Tinnitus: How to Know If It's Getting Better?

Tinnitus is a condition in which people can hear sound in their ear or head without any external source. This condition can affect activities of daily living such as sleeping and reading. Given the subjective nature of the symptom, how do doctors know that tinnitus is getting better? Are there any tests for tinnitus? Let’s try to delve deeper into these questions.

What is tinnitus?

Tinnitus is a chronic medical condition characterized by the perception of sound in the ear and/or in the head without any external source. People experiencing tinnitus often report buzzing, ringing, hissing, whistling, and other similar sounds. Tinnitus has various causes and usually is a sensorineural reaction to trauma, disturbance, or damage to the auditory system.

Some of the most common reasons are:

• Ear infections
• Consumption of certain drugs
• Exposure to loud noises
• Age-related damage to the auditory system

Increased sensitivity to sound (hyperacusis) and sound distortion usually accompany tinnitus. Both ears are usually affected by this condition. It can negatively impact a person's quality of life, like impaired concentration, emotional distress, and sleep disturbances.

Treatment for tinnitus

No single type of treatment is effective for all tinnitus conditions. Treatment for tinnitus varies depending on the severity and cause. Three types of therapies are commonly used:

• Cognitive behavioral therapy (CBT). CBT is a tinnitus treatment based on a psychological approach. CBT reduces anxiety, depression, and emotional distress in individuals with tinnitus. It focuses on correcting negative behaviors and thought patterns.
• Tinnitus retraining therapy (TRT) and sound therapy. These therapies improve the auditory system of tinnitus sufferers by retraining the brain to perceive neutral sounds. The sound of running water, waterfall, rain, and other soothing sounds can be used to treat tinnitus. It helps improve hearing sensitivity in individuals with tinnitus.
• Counseling. Counseling helps individuals with tinnitus deal with psychological stress and perceived hearing problems.

Remember that tinnitus triggers, such as exposure to loud and noisy sounds over a long period, must also be avoided.

There are currently no FDA-approved drug regimens that specifically treat tinnitus. However, doctors may prescribe medications to treat symptoms caused by tinnitus. If the patient is experiencing depression, anxiety, or stress due to tinnitus then those symptoms can be relieved with medication.

Anti-anxiety medications, such as diazepam and benzodiazepines, and antidepressants, such as fluoxetine and amitriptyline, can be used to treat the agitation, anxiety, and emotional distress associated with tinnitus. Additionally, a vasodilator agent may be given to increase blood flow to the inner ear.

How do we measure the progress?

Although there is no single type of treatment that is effective for each instance of tinnitus, here are the possible methods to measure the progress.

Self-reports

Due to the subjective nature of the condition, measuring progress in patients with tinnitus is a challenge. Without measuring the progress, doctors and psychologists cannot determine further treatments. A good place to start is by using self-report measures to assess the burden or distress caused by tinnitus.

The Tinnitus Handicap Inventory (THI) is used to assess the impact and severity of tinnitus. TheTHI questionnaire has several questions related to sleep disturbances, cognition, concentration, communication, and emotional distress.

This assessment is conducted several times over the course of the treatment to evaluate the effectiveness of various tinnitus treatments. A similar questionnaire, the ‘Tinnitus Handicap Questionnaire,’ is also available in different languages to measure the impact of tinnitus. This questionnaire is typically used in clinical trials.

Objective tests

Apart from subjective measures, audiologists may also conduct various auditory tests for an objective evaluation. Speech audiometry, or a speech recognition test, is conducted to determine if a patient can repeat the words they hear. Another test called a tympanogram measures how well the eardrum vibrates and the mobility of bones in the middle ear. Some additional objective tests are acoustic reflex testing and otoacoustic emission testing.

Research has shown that functional near-infrared spectroscopy (fNIRS) can be a useful objective test for tinnitus. The activity in brain regions such as the frontal cortex, auditory cortex, and cuneus region is typically associated with tinnitus. As the ratings of loudness increased, patients with tinnitus showed increases in the temporal-occipital connectivity in the brain.

Can tinnitus improve?

Although some patients may have lifelong tinnitus, most patients with tinnitus experience relief from tinnitus and associated symptoms over time. Improving tinnitus means a person can focus better, sleep well, and feel emotionally calmer. The pressure inside the ear begins to reduce and most importantly, the volume of tinnitus starts to lower.

These symptoms would suggest that tinnitus is getting better. Additionally, the reports of objective testing such as fNIRS, would suggest improvement in the symptoms. As tinnitus and associated symptoms reduce, patients report an overall improved quality of life.

Overall, measuring the progress in patients with tinnitus requires a combination of subjective and objective measures, which further helps in obtaining reliable results. Along with your doctor, other medical professionals such as an audiologist, a psychologist, and a counselor may be involved in the treatment of tinnitus. If you experience tinnitus and associated symptoms, consult your care team periodically to measure your progress.