Medical Edge Newspaper Column

Options for Treating Ringing in the Ear

January 7, 2008
Dear Mayo Clinic:
My son sustained a basal skull fracture a few years ago. He lost the hearing in his left ear and suffers from ringing in that ear. We were told there was nothing that can be done about this. I wonder if there have been any new developments regarding this condition.

Answer:
At this time, there isn't a cure for ringing in the ear (tinnitus). But, there are treatments your son can try that might make living with the condition easier.

Some physicians treat tinnitus with medication, which is controversial. Anecdotal evidence suggests a role for antidepressant drugs in people who have depression and tinnitus. Antidepressants won't cure tinnitus but can help with coping. Also, several inexpensive combinations of herbal and vitamin mixtures are on the market for tinnitus, but please keep in mind that the effectiveness of herbal supplements in treating tinnitus is still being studied. And it is always a good idea to talk with your doctor before trying any medical therapy.

Most other treatments for tinnitus focus on training the brain to ignore the ringing. In a person with tinnitus, the brain tends to focus on the ringing sound, particularly when the surroundings are quiet. Many physicians recommend the use of an environmental noise machine during quiet times, such as bedtime. These devices play natural sounds — ocean waves or falling rain, for example — which compete for the brain's attention and so draw attention away from the ringing.

Because your son has hearing loss, a hearing aid could also help in a similar way by bringing in more sounds from the environment around him to compete with the tinnitus sounds. However, this may not be helpful if he doesn't have measurable hearing, or if he has severe sound sensitivity (hyperacusis). Ask that your son be allowed to use a hearing aid for a trial period. That way, he can assess whether the hearing aid is helpful in reducing tinnitus severity before you purchase it.

Noise maskers are another means of trying to reduce tinnitus. These devices are placed in the ear and look similar to a hearing aid. But instead of bringing in noise from the environment, these devices emit white noise at a very low level. Again, the idea is to provide noise to compete with the tinnitus and teach the brain to ignore the ringing.

For most patients, one of the therapies mentioned above usually works to reduce tinnitus. But, if they don't help your son, tinnitus retraining therapy is another option. It combines 12 to 18 months of counseling and habituation therapy — another means of training the brain to ignore the ringing — with relaxation or biofeedback techniques. This therapy also uses a noise generator for background noise (again, to provide a competing sound). It can be effective in people for whom other treatments have failed. Tinnitus retraining therapy can be expensive, though, and it requires a significant time commitment.

I suggest seeking a second opinion from an ear, nose and throat specialist to have your son's condition re-evaluated and to determine the right treatment for him.

— Brian Neff, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.