1. Managing Your Tinnitus: What to Do and How to Do it

2. Tinnitus Education

3. Tinnitus Education: Outline What is Tinnitus? How we hear vs. tinnitus hearing. Sounds of tinnitus How many people have tinnitus? What causes Tinnitus? How can Tinnitus affect you? Tinnitus can affect concentration Tinnitus can cause emotional reactions Tinnitus can disrupt sleep Why is tinnitus a problem? Is there a cure? Methods to eliminate tinnitus or reduce its loudness Prescription Drugs Use of Sound Methods to manage tinnitus Cognitive-Behavioral Therapy Mindfulness Based Therapy What is Tinnitus? How we hear vs. tinnitus hearing. Sounds of tinnitus How many people have tinnitus? What causes Tinnitus? How can Tinnitus affect you? Tinnitus can affect concentration Tinnitus can cause emotional reactions Tinnitus can disrupt sleep Why is tinnitus a problem? Is there a cure? Methods to eliminate tinnitus or reduce its loudness Prescription Drugs Use of Sound Methods to manage tinnitus Cognitive-Behavioral Therapy Mindfulness Based Therapy

4. What is tinnitus? TIN-i-tus i s a ringing, humming, buzzing, or other chronic noise that is perceived that does not have an outside source. This sound can occur from one or both ears, or within the head. In the U.S., 50 million people have experienced tinnitus at some point and 10 million people visit physicians for this problem TIN-i-tus i s a ringing, humming, buzzing, or other chronic noise that is perceived that does not have an outside source. This sound can occur from one or both ears, or within the head. In the U.S., 50 million people have experienced tinnitus at some point and 10 million people visit physicians for this problem

5. How we hear vs. tinnitus Sound waves in the air become transformed into signals that the brain recognizes as sound. With tinnitus there are NO sound wave vibrations that cause nerve fibers to activate. In most forms of tinnitus, it is thought that nerves fire on their own. The brain perceive these signals as sound Figure 1

6. What Causes Tinnitus When we get hearing loss, we lose some cells in the inner ear that sense sound. The brain cells that do the function of hearing, however, do not die. This causes an increase in activity in the brain cells that do the function of hearing. Tinnitus is caused by a combination of this increase in activity and usually one of the following factors: Stress Anxiety Fatigue Poor sleep Depression When we get hearing loss, we lose some cells in the inner ear that sense sound. The brain cells that do the function of hearing, however, do not die. This causes an increase in activity in the brain cells that do the function of hearing. Tinnitus is caused by a combination of this increase in activity and usually one of the following factors: Stress Anxiety Fatigue Poor sleep Depression

7. What Causes Tinnitus Factors such as stress, anxiety, depression, poor sleep, etc. cause some changes in the brain that makes the brain more aware of the tinnitus Since tinnitus is affected by emotional factors (e.g., stress, anxiety, depression, etc), management of tinnitus requires managing any of these co-existing issues This includes, sleep management, stress management, etc. Factors such as stress, anxiety, depression, poor sleep, etc. cause some changes in the brain that makes the brain more aware of the tinnitus Since tinnitus is affected by emotional factors (e.g., stress, anxiety, depression, etc), management of tinnitus requires managing any of these co-existing issues This includes, sleep management, stress management, etc.

8. Sounds of Tinnitus Patients with tinnitus often report sounds of: Ringing High pitched tone Hissing High tension wire Buzzing Sizzling Crickets Patients with tinnitus often report sounds of: Ringing High pitched tone Hissing High tension wire Buzzing Sizzling Crickets You can hear more than 1 sound

9. How can tinnitus affect you? Tinnitus can affect a person’s life in a variety of ways Some of the main effects are: Concentration difficulties Emotional reactions Disrupted sleep The onset of tinnitus can be life-altering Tinnitus can affect a person’s life in a variety of ways Some of the main effects are: Concentration difficulties Emotional reactions Disrupted sleep The onset of tinnitus can be life-altering

10. Tinnitus can affect concentration The sound of tinnitus can disrupt work and tasks that require your attention The chronic sound of tinnitus is unpleasant and cannot be eliminated Some people differ in their ability to ignore sounds. For some, it is easy to ignore, but for others it can be challenging Tinnitus does not make it difficult to hear, but it can disturb with focused listening The sound of tinnitus can disrupt work and tasks that require your attention The chronic sound of tinnitus is unpleasant and cannot be eliminated Some people differ in their ability to ignore sounds. For some, it is easy to ignore, but for others it can be challenging Tinnitus does not make it difficult to hear, but it can disturb with focused listening

11. Tinnitus can cause emotional reactions Tinnitus is a chronic noise and can become irritating Emotional reactions to tinnitus have been reported to cause: Depression Anxiety Anger Frustration Worry People with previously existing anxiety and depression are more prone to chronic tinnitus The goal of tinnitus management is to manage these reactions to tinnitus. Tinnitus is a chronic noise and can become irritating Emotional reactions to tinnitus have been reported to cause: Depression Anxiety Anger Frustration Worry People with previously existing anxiety and depression are more prone to chronic tinnitus The goal of tinnitus management is to manage these reactions to tinnitus.

12. Tinnitus can disrupt sleep Many tinnitus patients have reported sleep problems Tinnitus can make it hard to fall asleep and returning to sleep after waking up in the middle of the night The worse your sleep is, the worse your tinnitus will be the next day Tinnitus can cause you to become sleep deprived and make it harder to normally function during the day Many tinnitus patients have reported sleep problems Tinnitus can make it hard to fall asleep and returning to sleep after waking up in the middle of the night The worse your sleep is, the worse your tinnitus will be the next day Tinnitus can cause you to become sleep deprived and make it harder to normally function during the day

13. Why does tinnitus become a problem? 1. Many people with tinnitus report that “it came out of nowhere.” Tinnitus is a different sound and it can be annoying by focusing on it. 2. It can be perceived as a threat and keep our attention. It can create fear that it is a serious medical condition or a psychological disorder. There are often reports of “going crazy” or “having a tumor”. 3. There are different reactions to tinnitus. The sound of tinnitus may disturb one person, but not another. 4. Tinnitus can be annoying because the sound is persistent. There is a loss of “peace and quiet”. 1. Many people with tinnitus report that “it came out of nowhere.” Tinnitus is a different sound and it can be annoying by focusing on it. 2. It can be perceived as a threat and keep our attention. It can create fear that it is a serious medical condition or a psychological disorder. There are often reports of “going crazy” or “having a tumor”. 3. There are different reactions to tinnitus. The sound of tinnitus may disturb one person, but not another. 4. Tinnitus can be annoying because the sound is persistent. There is a loss of “peace and quiet”.

14. Why does tinnitus become a problem? 5. Tinnitus can trigger negative memories if the onset of tinnitus was associated with a traumatic event. Traumatic events can include stressful experiences, severe sleep disturbance, combat, head injury, or explosion. 6. Tinnitus is an unwelcomed sound and can be more irritating if it is louder. Those with a higher sensitivity of tinnitus appear to be most bothered by it 7. The more attention given to tinnitus, the more it becomes problem. It may affect you lifestyle. 8. Tinnitus can cause a lack of control. People with tinnitus feel like it is uncontrollable or escape it. 5. Tinnitus can trigger negative memories if the onset of tinnitus was associated with a traumatic event. Traumatic events can include stressful experiences, severe sleep disturbance, combat, head injury, or explosion. 6. Tinnitus is an unwelcomed sound and can be more irritating if it is louder. Those with a higher sensitivity of tinnitus appear to be most bothered by it 7. The more attention given to tinnitus, the more it becomes problem. It may affect you lifestyle. 8. Tinnitus can cause a lack of control. People with tinnitus feel like it is uncontrollable or escape it.

15. Is there a cure? Curing tinnitus means that the sound that you hear would be eliminated. Unfortunately, there is no cure for tinnitus yet. There are available treatments to manage living with tinnitus. These treatments can: Reduce its loudness Reduce the person’s reactions to the tinnitus Curing tinnitus means that the sound that you hear would be eliminated. Unfortunately, there is no cure for tinnitus yet. There are available treatments to manage living with tinnitus. These treatments can: Reduce its loudness Reduce the person’s reactions to the tinnitus

16. There are many ways to try treat tinnitus, but there is no proven cure Some ways to reduce its loudness are: Prescription drugs Use of sound Hearing aids Masking Generic Masking Table-top noise generator Music Customized Masking Sound therapy customized to the hearing and tinnitus profile There are many ways to try treat tinnitus, but there is no proven cure Some ways to reduce its loudness are: Prescription drugs Use of sound Hearing aids Masking Generic Masking Table-top noise generator Music Customized Masking Sound therapy customized to the hearing and tinnitus profile Reduce Its Loudness

17. Prescription Drugs There have been many drugs used to treat tinnitus, but most are based on a trial-and-error process. The drugs used are designed to manage other tinnitus-related problems such as Depression Anxiety Mood disorders Lack of sleep With this method for treatment, it must be approached with great care due to potential side effects. There have been many drugs used to treat tinnitus, but most are based on a trial-and-error process. The drugs used are designed to manage other tinnitus-related problems such as Depression Anxiety Mood disorders Lack of sleep With this method for treatment, it must be approached with great care due to potential side effects.

18. Use of Sound Hearing aids Hearing aids can assist in tinnitus management since they allow more sound to reach the brain to reduce the perception of tinnitus, they increase background noise, this allows you to hear soothing and interesting sounds, also they can make difficult listening situations less stressful. Tinnitus Masking This treatment method can give the perception that tinnitus is eliminated or reduced in loudness. This method can give the patient a sense of relief from tinnitus. Hearing aids Hearing aids can assist in tinnitus management since they allow more sound to reach the brain to reduce the perception of tinnitus, they increase background noise, this allows you to hear soothing and interesting sounds, also they can make difficult listening situations less stressful. Tinnitus Masking This treatment method can give the perception that tinnitus is eliminated or reduced in loudness. This method can give the patient a sense of relief from tinnitus.

19. Reduce Reactions to Tinnitus Reducing the reactions to tinnitus is a way of management. This approach of treatment can help you better cope living with tinnitus. This includes: Psychological approaches Cognitive-Behavioral Therapy (CBT) Mindfulness Based Therapy Reducing the reactions to tinnitus is a way of management. This approach of treatment can help you better cope living with tinnitus. This includes: Psychological approaches Cognitive-Behavioral Therapy (CBT) Mindfulness Based Therapy

20. Cognitive-Behavioral Therapy (CBT) CBT combines helping patients change how they think about their tinnitus to help them feel better with everyday activity changes CBT was initially used to treat depression, anxiety, and chronic pain. It is now used to psychologically manage tinnitus by reducing negative reactions to tinnitus. CBT combines helping patients change how they think about their tinnitus to help them feel better with everyday activity changes CBT was initially used to treat depression, anxiety, and chronic pain. It is now used to psychologically manage tinnitus by reducing negative reactions to tinnitus.

21. Mindfulness Based Therapy Mindfulness based therapy is used to acknowledge thoughts of tinnitus in a nonjudgmental way and living in the moment. It is used to accept tinnitus by becoming aware of it. Mindfulness based therapy is used to acknowledge thoughts of tinnitus in a nonjudgmental way and living in the moment. It is used to accept tinnitus by becoming aware of it.

22. Can Tinnitus be Cured? “Cure” = eliminate or reduce the tinnitus No cure yet – research underway It can’t be cured, but you can learn to manage your reactions to it “Cure” = eliminate or reduce the tinnitus No cure yet – research underway It can’t be cured, but you can learn to manage your reactions to it

23. Tinnitus Management There are 2 components to tinnitus 1. The sound that you hear 2. The reaction you have to the sound To help Manage your tinnitus, you need to address both components 1. Using sound to help reduce the perception of the sound 2. Manage your reaction to the sound that you hear There are 2 components to tinnitus 1. The sound that you hear 2. The reaction you have to the sound To help Manage your tinnitus, you need to address both components 1. Using sound to help reduce the perception of the sound 2. Manage your reaction to the sound that you hear

24. Goals of Tinnitus Management (All Methods) Emotional reactions are reduced Stress is reduced Little if any attention is given to tinnitus Tinnitus does not affect any life activities in a major way Further help is not needed or wanted These goals can be reached even if the sound of your tinnitus doesn’t change! Emotional reactions are reduced Stress is reduced Little if any attention is given to tinnitus Tinnitus does not affect any life activities in a major way Further help is not needed or wanted These goals can be reached even if the sound of your tinnitus doesn’t change!

25. Sound Therapy What is it? Sound that helps reduce the perception of tinnitus How can it help? By giving you a sense of relief from tension and stress caused by tinnitus When can it help? Any time your tinnitus bothers you What is it? Sound that helps reduce the perception of tinnitus How can it help? By giving you a sense of relief from tension and stress caused by tinnitus When can it help? Any time your tinnitus bothers you

26. Sound Therapy Things to Remember Sound therapy is more soothing to some people, and less soothing to others The goal of customized sound therapy is to direct more sound to areas of the brain that are thought to be responsible for the perception of tinnitus Music therapy is the combination of sound therapy and relaxing music This allows you to listen to music while the sound therapy is playing in the background Sound therapy is more soothing to some people, and less soothing to others The goal of customized sound therapy is to direct more sound to areas of the brain that are thought to be responsible for the perception of tinnitus Music therapy is the combination of sound therapy and relaxing music This allows you to listen to music while the sound therapy is playing in the background

27. Martha When Martha reads at home, she listens to music therapy The sense of relief she feels from the music makes it easier for her to concentrate This an example of using music therapy When Martha reads at home, she listens to music therapy The sense of relief she feels from the music makes it easier for her to concentrate This an example of using music therapy

28. Background Sound What is it? Any sound that is neutral (not soothing and not interesting) For example like the sound of the air conditioner, dishwasher or talking of others in a restaurant How can it help? Reduces contrast to make it easier to ignore your tinnitus (we’ll explain!) When can it help? Any time What is it? Any sound that is neutral (not soothing and not interesting) For example like the sound of the air conditioner, dishwasher or talking of others in a restaurant How can it help? Reduces contrast to make it easier to ignore your tinnitus (we’ll explain!) When can it help? Any time

29. Imagine a Lit Candle in a Dark Room The candle is the only light in the room The candle is the only light in the room There is sharp contrast between the bright candle and the dark room There is sharp contrast between the bright candle and the dark room The candle naturally attracts a lot of attention The candle naturally attracts a lot of attention

30. Turn on the Lights! This is the same lit candle, but with the lights on The contrast between the candle and the room has been reduced The candle is just as bright as before, but attracts less attention because now there is other light in the room along with the candle This is the same lit candle, but with the lights on The contrast between the candle and the room has been reduced The candle is just as bright as before, but attracts less attention because now there is other light in the room along with the candle

31. Same Candle – Different Backgrounds This same idea works for tinnitus…

32. Imagine “Tinnitus” in a Quiet Room The tinnitus is the only “sound” The tinnitus is the only “sound” There is sharp contrast between the tinnitus and the quiet room There is sharp contrast between the tinnitus and the quiet room The tinnitus naturally attracts a lot of attention The tinnitus naturally attracts a lot of attention

33. Turn on the Sound! Same tinnitus, but in a background of sound The contrast between the tinnitus and the quiet room has been reduced The tinnitus is just as loud as before, but attracts less attention because of the background sound Same tinnitus, but in a background of sound The contrast between the tinnitus and the quiet room has been reduced The tinnitus is just as loud as before, but attracts less attention because of the background sound

34. Same Tinnitus – Different Backgrounds

35. Spend a few moments listening to your tinnitus in quiet Then, with the background sound turned on, notice the reduced contrast Reducing contrast makes it easier to ignore your tinnitus Spend a few moments listening to your tinnitus in quiet Then, with the background sound turned on, notice the reduced contrast Reducing contrast makes it easier to ignore your tinnitus Tinnitus Contrast Activity Let’s try it! click icon to play sound

36. Background Sound: Things to Remember Tinnitus is less likely to get your attention when you add background sound You might not notice background sound helping you right away—that doesn’t mean it’s not helping you Using constant background sound over weeks or months can help you get better at ignoring tinnitus Never use sound that is irritating or annoying to you to manage your reactions to tinnitus Tinnitus is less likely to get your attention when you add background sound You might not notice background sound helping you right away—that doesn’t mean it’s not helping you Using constant background sound over weeks or months can help you get better at ignoring tinnitus Never use sound that is irritating or annoying to you to manage your reactions to tinnitus

37. Janet Janet keeps a tabletop fountain running on her desk The background sound from the fountain makes it easier for her to ignore her tinnitus This is an example of using background sound Janet keeps a tabletop fountain running on her desk The background sound from the fountain makes it easier for her to ignore her tinnitus This is an example of using background sound

38. Interesting Sound What is it? Sound that keeps your attention Sound that involves active listening Some examples include talk radio, audio books, interesting music, dynamic speeches How can it help? Shifts your attention away from your tinnitus When can it help? When you do not need to concentrate on something else When you want to relax or sleep What is it? Sound that keeps your attention Sound that involves active listening Some examples include talk radio, audio books, interesting music, dynamic speeches How can it help? Shifts your attention away from your tinnitus When can it help? When you do not need to concentrate on something else When you want to relax or sleep

39. Interesting Sound: Things to Remember We’re all different! Some sounds (e.g., talk radio) are more interesting to some people, and less interesting to others Your job is to find sounds that are interesting to you It might take time and patience to find the sounds that are most interesting and helpful for you Never use sound that is irritating or annoying to you to manage your reactions to tinnitus We’re all different! Some sounds (e.g., talk radio) are more interesting to some people, and less interesting to others Your job is to find sounds that are interesting to you It might take time and patience to find the sounds that are most interesting and helpful for you Never use sound that is irritating or annoying to you to manage your reactions to tinnitus

40. Patrick Patrick talks to his friends on the telephone to keep his mind off of his tinnitus This is an example of using interesting sound Patrick talks to his friends on the telephone to keep his mind off of his tinnitus This is an example of using interesting sound

41. To help you come up with ideas for choosing sounds… You can use Environmental Music Speech You can use Environmental Music Speech

42. Environmental Sound Sounds of nature Moving water Beach sounds Forest sounds Animals Wind Storms and more… Sounds of nature Moving water Beach sounds Forest sounds Animals Wind Storms and more… Manmade sounds Masking noise Electric fan noise Shower sound Aircraft noise Wind chimes Traffic noise Radio static and more…

43. Music There are many styles of music We all have our preferred styles Any music that is neutral or pleasant can be used to manage tinnitus – as long as it is not too loud There are many styles of music We all have our preferred styles Any music that is neutral or pleasant can be used to manage tinnitus – as long as it is not too loud

44. Speech Speech can be used as part of your plan to manage tinnitus There are many kinds of speech, and we react differently depending on the type of speech and the situation Some examples: Talking on the phone Listening to an audio book Listening to a lecture Speech can be used as part of your plan to manage tinnitus There are many kinds of speech, and we react differently depending on the type of speech and the situation Some examples: Talking on the phone Listening to an audio book Listening to a lecture

45. Nine Combinations of Sound to Manage Reactions to Tinnitus

46. You Have Now Finished This Module Next let’s take a closer look at an example

47. Bob Listening to talk radio helps Bob get his mind off of his tinnitus at night This helps him get to sleep This is an example of using interesting sound Tip: It’s best to NOT use the TV for this as the flashing images can prevent you from falling asleep Listening to talk radio helps Bob get his mind off of his tinnitus at night This helps him get to sleep This is an example of using interesting sound Tip: It’s best to NOT use the TV for this as the flashing images can prevent you from falling asleep

48. Won’t Interesting Sound Keep Me Awake? Interesting sound can be a powerful way to get your mind off of your tinnitus This helps some people relax enough to fall sleep It might not be helpful for others Be open to using sound in surprising or unusual ways to manage your reactions to tinnitus! Interesting sound can be a powerful way to get your mind off of your tinnitus This helps some people relax enough to fall sleep It might not be helpful for others Be open to using sound in surprising or unusual ways to manage your reactions to tinnitus!

49. Another Sleep Challenge for Bob Listening to talk radio helps Bob get to sleep when he goes to bed at night However, he wakes up in the middle of the night and has trouble getting back to sleep because of his tinnitus He does not like to listen to interesting sound in the middle of the night What did Bob do? Listening to talk radio helps Bob get to sleep when he goes to bed at night However, he wakes up in the middle of the night and has trouble getting back to sleep because of his tinnitus He does not like to listen to interesting sound in the middle of the night What did Bob do?

50. Bob’s Solution Keeping a fan running all night long reduces the contrast between Bob’s tinnitus and the quiet of his bedroom The reduced contrast helps Bob stay asleep all night long Keeping a fan running all night long reduces the contrast between Bob’s tinnitus and the quiet of his bedroom The reduced contrast helps Bob stay asleep all night long This is an example of using background sound This is an example of using background sound

51. Develop a Sound Plan That is Easy to Do Your first Sound Plan should be easy to do and practical for you Use sounds and devices that you already have As you try the Plan, you will learn what helps the most You will get ideas about how to improve your Plan Your first Sound Plan should be easy to do and practical for you Use sounds and devices that you already have As you try the Plan, you will learn what helps the most You will get ideas about how to improve your Plan

52. Write Down Your Sound Plan What will you use for background sound _ _ _ _ _ _ _ _ (examples include Sound therapy, fan, fountain, etc.) What will you use as an interesting sound _ _ _ _ _ _ _ _ (examples include audio book, talk radio, Music therapy, etc.) What will you use for background sound _ _ _ _ _ _ _ _ (examples include Sound therapy, fan, fountain, etc.) What will you use as an interesting sound _ _ _ _ _ _ _ _ (examples include audio book, talk radio, Music therapy, etc.)