NHS Forth Valley – Tinnitus

What is Tinnitus?

Tinnitus is a noise which can be heard when there is no external sound present.
Tinnitus can be many different sounds including buzzing, ringing, humming, whooshing, pulsing or even music.
Tinnitus can be constant or intermittent.
Tinnitus can be in one ear, both ears or heard in the head.

What can trigger Tinnitus?

These are the most common causes:

Hearing loss
Stress
Impacted ear wax
Ear Infections
Otoscelerosis
Noise Exposure
Ototoxic drugs
Menieres
Temporomandibular joint dysfunction (Jaw condition)

Understanding Tinnitus and the vicious cycle

There are many theories regarding the origins of tinnitus however the exact mechanism of tinnitus remains unknown. The brain is constantly filtering out (tuning out) any unimportant sounds e.g. fridge humming, clock ticking, clothes rustling. Sometimes this filter fails to work as effectively, and we become more aware of the internal body noises and this is how people become aware of tinnitus.

Once we become aware of tinnitus it can become difficult to ignore and creates a worry/focus vicious cycle.

Why does the filter change?

Hearing loss (even a very mild loss)
- The brain is overcompensating for lack of sound input.
- This causes the filters to widen and allow more sound through in an attempt to ‘help’ you hear better.
- As the filters widen your awareness of normal body noises also increases therefore making you aware of tinnitus.
Stress (bereavement, job, money, family, health)
- Increased activity in the emotional centres of the brain causes the filters to widen and create a fight or flight response.
Chronic Pain
- Pain makes your body more sensitive to change.
- If you are in pain it is generally more difficult to cope with other things going on in your body or life which can make tinnitus more noticeable.
Medication
- Rarely some medications can trigger tinnitus.
- If you are concerned about any links with medication, please speak to your GP. DO NOT STOP TAKING MEDICATION WITHOUT CONSULTING YOUR GP.

Very occasionally there are some people who do not experience any of the above yet still experience tinnitus. The widening of the filters seems to happen randomly.

Tinnitus management

The good news is the brain gradually relearns to filter the tinnitus out. To help the habituation process we recommend 3 main things:

Sound enrichment (and avoiding silence)

Your tinnitus is more likely to be noticeable in a quiet room.
- By avoiding silence, you can retrain your brain to focus on external sounds rather than internal sounds (tinnitus).
Hearing Aids
- If you have a hearing loss wearing a hearing aid can help reduce awareness of your tinnitus even if you only have a mild loss.
- This is usually the first line of treatment in tinnitus management if a hearing loss is present.
- By helping your hearing your brain no longer needs to overcompensate for the lack of sound input and the tinnitus can reduce.
Other sound enrichment
- Environmental sounds – opening a window or having a fan on.
- Sound enrichment apps (white noise, nature sounds etc) – usually free and can be downloaded on most smartphones and tablets. See the last page of the guide for some examples.
- Relaxation CD’s/music – soothing music designed not to make the brain listen e.g. no lyrics.
- Relaxation sound balls – produces white noise/nature sounds. These can be purchased from various places including the Tinnitus UK and Connevans Ltd (details on the Resource page of this guide).
- Pillow speakers/ sound head bands – useful for listening to sounds when in bed if you do not want to disturb anyone.
Tinnitus retrainers
- In some cases, if more support is required we may consider trying wearable sound generators (also known as tinnitus retrainers). This would be at the discretion of your audiologist.
- These are small devices that look like hearing aids that emit various sounds; white noise, waves etc.
- These can provide more consistent sound enrichment throughout the day in order to retrain the brain.

Relaxation

Relaxation can be used as a way of dealing with the physical reactions associated with stress. It lowers adrenaline levels (chemicals) in your brain/body which in turn reduce the physical reactions to stress. Relaxation can take different forms for different people, but try to set aside some time to relax every day:

Try Breathing exercises, muscle relaxation or mindfulness.
Use a relaxation CD or app.
Find a comfortable chair and sit for a minute or two allowing yourself to let go as much as you can.
Take a couple of slow breaths.
Concentrate on relaxing muscles in the face and shoulders, allowing your hands to rest in your lap.
It really does not matter how you achieve relaxation but do persevere and you will gradually notice the benefits.
Try not to expect this to help your tinnitus directly or straight away; most people find relaxation helpful, but it requires time and practice.
Try Yoga or Pilates.
Some people choose to go for a gentle walk, swimming, listen to music or speak to a friend. What can you do?

Distraction

Behaviour – Some people and changes in their behaviour (distractions) can help them to better manage their tinnitus, for example by focusing their attention more on interesting activities and less on the tinnitus. This may be:

Exercise
Doing something for you that you enjoy (e.g. reading, walking, puzzles)
Problem solving/changing things in life that are causing you stress.
Perhaps talking to supportive people such as your GP or friends/family may also help.
There are various types of distractions for your tinnitus and depending on how you feel will affect which type helps the most.

These are examples of distractions for all ages; some may be more suitable than others:

Allowing yourself to cry
Sleeping
Taking a shower or bath
Cuddling a soft toy/pillow
Exercise – Sit ups etc.
Going to the gym
Punching a punch bag
Having a pillow fight with the wall
Doing school work, homework, paperwork
Writing a to do listUntangling necklaces, string, wool
Watching your favourite TV show
Generally being with other people
Phoning a friend
Helping someone else
Going to a public place
Visiting a friend
Hugs

As you can sees some activities cross over, listening to music can relax you, provide sound enrichment and distract you.

Sleep

Many people with tinnitus believe that the noises disrupt their sleep. If you have difficulty getting off to sleep, it may be that the shift from a relatively noisy daytime environment to the quietness of the bedroom makes the tinnitus more noticeable.

Some people find that having some low-level sound in the bedroom (e.g. wave sounds, a fan, or calming music) can help to distract from the tinnitus noises.
However, using sound that is too loud or attention-grabbing (e.g. rock music or listening to a talk programme on the radio) may get in the way of falling asleep.
Some people believe that their tinnitus wakes them up during the night. This, however, is unlikely to be the case.
Sleep naturally comes in cycles from deep sleep to light sleep.
When people feel that their tinnitus has woken them up, it is more likely that they have become more aware of their tinnitus during a lighter phase of sleep.
The amount of sleep we need changes with age. The older we are, the less sleep we need.
Good sleep hygiene can help you to achieve a better sleep pattern.
What matters most is that you can find ways to help any sleep problems so that you feel more rested, less tired, etc.
When people sleep well, it has a knock-on effect on their health in many different ways, and feeling better can help you manage your tinnitus better.

Sleep Hygiene

DO	DON’T
Schedule bedtime, go to bed when tired and get up at the same time every day	Avoid too many stimulants such as coffee, alcohol, or a large meal at or near bedtime
Get daily exercise, a simple walk or stretching can help	Avoid physical activity too close to bedtime, as it can disrupt falling asleep
Write down worries and concerns on a piece of paper so you’re not taking them to bed with you	Avoid anything too stimulating at bedtime, especially using blue screens (phones/tablets)
Have a cool, comfortable, dark bedroom	Don’t nap during the daytime, especially in the afternoon
If you find after 20 minutes you cannot sleep, get up and do something relaxing in another room	Don’t expect to get 8 hours of unbroken sleep—our sleep patterns change over time
Keep your bedroom for sleep only, no watching TV in bed	Do not panic if you wake up—your body will ensure you get the minimum sleep you need

Sounds of Tinnitus

Tinnitus Newsletter

Tinnitus Newsletter 2023

Useful Information

Useful Links

There are various free Apps for tinnitus on Google play & Apple App store and on the internet:

Useful Contacts

Action On Hearing Loss

(Formerly RNID) Works in partnership with the Forth Valley Sensory Centre

Information Line:
Telephone 0808 808 0123
Textphone 0808 808 9000
SMS 0780 0000 360
Email: informationline@hearingloss.org.uk

Tinnitus Information Line:
Telephone 0808 808 6666
Textphone 0808 808 9000
SMS 0780 0000 360
Email: tinnitushelpline@hearingloss.org.uk
Website: www.actiononhearingloss.org.uk

Tinnitus UK

Tinnitus UK was founded over 30 years ago by people with tinnitus and is the only national charity in the UK devoted to tinnitus. It is here to support the 10% of people in the UK who have tinnitus, to raise awareness amongst the general public and fund medical research.

Freephone Helpline 0800 018 0527
Email: info@tinnitus.org.uk
Other numbers:
Phone 0114 250 9933
Textphone 01142585694

Connevans

Connevans specialises in meeting the needs of people who are deaf or hard of hearing or who have tinnitus. They specialise in assistive equipment for hearing and visual impairment. (Such as phones, headphones and loop equipment) as well as sound generators/speakers.

Assistive equipment.
Phone 01737 247571
Email: info@connevans.co.uk
Website www.connevans.co.uk

Spiritual Care

Spiritual Care is about having someone listen to your story and help you deal with your experience.

Telephone 07824 460 882
Website: www.nhsforthvalley.com

Mental Health Teams: NHS Forth Valley