Up to 15 percent of adults experience tinnitus (either tih-NITE-us or TIN-ih-tus is correct), which causes ringing in the ears. The sound may seem to come from inside your head, or from a distance, in one ear or both. It may be steady or pulsating, but only you can hear it.
For most tinnitus patients, stress, anxiety and sleep deprivation are the biggest factors. The vicious cycle of tinnitus always starts with a fight or flight stress reaction in the nervous system, and so additional stress or anxiety will always make tinnitus worse, while sleep deprivation will exacerbate any health problem, tinnitus or otherwise.

But beyond the big three, every case of tinnitus is unique to such an extent that some specific triggering element for one person (be it dietary, environmental, or otherwise), could be something that improves tinnitus for someone else.

Common tinnitus triggers include:
  • Stress/anxiety
  • Sleep deprivation
  • Certain noises
  • Loud noises and noise-induced hearing loss
  • Certain medications
  • Supplements and vitamins
  • Dehydration
  • High sodium diet
  • High sugar diet
  • Caffeine
  • Nicotine (all forms)
  • Alcohol
  • Recreational drugs
  • Food sensitivities
  • Allergies
  • Pollution
  • Temporomandibular joint disorder (TMJ)
  • Specific changes in the weather or barometric pressure
  • Extensive air travel
Habituation/ Tinnitus Retraining Therapy takes time regardless of the strategy, and it’s not an “every day is a little better than the day before” sort of process. It’s often three steps forward and two steps back.

Common strategies used to do so include the following:
  • Tinnitus Retraining Therapy (TRT): White noise machines or hearing aids with noise generators or even a fan can help get you accustomed to the sounds from tinnitus.
  • Cognitive behavioral therapy (CBT): CBT is based upon the idea that our thoughts and only our thoughts – thus not any external event nor any person or situation – are actually the cause of our feelings and behaviors. What this tells us is that we have a lot more control than we think, and we can change things by changing our thoughts. Our feelings and behaviors stem from our thoughts, and not from external stimuli. The idea is that your emotions and thoughts are responsible for how you behave and feel. It can help you accept and understand that you can change things by ‘simply’ changing your thoughts. The advantage is that it helps you understand that changing your thought processes can lead to a positive outcome, which is different from more traditional therapy forms.
  • Hearing aids: If tinnitus is paired with hearing loss, using hearing aids can be quite helpful. They allow you to hear the sounds that you want to hear (as opposed to the ringing) and often come with masking features that can help to obscure the sounds of tinnitus.

How to get started with tinnitus retraining therapy

Tinnitus retraining therapy uses a process known as habituation to retrain the way the brain interprets tinnitus. Essentially, the brain learns to reclassify the unwanted sound as something neutral or unimportant.
When the sound is constant and your brain is confused as to where it’s coming from, that’s when the tinnitus sound becomes bothersome.
It helps a person “forget” about the sound. That might sound tricky, but your brain already does it all the time.
It’s very similar to when you put on your glasses and your nose [nerve endings] start sending signals to the brain that there’s something on your nose, after a while, you tend not to think about the feelings.
There are different methods and types of sounds that can help, and an audiologist trained in tinnitus therapy can explore several options. One common way to initially try sound therapy is by selecting a relaxing, neutral sound—like ocean waves crashing, rain falling, white noise or instrumental music—and playing it as background noise throughout the day.
Who can benefit from TRT/ sound therapy?

Almost anyone who is bothered by their tinnitus is a good candidate for sound therapy.
If there is no medical condition, anyone who reports their tinnitus to be bothersome would be a good candidate for sound therapy
Besides hearing loss, tinnitus can be caused by a host of auditory and medical problems, including Meniere’s disease, obstructions in the middle ear, head and neck trauma, temporomandibular joint disorder (TMJ), clogged ears, sinus pressure and barometric trauma, autoimmune disorders, among many other causes.

Hearing aids and other tools for sound therapy

Sound therapy itself isn’t expensive; however, your audiologist also may recommend hearing aids. Hearing aids amplify external environmental noise, giving your nervous system more sound to process. Bringing in more auditory stimulus to the brain can help reduce the perception of tinnitus. Also, many hearing aids come with technology known as tinnitus masking built right in, which an audiologist or hearing instrument specialist can program for you.
Keep in mind that tinnitus is often an early warning sign that a person has hearing loss. Treating the hearing loss promptly can help minimize tinnitus.

Sound therapy is a progressive treatment program that is most effective when it’s paired with CBT. It may take as long as two to three months to notice any changes and as much as a year before the tinnitus is no longer noticeable.

Behavioral help for tinnitus- CBT- Cognitive behavioral therapy 

In addition to sound therapy, many people find cognitive-behavioral therapy useful for managing the emotional impact of tinnitus. In fact, a review published in the Journal of the American Academy of Audiology found that “CBT treatment for tinnitus management is the most evidence-based treatment option so far.”
CBT- Cognitive behavioral therapy 
CBT was developed in the 1960s by psychiatrist Dr. Aaron Beck as a form of psychotherapy for depression (Beck, 2011). Thoughts and beliefs were prominent features of depression, and these features could be targeted in cognitive therapy, which was later expanded to CBT. With this therapeutic technique, people learn to adjust their reaction and response to tinnitus. We can change how we tolerate physical sensations, particularly if they are aversive and causing any anxiety.
That is, if you embark on cognitive-behavior therapy, the goal isn’t to end your tinnitus—but to change how you respond to the symptom. CBT for tinnitus has been endorsed by the American Academy of Audiology, American Academy of Otolaryngology–Head and Neck Surgery Foundation, and American Speech-Language-Hearing Association as an effective treatment approach for tinnitus supported by strong evidence.
There are other keyways CBT can be helpful:
  • Building familiarity: CBT therapy often involves gradual exposure to uncomfortable situations. That’s true when it’s used for tinnitus as well. “We work on behavioral exposure exercises that bring on similar sensations to the tinnitus,”
  • Helping with redirect strategies: “Attentional bias” means you’re frequently distracted by a stressor in your life. In this case, tinnitus. Learning redirect techniques can help. “We address attentional bias to the symptoms and how to redirect your attention to reduce symptoms without actually avoiding them,”
CBT framework
Within the CBT framework, concepts such as dysfunctional thinking and behaviors are discussed. These terms refer to negative, distorted, or emotionally distressing thoughts leading to unhelpful behaviors (Beck, 2011).
A tinnitus patient’s thoughts, feelings, and behaviors are conceptualized as elements that can influence and perpetuate one another. These components do not necessarily interact in a cyclical fashion.
Negative thoughts, such as “no one can help me,” can lead to lifestyle disruptions (e.g., avoidant behaviors) and can contribute to negative emotional effects (e.g., depression, frustration, etc.) and vice versa.
Dysfunctional thoughts and feelings may contribute to, and reinforce, negative behavioral patterns in subtle and automatic ways. This makes it difficult for an individual to recognize the unhelpful alliance their thoughts and feelings have formed with their behaviors.
CBT is based on a conceptual model that describes the interplay between thoughts (i.e., cognitions), behaviors, and emotions and provides practical strategies to employ when the relationship among these elements goes away.

At its core, CBT for tinnitus is intended to help patients cope with tinnitus and is not intended as a cure or an approach to make the tinnitus quieter

CBT typically involves six to 10 weekly therapy sessions, either individually or in small groups. Each session addresses a specific topic, such as an educational overview of tinnitus, sleep hygiene, stress management, relaxation, and cognitive restructuring

The CBT process may look different for each patient. Therapy is tailored to meet the individual patient’s needs. What is similar across patients is the overall theme of using goal-oriented problem-solving techniques, assessing and responding to dysfunctional thoughts, and modifying negative behavior patterns.

Therapists may also incorporate aspects of other behavioral approaches, such as acceptance commitment therapy (ACT) and mindfulness, which are complementary practices to CBT.

Hearing aids for tinnitus

There are a few reasons why hearing aids—and an improved ability to hear—can help lessen the symptoms of tinnitus:

Hearing aids restore auditory stimulation to the brain

In a nutshell: Hearing loss makes your brain a bit hyperactive, with nerve cells in the dorsal cochlear nucleus go wild with activity, which may potentially get mistakenly interpreted as a sound. It’s theorized that since hearing aids restore some of the stimulation that the brain has been missing, they may help manage tinnitus

Hearing aids allow you to hear background noises

Another potential benefit of hearing aids: The restoration of subtle, quiet background noises. Hearing aids can increase the contrast in the brain to the tinnitus by increasing environmental sounds in the background that the person may be missing, such as a gentle breeze or leaves rustling in the wind

Hearing aids may help reduce stress

“Stress can make tinnitus worse” There are so many things that can cause stress: our work, money, relationships, and so on. Not being able to hear and communicate with people around you are a stressor, too. Wearing hearing aids can help to alleviate stress that accompanies hearing loss

Hearing aids have helpful features, too

Just putting in hearing aids often helps reduce tinnitus symptoms, but these devices also have features that can help
For instance, many hearing aids come with masking features—these are white noise-like sounds (think: rushing water or rain noise). These are known as a tinnitus sound generator (TSG). With it on, you may find that the buzz, ring, or whoosh of tinnitus is completely covered up. But usually what they’re designed to do is to help the person cope with their tinnitus by allowing them to get used to it in a way that’s controlled
In addition to TSG and masking features, many hearing aids allow you to easily connect to a phone, so you could stream sounds from a relaxation app or one that offers a range of white noises.

Hearing test is important first step

A hearing test is a good first step if you experience tinnitus, since it can rule out medical causes for the condition (such as medications that cause tinnitus as a side effect). if your hearing test reveals some hearing loss, it’s possible you’ll find that being fitted with hearing aids helps with tinnitus.
good first step if you experience tinnitus,

Find a tinnitus specialist

If you have tinnitus, you may also have hearing loss–even if you haven’t realized it. Consult an audiologist who specializes in tinnitus retraining therapy and CBT (cognitive behavioral therapy) Get your hearing checked, addressing your hearing loss can help ease the intensity of your tinnitus, and in some cases hearing aids can mask tinnitus by subtly amplifying other sounds.

And be committed for the long haul. TRT is progressive treatment program that is most effective when it’s paired with CBT (cognitive behavioral therapy). It may take as long as two to three months to notice any changes and as much as a year before the tinnitus is no longer noticeable.
References
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  • Beck JS. (2011) Cognitive Therapy: Basics and Beyond (Second Edition). New York: Guilford Press.
  • Cima RF, Andersson G, Schmidt CJ, Henry JA. (2014) Cognitive-behavioral treatments for tinnitus: A review of the literature. J Am Acad Audiol 25(1):29–61
  • Tinnitus and hearing loss, Healthy hearing
  • Cognitive Behavioral Therapy for Tinnitus, Audiology today, The American Academy of Audiology
  • Edmonds CM, Ribbe C, Thielman EJ, Henry JA. (2017) Progressive tinnitus management level 3 skills education: A 5-year clinical retrospective. Am J Audiol 26(3):242–250. 
  • Hayes SC, Strosahl KD, Wilson KG. (1999) Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: Guilford Press.
  • Husain FT, Gander PE, Jansen JN, Shen S. (2018) Expectations for tinnitus treatment and outcomes: A survey study of audiologists and patients. J Am Acad Audiol 29(4):313–336.
  • Kabat-Zinn J. (1994) Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. Hyperion.
  • Kleinstäuber M, Jasper K, Schweda I, Hiller W, Andersson G, Weise C. (2013) The role of fear-avoidance cognitions and behaviors in patients with chronic tinnitus. Cogn Behav Therapy 42(2):84–99.
  • Manning C. (2019) Tinnitus in 10: What every audiologist should know to provide research-based care. Audiol Today 31(3):16–26.
  • Meikle MB, Henry JA, Griest SE, et al (2012) The tinnitus functional index: Development of a new clinical measure for chronic, intrusive tinnitus. Ear Hear 33(2):153–176.
  • Newman CW, Sandridge SA. (2016) Care path for patients with tinnitus: An interprofessional collaborative model. Perspectives of the ASHA Special Interest Groups. 
  • Tunkel DE, Bauer CA, Sun GH, et al (2014) Clinical practice guideline: Tinnitus. Otolaryng Head Neck 151(2_suppl).