While antidepressants or tranquilizers are in general not required for a treatment of tinnitus, there may be cases where it makes sense to take them at least for a while. I get many reports from people who, especially in the early phase of the tinnitus, suffer from severe anxiety and depression due to the condition, which in turn then can further aggravate the tinnitus, thus leading to a vicious circle. Anti-anxiety drugs like Xanax, Temazepam or others can well help to break this vicious circle if taken for a while (a few weeks). But as these drugs can have considerable side effects and make dependent in the long term, it should really be only the last resort if one can't see any other way to cope with the condition. If you feel you are in this situation, don't hesitate to ask your doctor for a possible prescription of something suitable in this sense (note that antidepressants and tranquilizers should only be taken under strict medical supervision). Note also that in some cases these (like many other) drugs can actually make the tinnitus worse. In that case one should obviously stop taking them and look for alternatives. Thomas

I want to take a short break from my series 'Tinnitus Remedies and Treatments' and today focus on the issue of hearing damage in connection with tinnitus. I addressed this already shortly in the article 'What is tinnitus?', but it is so important that I felt it should be a separate entry. Most people suffering from tinnitus are being subjected to hearing tests by their doctor, and are subsequently told they have some degree of hearing loss in a certain frequency range (let's say 20db at 8000 Hz). This however should not be taken as a sign that the inner ear is actually damaged in any way (which is what some tinnitus theories are proposing). Often the apparent 'hearing loss' is only due to the fact that because of the tinnitus the test tone can not be heard anymore that well. If the tinnitus subsides, the hearing tests should therefore return a normal result again. In many cases (for instance mine) there is indeed no conceivable cause that could have caused a hearing damage. And according to more recent research, the tinnitus is in these cases solely a nervous problem (see the Tinnitus.org Website). Of course, hearing damage can occur for instance through a noise trauma, and often this will go along with a tinnitus, but the reverse is in general not true. So people should not be misled by the test diagnosis 'hearing loss' in connection with tinnitus and wrongly come to the conclusion they have an irreversible hearing damage. In many cases the tinnitus will improve and with it the apparent 'hearing loss' as well. Thomas

Although the low level laser therapy against tinnitus is known for more than 20 years, it is still a rather controversial treatment (and therefore usually not covered by health insurances). It is based on the theory that tinnitus is caused by damage or deterioration of the hair cells in the inner ear, and that this damage can be repaired by supplying radiative energy to the inner ear by means of the laser (although the laser can not directly reach the inner ear due to the amount of tissue that must be traversed, it is assumed that there is still sufficient energy being supplied to the inner ear). The low level laser therapy is either applied by a practitioner in special tinnitus clinics/practices (of which however there exist only very few) or one can buy or rent corresponding devices for home treatment. Whilst the latter are usually less expensive than a clinical treatment (which has to last for several sessions), they are also less powerful and therefore probably less effective. Whether the above theory of the laser repairing the hair cell damage is correct is at least debatable since in many (if not the majority) of cases there is no reason to assume that the hair cells are damaged at all (the tinnitus is solely caused by by the nervous system). But there are a number of studies which seem to indicate that the low level leaser therapy is effective in at least significantly improving the condition, but these have usually been performed or sponsored by the institutions applying these treatments or selling lasers for home treatments. This is not to say that they should necessarily be questioned, but, as far as I am aware, independent studies have as yet not conclusively confirmed the effectiveness of the low level laser therapy. Nonetheless, I know personally of people who have experienced a substantial improvement of the condition after having had a low level laser therapy treatment, so for anyone looking for a last resort it might still be worth checking out (even though it is a costly option).

Sound therapies in various forms are often being applied in order to alleviate the tinnitus symptoms. The most common form of a sound therapy is a 'tinnitus masker (noiser)' , which is a device that produces 'white noise' in order to distract from the tinnitus noise. In this way it is hoped that the person learns to focus less on the tinnitus and thus push the latter in the background. For some people tinnitus maskers appear to provide some relief in this sense (especially in the early phase), but the drawback is that they make it more difficult to get used to the tinnitus and thus habituate to the latter. So a masker (noiser) could actually lengthen the time required for the tinnitus if not to be cured but then at least be reduced to a level where it does not present any problems anymore (compensated tinnitus). The strategy of fighting fire with fire in this sense may therefore not be the best one for everybody. In fact, it is not rare that maskers worsen the tinnitus (I personally had contact with a couple of people where the noiser actually added a new tinnitus tone to the existing one). Sounds are however not only used to acoustically mask the tinnitus, but also in order to provide relaxation. Relaxation CDs and sound files (especially nature sounds) are very popular and in general helpful for tinnitus sufferers (as relaxation will calm the nerves down and thus reduce the tinnitus noise). Recently there have been some scientific experiments with 'notched' music where certain frequencies (centered around the tinnitus frequency) were filtered out (see for instance this BBC news bulletin. Whether this has the potential for a recognized therapy is still questionable, music CDs treated in this sense are already commercially available. Their prices are unfortunately quite inflated, but with suitable Audio software, one cam actually produce 'notched' recordings oneself without any cost. So whilst sound therapies can be quite useful and effective in improving tinnitus symptoms, one should be aware of its limitations and not expect a full cure from this. One should also take care not to overdo it and cause more harm than good by exposing oneself to too much music and sounds. This holds especially if one uses headphones as these can cause problems with regard to pressure equalization on the ear. In particular, in-ear headphones ('earbuds') should be avoided, but also headphones that completely close around the ears. Better use 'open' headphones that don't prevent ventilation of the ear. Thomas

Today I want to briefly discuss blood thinning medication (administered either orally or by means of infusion) which is frequently prescribed by doctors in case of tinnitus. The theory behind this is that tinnitus is caused by a lack of blood circulation in the inner ear, so the thinning of the blood is supposed to remedy this. However, it is well accepted now that tinnitus is a nervous condition and has, in the vast majority of cases, little if anything to do with problems in the inner ear. So for most people the blood thinning measures will have no effect. On the contrary, in some cases these drugs can, similar to caffeine, stimulate the nervous system and thus aggravate the tinnitus. In those cases where these measures appear to have some success, this is likely to be a placebo (i.e. a psychological) effect. In other cases (for instance for Ginkgo Biloba extract) the beneficial effect is likely to be due to chemical substances that act directly on the nervous system rather than a blood thinning effect. Although I do not want do discourage anybody to try any of these measures (if just in order to have the peace of mind to have tried everything possible), you should be aware of the issues I mentioned, and not be disheartened if things don't work out as hoped. The path to a cure of tinnitus is very much one of trial and error, and negative experiences are just part of this path. The important point just is to learn the lessons from each bad experience and thus narrow down the options to find a remedy that actually works for you. Thomas