considers
unimportant. This is called habituation.
One of the goals of TRT is to teach your brain
to consider any remaining tinnitus so unimportant
that you will automatically ignore it unless and
until you choose to hear it. Pretty neat
choice, huh? Follow my recommendations and it
will become your choice.
A) Sound therapy in TRT consists of presenting
a second or new intruding sound(NIS)
to your ears, with that sound being far less intense
than the tinnitus in your head. The NIS typically
consists of a constant low level of white or pink
noise, balanced broad spectrums perceived as a
gentle hissing. When a NIS is first presented,
you notice it because it’s new, and the
limbic system in your brain needs to determine
if it’s threatening or warning of danger.
Because this NIS is constant, innocuous, and fairly
faint compared to other environmental sounds,
your limbic system quickly decides that it’s
not important, so it pushes it into the background.
Your mind then switches focus and actively listens
for other sounds. In so doing, you quickly ignore
the NIS as though it doesn’t exist. This
process is slow, but while training your mind
to ignore this artificially induced, not real
and not important NIS, your
mind also learns to ignore other not real and
not important sounds inside your head—your
tinnitus. A word of advice: Tinnitus sufferers
must avoid silence at all times. I’ll explain
in more detail under Hyperacusis (below,) but
beginning right now, keep some sound around you
at all times—something you enjoy such as
music, a waterfall, etc. Not loud, just at a volume
you find pleasant.
B) Professional counseling is an essential
component of TRT. Studies have shown that sound
therapy alone results in far less improvement
for tinnitus sufferers than the combination
of sound therapy and professional counseling.
The primary aim of professional counseling is
to remove negative emotions associated with tinnitus,
such as anxiety, stress, and fear. Understanding
the roles of the auditory system and brain plays
an important part in removing fear surrounding
tinnitus. 75% of all people with tinnitus automatically
habituate the sound and generally ignore it. And
85% of those who initially suffer show significant
improvement following 12 to 18 months of TRT. It has been
my experience that Anxiety Relief Techniques is more effective
and works much faster than TRT in relieving the anxiety
associated with tinnitus.
3) Hypnotherapy is a
good method to correct some issues
faced by tinnitus sufferers; however I no longer find face-to-face sessions necessary. Self hypnosis can be helpful in some cases. When properly and
professionally administered, however, hypnotherapy
is as effective for tinnitus as medications or
TRT. Combining it with other treatment options such as EFT or ART (see below,)
improves the results.
Hypnotherapy deals directly with
the subconscious mind, the seat of your memory,
emotions, and imagination. Negative emotions are
nearly always associated with past experiences
that were frightening. When these emotions well
up in response to the noise of tinnitus, they
bring along associated memories, compounding the
fear we feel about tinnitus. Adding anxiety into
the mix rapidly increases overall suffering and
a sense of impending doom. While anti-anxiety
medications can be effective for tinnitus sufferers,
some carry unpleasant or even dangerous side effects.
Equally as effective as medications, hypnotherapy
presents no harmful side effects. Please note
that I refer only to hypnotherapy performed by
qualified and experienced professionals
familiar with all aspects of tinnitus therapy.
I know several good hypnotherapists, but only
a few who meet these requirements. One is a board
certified hypnotherapist AND board certified Otolaryngologist—Charles
Smithdeal, M.D., F.A.C.S., C.Ht.--that’s
me. Incidentally, F.A.C.S. indicates that I was
elected as a Fellow in the prestigious American
College of Surgeons, which in turn requires prior
certification by the American Board of Medical
Specialties (in my case, the American Board of
Otolaryngology.) C.Ht. indicates that I am board
certified by the American Board of Hypnotherapy.
I am also certified by the National Guild of Hypnotists.
4) Anxiety Relief Techniques ™
(ART) is a method that defuses
negative emotions through self-hypnosis AND correcting
an imbalance in your own energy system. This is the most effective method available today for relieving the anxiety generated by tinnitus. Anxiety
is the most basic negative emotion. As you already
know, your energy system is what gives you life.
This is the energy being measured
when you undergo an MRI. Dr. Roger Callahan, a brilliant
psychologist, discovered more than 20 years ago
that traumatic events cause a disruption in our
circulating energy system—some big, some
small. He further determined that the disruption
generates negative emotions of anxiety, fear,
frustration, etc. It is NOT the traumatic event
that makes us feel bad; rather, it is the disturbed
energy flow. Mr. Gary Craig, a Stanford engineer, entrepenuer, and humanitarian,
expanded upon Callahan's technique and developed Emotional Freedom Techniques (EFT.)
EFT is highly effective for relieving negative emotions including stress,
anxiety, and fear. Incidentally, www.emofree.com offers a free download of EFT. Anxiety Relief Techniques (ART) combines components of both
methods, plus TAT, a marvelous technique developed by acupuncturist Tapas Fleming.
The onset of tinnitus is a traumatic
event, and certainly disrupts the energy system
to cause anxiety, fear, frustration, or outright
panic. Once this disruption is restored, however,
it becomes far easier to habituate the
noise because the negative emotions go away.
In more than 30 years of practicing medicine
and surgery, I have never witnessed any technique for relieving anxiety that's
as powerful as EFT or Anxiety relief Techniques™.
Combining self hypnosis with EFT or ART offers amazing
relief from the anxiety that accompanies tinnitus.
My motto has become When Nothing Else Works
because these methods typically succeed after
everything previously tried has failed. With proper
instruction and guidance, ART can be self-administered
at home. I teach these techniques nationwide during
distance sessions that incorporate telephone,
fax, and e-mail.
5) Select Combinations of therapies
provide better results than any single option
for tinnitus. While many clients share common
characteristics such as symptoms, medical issues,
age, etc, every tinnitus sufferer is unique. All
therapies need coordination by a knowledgeable
professional to achieve maximum benefit. Even
dietary considerations are important. 90% of tinnitus
sufferers have a metabolic disorder called hyperinsulinemia—an
increased level of insulin in the bloodstream.
In general, tinnitus sufferers should follow a
diet low in refined sugar and simple carbohydrates
and limit their intake of caffeine, nicotine,
and alcohol. I also advise our clients to strictly
avoid the food additive monosodium glutamate (MSG,)
and anything containing the artificial sweetener,
aspartame (especially diet sodas.) Ongoing self
education, self-hypnosis, ART practice, and sound
therapy or enrichment must be carried out at home.
I also recommend that every person who uses cell phones or cordless phones be aware of the dangers from low frequency electromagnetic frequency irradiation (EMF.) Excellent research on the damage to the inner ear and brain from EMFs is available at www.123safetalk.com. Cell chips that neutralize and prevent this damaging radiation are available at the same site. (See Biopro link at the bottom of this page.)
After performing a detailed analysis of each person's specific issues via e-mail and fax, clients achieve marked improvement after
three one-hour telephone sessions. Many achieve dramatic relief
following their first session.
My goal is to: 1) reduce
your anxiety, 2) relieve your emotional suffering, and 3) reduce your sound’s volume.
As distressing as it seems at the beginning, your suffering from
tinnitus can become largely a memory.
HYPERACUSIS
Hyperacusis is a bothersome condition related
to and often accompanied by tinnitus. It is also
generally misunderstood by lay people and physicians
alike. Hyperacusis literally means super hearing--perceiving
sound as louder than it is. It represents a reduction
in your threshold of comfort for sound, and is
caused by an alteration in a sound-processing
system in your brain. Sometimes referred to as
sensitive ears or tender ears,
hyperacusis actually originates in the brain rather
than in the ears. Perhaps the biggest problem
sufferers experience is fear of sound--fear
that loud sounds will permanently damage their
hearing. An acoustic guitar, a passing truck on
a city street, clanging dishes in a noisy restaurant,
or booming sounds in a movie theater are all painful
to their ears. The natural tendency is to seek
silence—sweet, comfortable silence. And
what is the worst possible thing for these people?
Sweet, comfortable silence. Nerve cells in the
brain need to function. They don’t do well
when idle, so if there’s no sound to hear,
they recall earlier sounds and then attempt(poorly)
to duplicate them—this causes tinnitus,
a frequent companion of hyperacusis. Like many
sensory sensations, sound is interpreted in relation
to other sounds. If you’ve just listened
to a loud recording or fireworks display and somebody
walks past whistling a tune, you probably won’t
hear the whistling at all. But if you awaken from
a deep sleep in a silent room in the middle of
the night, and the same whistler walks past your
open window, it seems so loud that you could hear
it from across the block. Why does that happen?
Because silence or low levels of sound result
in an increased sensitivity of hearing.
For example, when you wear ear plugs to block
out most sound, your hearing system becomes super
attentive, literally searching for sound. Whatever
gets through seems far louder than it actually
is. Conversely, if you keep some background sound
around you at all times, such as a radio or CD
playing, or a waterfall or fountain, other sounds
will not seem nearly as loud or uncomfortable.
The hearing system thrives best when performing
its basic function of receiving external sounds.
Sounds of 75 or 80 dB that seem dangerously loud
or uncomfortable when you have hyperacusis will
not damage your ears. Prolonged or repeated exposure
to noise levels above 85dB will harm anybody’s
hearing, and levels above 140dB may cause permanent
damage with a single exposure.
As with tinnitus, we insist that our clients
undergo a through examination in their home area
by a qualified ENT specialist. Once that’s
completed, we coordinate many of the same therapies
we find effective for tinnitus because these also
help hyperacusis. Medication is rarely necessary,
but self hypnosis and EFT or ART, Anxiety Relief Techniques™
work wonders. We are always delighted to personally
see our clients in St Petersburg, Florida; however by first performing a detailed analysis
of each client's specific situation via e-mail and fax,
we're able to provide extremely effective sessions
via telephone. For continuing home therapy, we
offer self-hypnosis CDs specifically designed
for victims of hyperacusis as well as for tinnitus.
Don’t forget to perfuse your environment
with sound because a sound-rich background is
essential. Play a radio, CDs, listen to music
or conversation on TV, or even purchase a re-circulating
fountain. It doesn’t have to be loud, just
a comfortable level. It is always a good idea
to protect your ears from really loud or painful
sounds, but remove earplugs for normal everyday
activities and noises. Gradually increase the
amount and level of sound around you and see how
quickly you’ll improve. The biggest relief
generally comes when you realize 1) there is nothing
wrong with your ears, 2) normal sounds will not
damage your hearing, and 3) you have nothing to
fear.
More than 90% of our clients with tinnitus or
hyperacusis obtain relief. Do we have a magic
wand or pill? No. An overnight cure? No. But we
will help. You really are unique. So are we. We
fully understand tinnitus and hyperacusis, and sincerely
care about each of our clients.
Charles Smithdeal, M.D., F.A.C.S., C.Ht.
Director, Anxiety Relief Specialists & Hypnotherapy Institute
St Petersburg, Florida, U.S.A. 33706
(727) 512-5131
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