Are You Suffering From Any of These Symptoms as a Result of Tinnitus? Call Today for a Consultation.
■ Mild to severe anxiety
■ Depression
■ Insomnia
■ Negative thinking
■ Triggered fight or flight
■ Crying spells
■ Hopelessness
■ Ringing in the ears
■ Suicidal thoughts
Are you growing more isolated? Do you feel like life will never be the same? Are you refraining from activities that you enjoy? Are you fearful of losing your job? Do you find that your thoughts tend to be negative?
If you answered yes to 3 or more of these questions or symptoms, then we can help. You may be a candidate for Tinnitus Cognitive Retraining Therapy, or TCRT.
With over 20 years of clinical experience, Stephen Geller Katz, LCSW-R developed Tinnitus Cognitive Retraining Therapy and founded the Tinnitus Cognitive Center™ in response to the growing number of Tinnitus sufferers coming to his private practice.
He discovered that by helping people to retrain and reinterpret the thoughts around their Tinnitus, anxiety and depression symptoms began to improve. But even more important so did the Tinnitus.
The mechanisms of hearing are complex and our understanding of them is continually evolving. Simplified, the ear translates air movements into nerve impulses sent to the brain. These impulses are then further processed based on things like location to the listener, volume and quality to determine what’s “important” and what can be ignored.
The acoustics of hearing
The intricate process of hearing begins with the ear canal and drum. That little opening in the side of your head has a surprisingly significant impact on how you hear. Like a subwoofer, the canal itself creates resonances which amplify or reduce specific frequencies. This is why even minor blockages can create problems with sound and speech recognition. Voice communications average around the 2000Hz range and the ear canal amplifies this peak. Changes in the shape of this acoustic chamber (as well as changes to the external ear) can alter the location of this peak, causing a distortion in sound.
Figure 1: Amplification in the ear canal
(Musiek, Frank E., Jane A. Baran. The Auditory System: Anatomy, Physiology, and Clinical Correlates. Allyn & Bacon. March 2006. Page 46)
The anatomy of hearing
After air vibrations reach the eardrum, delicate bones transcribe them to the fluid-filled chambers of the inner ear. Similar to tapping the skin of a water balloon, the sound ripples through the perilymph to a second fluid-filled chamber containing endolymph where things get really interesting.
Bathed within the endolymphatic chamber are the hair cells. These marvels of evolution translate fluid vibrations into nerve impulses that get carried to the brain. These hair cells are evolutionally related to neurons, and function in much the same way. The vibration causes change in the intracellular (inside the cell) potassium and calcium levels, releasing neurotransmitters that stimulate electro-chemical impulses down the hearing nerves.
The psychoacoustics of hearing
These afferent (to the brain) nerves carry impulses through the brainstem to the “auditory belt” which decides which signals are important. The “important” signals continue on to the cortices of the brain and our conscious hearing while others – don’t. This is one reason we can locate sound and “tune-out” background noise like ignoring someone else’s conversation at a party. As a part of this process, the brain also sends impulses back to the ear (efferent impulses) which change how the hair cells respond to sound by physically changing their shape and how they respond to ions.
How does anatomy affect tinnitus?
Considering this elaborate chain of events, it’s easy to see how a hiccup at any point could create noise. It’s also why tinnitus can be so difficult to treat effectively. When an obvious link in the chain is disrupted, for example with acoustic neuroma, the targeting of treatment is relatively straightforward. When it’s more idiopathic (unknown) things become challenging. Research into both the hearing mechanisms and treatments for tinnitus continue. Every day new and amazing discoveries are made although it will be some time before the mysteries of the ear, hearing and balance fully unravel.
Tinnitus affects more than 10% of the American population. A constant ringing in the ears, it can vary from little more than an irritation to a debilitating condition. Tinnitus is caused from a variety of problems ranging from hearing loss to injury, and has been the subject of extensive research into both its causes and potential treatments.
New research into tinnitus
Researchers at Berkeley recently published an article in the Proceedings of the National Academy of Sciences offering insight and new hope into the phenomena that is hearing loss induced tinnitus. In their paper they claim tinnitus is the result of acoustic cortex neurons attempting to “fill in the gap” of missing sound. It is this attempt that results in tinnitus.
Over-excited neurons may lead to tinnitus
Co-author Shaowen Bao and his team support the idea that neural cells of the auditory cortex strive to maintain a constant rate of firing regardless of the level of sound. The balance between this constant rate and the actual input from the inner ear is part of hearing homeostasis. In hearing loss induced tinnitus, the sound transcribing hair cells of the ear are destroyed and stop sending their signal to the brain. In the brain’s attempt to reconcile this loss the cortex neurons become hyperactive – creating the sensation of constant sound (tinnitus). Bao describes this phenomenon as similar to “phantom limb syndrome” where amputees continue to feel sensation from the missing limb. It’s this last observation that leads to the first of two exciting new possibilities for treatment.
A new therapy for tinnitus?
Re-training the brain to ignore or otherwise minimize tinnitus is a long standing therapy. However, this new information has created a paradigm shift in the way hearing specialists view the process.
“We changed our [brain retraining] strategy from one where we completely avoided the tinnitus domain [of the cortex] to one where we directly engage it and try to re-differentiate or reactivate it; and we seem to be seeing improvement…” said Dr. Michael Merzenich, professor emeritus of otolaryngology at UCSF and chief scientific officer at Posit Science.
The idea is that the overactive neurons can be convinced to “calm down” by offering them input from alternative sources. This is similar to treatments for phantom limb syndrome where the brain is convinced to substitute different input (such as from a finger next to the missing finger) to correct its sensory gap.
Activating GABA may help tinnitus
This new research has also opened the way for a second, pharmacological solution. Neurotransmitters are chemicals in the brain which both excite and dampen neuron signaling. Serotonin and glutamate are well known excitatory neurotransmitters, with GABA (gamma-aminobutyric acid) being one of the common inhibitory neurotransmitters. In the brain, these inhibitory and excitatory actions are in constant debate. Signals from one source attempt to excite a neuron while contradictory signals dampen it. The analogy here is a balance scale, where sand is constantly being added and subtracted from both sides and the overall activity of the neuron being the weight at any given moment.
Bao’s experiments have shown that tinnitus is out of balance with GABA. “There are a lot of things we can do to change GABA functions, some of which could potentially alleviate tinnitus with fewer side effects.” He and his team have begun applying for research grants into way to modify GABA levels in the auditory cortex. Some of these include enhancing GABA receptor function in the auditory cortex, increasing GABA synthesis, and slowing re-uptake or enzymatic degradation of the neurotransmitter.
Tinnitus is an aggravating condition of unrelenting ringing in the ears. It affects an estimated 12 million people in the U.S., with as many as 2 million suffers finding it difficult to lead a normal life as a result of the noise. Researchers have been investigating the possibility that tinnitus may be related to a disparity in the brain’s processing of hearing and tactile (touch) nerve impulses. Treatments based on external stimulation of these nerves have shown promise for a return to silence.
What is the Vagus nerve?
The Vagus nerve (also known as the 10th cranial nerve) supplies parasympathetic information to and from the medulla. It communicates in one way or another with nearly every part of the neck, face and torso including portions of the Glossopharyngeal nerve (throat and swallowing) and the seventh facial nerve which carries impulses of facial sensation.
What is Vagus nerve stimulation (VNS)?
Vagus nerve stimulation has long been used for the treatment of epilepsy and depression, however new studies have shown that it may also reduce symptoms of tinnitus. In VNS, small electrical pulses are delivered to the Vagus nerve via a pulse generator implanted in the neck. During one study conducted by the University Hospital Antwerp, Belgium, tinnitus patients received two and a half hours of VNS every day for 20 days. The electrical stimulation was paired with audible tones that excluded the hearing frequencies where the tinnitus was active.
Four of the patients in the study experienced a clinically significant reduction in tinnitus by as much as 26 decibels. Three of these sufferers had a 44% reduction in the impact the illness was having on their daily lives. Dr. Sven Vanneste of the School of Behavioral and Brain Sciences at UT Dallas was optimistic;
“VNS-tone therapy was expected to be safe because it requires less than 1 percent of the VNS approved by the FDA for the treatment of intractable epilepsy and depression. […] In all, four of the ten patients showed relevant decreases on tinnitus questionnaires and audiological measures. The observation that these improvements were stable for more than 2 months after the end of the 1-month therapy is encouraging.”
What’s next for Vagus Nerve Stimulation and tinnitus?
The team is already working on a larger study where they hope to use more convenient implanted pulse generators so subjects need not come to the clinic for treatments. This study is one of many showing that nerve stimulation, when used in conjunction with cognitive and behavioral retraining, may be the golden ticket for new treatments to relieve the symptoms of tinnitus.
Tinnitus is a condition where people experience a ringing, humming, buzzing, hissing, chirping or cricket-like sound in their ears. Most tinnitus cases begin in middle age or older, however, due to an increase in younger people returning from combat, listening to loud music with unprotected ears in clubs, shows, or through head phones and through earphones, we are seeing a sharp rise in tinnitus among younger people.
With tinnitus there exists a strong mind body-body mind interaction, with one influencing the other in a circular fashion. Here are the common symptoms that you may be experiencing if you have tinnitus. The good news is that Tinnitus Cognitive Retraining Therapy helps with practical strategies aimed at re-scripting, reframing and redirecting the negative thoughts that are responsible for maintaining anxiety and tinnitus at higher levels.
1.Anxiety. Tinnitus sufferers almost always experience mild to severe anxiety because the brain frequently interprets any noise it doesn’t recognize as a potential threat or danger. As a result, the sound signals the brain to feel anxious. The problem is that it is precisely this anxiety that makes the tinnitus worse, creating a classic feedback loop or vicious cycle that is often difficult to break. The interventions of Tinnitus Cognitive Retraining Therapy are precisely designed to break this cycle.
2. Fight-or-Flight Response. After becoming anxious over a perceived threat, a biochemical cascade of stress hormones are released, creating fight-or-flight response. The most prominent of these is adrenaline. The physiological reaction is a natural response, but its symptoms can be very anxiety provoking. They may include rapid heartbeat, flushing, and trembling. Tinnitus Cognitive Retraining Therapy effectively helps to interrupt this response.
3.Panic Attack/Fears. Sometimes when tinnitus sufferers start having trouble breathing or increased heart rate from anxiety over the fight-or-flight trigger, they begin to worry they are having a heart attack or are going to die. This fear ramps up the anxiety level even more, which increases the tinnitus symptoms. Tinnitus Cognitive Retraining Therapy is very effective in preventing the circular thinking, which feeds into the panic attack.
4. Depression. Mild to severe depressive symptoms can be common with tinnitus. People commonly report that the constant noise they experience and the anxiety linked to it causes them socially isolate from people and normal activities. It is usual that you might stop going out to see family and friends, as well as stop doing the things you love to because nothing seems the same anymore. Not being able to do things you love can also cause you to feel depressed. Tinnitus Cognitive Retraining Therapy helps you to return to your normal activities. This is a very important part of the healing process because people just want to feel normal again. And anything you can do to feel normal again gives your brain a signal that you are okay. If you begin to feel that you are okay, your brain begins to enter a positive feedback loop! So when it comes down to it, how we define our reality is everything. Or certainly accounts for a big chunk of the puzzle.
5. Negative Thinking/Hopelessness. Untreated, the psychological consequences of ongoing tinnitus frequently produce negative thinking and hopelessness. In fact, some mental health professionals find that negative thinking is one of the principal hallmarks of the condition. Thoughts like, “Things are never going to get any better, my life will never be the same, I don’t have any more pleasure out of life and more…” are very common with tinnitus sufferers. The problem is, thinking hopeless thoughts increases the stress level, which is fuel for the tinnitus and gets you right back onto the negative-thinking feedback loop.
6.Suicidal thoughts. Although the vast majority of tinnitus sufferers aren’t suicidal or try to commit suicide, they may experience morbid or suicidal thoughts. Thoughts could be something like, “If I have to live like this for the next 40 years, I would rather die.” The good news is that you don’t have to live this way for the next 40 years. Tinnitus tends to improve over time and Tinnitus Cognitive Retraining Therapy helps by speeding the healing process by helping you to stay out of the emotionally reactive mode, which is responsible for pressing your stress button.
7. Insomnia. One of the main complaints of some tinnitus sufferers is that the condition sometimes affects their ability to sleep. This is a can be a vicious cycle, as the less sleep you get, the higher the tinnitus may increase. The good news is that part of the Tinnitus Cognitive Retraining Therapy protocols address many sleep hygiene issues. I personally work with you to develop simple but effective self-hypnosis techniques to help you condition your brain to sleep better. These techniques can also be a big help in slowly tapering off of prescription sleep aids.
8. Crying spells. Tinnitus sufferers often find they cry at things that never made them cry before. It may be a sad movie or frustrations and fears about the tinnitus itself. Crying spells are also common symptoms of depression. However, left unchecked crying spells may actually exacerbate depressive symptoms. Tinnitus Cognitive Retraining Therapy helps you to observe, reframe and rescript thoughts fueling depressive thoughts causing crying spells.
9. Post-Traumatic Stress Disorder (PTSD). People often feel traumatized by the symptoms of tinnitus. As a result, tinnitus itself may also cause symptoms of PTSD (Posttraumatic Stress Disorder). As previously stated, the brain automatically interprets the perceived sound as a danger, triggering the production of stress hormones including adrenalin. The repeated cycle causes fight or flight jitteriness or anxiety or panic attacks. In other words, the brain and body are responding as if the danger were real. Similarly, persons with PTSD will respond to things that aren’t threats, as potentially dangerous situations. They may be easily startled, worry constantly, feel that they are dwelling or obsessing about things and/or experience anticipatory anxiety and bad dreams.
10. Exhaustion. Tinnitus sufferers experience exhaustion because of several reasons. One is the lack of sleep, which sometimes accompanies tinnitus. Another cause of exhaustion is the release of hormones your body produces in moments of anxiety, during a panic attack, PTSD, or during a fight-or-flight trigger. The adrenal response, and the body’s biochemical efforts to counterbalance the adrenaline leaves you feeling drained. Tinnitus Cognitive Retraining Therapy helps retrain the brain, so that over time the adrenal stress induced response to the tinnitus is greatly reduced or eliminated.
11. Difficulty resting. The body’s natural response to stress caused by the tinnitus may result in lack of rest and sleep. If untreated, the stress, anxiety, and lack of rest may get worse, and a vicious cycle begins. TCRT utilizes some simple, effective self-hypnosis techniques to help the brain relax and get to sleep. Over time TCRT will help to break the cycle by retraining the brain not to perceive the noise as a threat, resulting in more restful sleep.
Tinnitus Cognitive Center™
Stephen Geller Katz, LCSW-R 19 West 34th Street Penthouse Floor New York, NY 10001
