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Tinnitus Program and Neuromonics

What is Tinnitus?

Tinnitus is an auditory perception that is not produced by an external sound. Tinnitus is not the same for everyone! People describe it as a hissing, roaring, chirping, buzzing, clanging or ringing sound. Tinnitus may range from high to low pitch, consist of multiple tones or sound like noise with no tonal quality at all. It may be constant, intermittent, or pulsed. It may begin suddenly or may come on gradually. Tinnitus is not a disease, but a symptom common to many problems, both physiological and psychological.

Approximately 50 million U.S. residents have experienced more than momentary tinnitus, with 2.5 million reporting feeling debilitated by it. As many as 10-12 million have sought help while 1 million new cases of tinnitus are identified per year.

Side effects of tinnitus may include sleep difficulties, fatigue, stress, trouble relaxing, difficulty concentrating, irritability and other mood disorders (Bauer and Bozoski, 2008). These side effects may impair one’s quality of life.

Tinnitus may be triggered or originate from within the auditory system or from related auditory structures. It may be a pointer to underlying pathological conditions or may be established on the basis of history. About half of sufferers do not have an identifiable onset point for their tinnitus (Bauer and Brozoski, 2008). It is therefore essential for a patient to receive a full medical evaluation for an extensive differential diagnosises. Underlying medical conditions must be identified and treated. Common causes include but are not limited to, acute acoustic trauma, Meniere’s disease attacks, chronic noise trauma, intoxications, acoustic neuromas, presbycusis (age-related hearing loss), and sudden deafness. Tinnitus may also be found in patients with normal hearing. Stouffer and Tyler (1990) found the primary diagnosis (35.8%) to be unknown.

Where is it coming from?

The neural generator for tinnitus was traditionally believed to reside in the cochlea (inner ear). Animal studies have found that following damage of the cochlear hair cells (cells that help us hear sound) due to noise exposure or ototoxic drugs that often induce tinnitus, there is no change and sometimes a reduction in spontaneous auditory nerve (hearing nerve) activity. Further, surgical sectioning of the auditory nerve fails to suppress tinnitus, and in >50% of the patients it made it worse. Also, surgical removal of the nerve often leads to the emergence of tinnitus in the ear that is surgically disconnected from the brain.

Sound evoked functional MRI studies have found activation in the Inferior Colliculi (Melcher, Levine, Bergevin, & Norris, 2009). Other studies have strongly suggested the limbic system and autonomic nervous system play a major role in the perception of tinnitus. The central auditory nervous system processes environmental sounds by identifying, sorting, and routing their associated neural signals. Sound can carry an emotional meaning and activate the limbic system, and/or cause behavioral reactions associated with the autonomic nervous system. Patients with tinnitus react the same way to external sounds as they do to their perceived tinnitus. Therefore, emotional responses increase the likelihood of paying attention to the tinnitus (Henry, Jastreboff, Jastreboff, Schechter, & Fausti, 2002). For example, if you are going to sleep one night and hear an unknown noise, your awareness and hearing sensitivity becomes heightened to listening for the sound again.

I have tinnitus, what can I do?

If there are no medical origins and tinnitus has become stressful, debilitating, and disruptive to your everyday activities, a therapy treatment may be beneficial. Our doctorate level audiologists trained in tinnitus treatment will provide a full audiological and tinnitus evaluation to determine the type of therapy that is most appropriate for you. Below is a list of common therapies.

Common therapies include:

Hearing Aids and Maskers

Often, hearing loss and tinnitus are seen together. The tinnitus does not cause the hearing loss, but rather it is a symptom of inner ear damage. When hearing loss is present, the audiologist will discuss with you the impact is it having on your daily life. The hearing aid can relieve the tinnitus by enhancing your acoustic environment while providing appropriate gain or amplification for the hearing loss. Hearing aids may also ease communication difficulties caused by hearing loss.

Maskers are electronic devices that can be worn at the ear level or be placed in an environment. These devices provide a “whooshing” sound that may cover up the tinnitus. Literature demonstrates these devices often do not provide narrow band masking sounds at a high enough frequency to match the tinnitus, requiring the sound to be louder to provide relief. This may, in turn, be a disadvantage for some. The masking sound can interfere with communication, resulting in more anxiety and difficulty understanding others. Also, tinnitus can change pitch or tone, so a device that is matched to a particular frequency can lose its effectiveness. Finally, wearing a hearing aid or masker is not recommended during sleeping hours.


Developed and tested since the early 1990s, Neuromonics is an FDA-cleared medical device used as a long-term treatment for tinnitus that actually treats the cause of the problem rather than just the symptoms. If you suffer from tinnitus, you may be a candidate for this treatment.

During your evaluation for Neuromonics Tinnitus Treatment, an audiologist will determine the frequencies of your tinnitus and the status of your hearing. Once that is determined, the Neuromonics device is customized to match your hearing and tinnitus profile.

This is a clinically proven, non-invasive, non-surgical treatment that is convenient to use and takes place in your own environment for about 2-4 hours per day without disrupting your lifestyle. The treatment usually takes place over a six month period. Immediate relief is achievable typically within 0-2 weeks of starting treatment, and the tinnitus disturbance continues to improve throughout the treatment. Unlike other therapeutic options, Neuromonics has proved to offer a significant long-term reduction of tinnitus disturbance.

The treatment is designed to target the neurological processes of tinnitus, including its auditory, attentional and emotional aspects. The audiologists at Physicians Audiology Center are certified providers of Neuromonics therapy. Your audiologist will work closely with you to help you achieve success. Please visit for more information.

Sound Therapy/Sound Enriched Environment

Used while awake or asleep, sound therapy involves avoiding quiet time. Your brain tries to hear any sound more clearly in quiet, including the sound of your tinnitus. Sound therapy includes increasing background sounds whenever the background is quiet. In doing so, sound therapy reduces the contrast between your tinnitus and background sound, thereby reducing the bother of your tinnitus and the tension is causes.

Throughout sound therapy, habitation will occur, where your brain becomes unaware of the tinnitus. For example, residents of homes with a grandfather clock typically no longer hear the clock chime every hour (they have become habituated to the sound), unlike visitors who are not only aware of the chime but may even be bothered by it. Examples of helpful background sounds include a television, radio, recorded music, a fan, natural sounds through an open window, small devices that play white noise, and/or a hearing aid.

Relaxation Exercises

Stress can aggravate tinnitus, and tinnitus can be very stressful. It is important to learn to manage stress. Relaxation exercise may include aromatherapy, massage therapy, reflexology, acupuncture, self-hypnosis, adequate sleep, and/or resting in a relaxing environment, such as one with special aromas, dim lights and soft music. Relaxation may also be sought by reading books, listening to audiotapes or taking relaxation exercise classes to learn more about various methods and techniques that help people relax. These exercises may include breathing and muscle exercises.

Here is an example of a breathing exercise:

Breathe slowly and deeply, and then hold your breath a moment. Relax and let your breath out. Wait a moment, and then breathe slowly and deeply again, and so on.

Overtime with practice, you may start to feel the benefits from these exercises by gradually learning how to relax your body. As you learn to relax your body, you will also find it easier to relax your mind.

Tinnitus Retraining Therapy

Tinnitus Retraining Therapy was developed by neurophysiologist Pawel Jastreboff, Ph.D. The ultimate goal is to “retrain” the brain to habituate to the tinnitus signal. This references the limbic and autonomic systems consisting of emotions and behavioral reactions. The tinnitus must undergo specific conditioning procedures to be processed differently as a meaningless, unimportant signal. Two strategies include removing any negative thoughts or fears that may be associated with the tinnitus perception and by removing the tinnitus from conscious perception. The latter can be accomplished if the first is successful.

Promoting General Health and Well Being

High blood pressure, thyroid dysfunction, vertigo, diabetes, and hormonal changes and/or imbalances may be a cause for your tinnitus. Physical problems such as neck, head and back pain and TMJ disorders may also result in tinnitus. Often certain foods, drinks, activities, or situations aggravate your tinnitus and you should therefore consider cutting down on them, cutting them out or finding alternatives. For example, by reducing your caffeine and alcoholic beverages and increasing light exercise, you may find that your tinnitus lessens and your general health will likely improve. Additionally, it is important to live an active life that gives balance to your personal and work lives. Hobbies and interests outside work can help you enjoy life to the fullest. A silver lining to tinnitus for some is that it helped give a push to try something new and rekindle old interests. Below is a list of herbal supplements that are thought to help reduce tinnitus, however, none have undergone rigorous scientific study on the true benefits.

Ginkgo Biloba, Chelated Zinc, Garlic, B- Complex, Folic Acid, Calcium, Magnesium, Lipoflavoids, Flax Seed Oils


No single medication works consistently from patient to patient. This is likely due to the multiple etiologies or causes of tinnitus. Prescription based pharmaceuticals have been used to attempt to reduce the perception and provide relief from tinnitus, such as anesthetics, anticonvulsants, tranquilizers, antidepressants, etc (Bauer and Brozoski, 2008).


Contrary to popular belief, earplugs will not help your tinnitus. They will make the tinnitus seem worse while you wear them! The reason is because earplugs prevent your ears from getting accustomed to normal sounds, especially if you have hyperacusis, (a heightened sensitivity to sound). Earplugs or any hearing protection should only be worn for situations when being exposed to loud or unbearably loud sounds.

About Dr. Prasad

Dr. Sanjay Prasad MD FACS is a board certified physician and surgeon with over thirty-two years of sub-specialty experience in Otology, Neurotology, advanced head and neck oncologic surgery, and cranial base surgery. He is chief surgeon and founder of the private practice, Metropolitan NeuroEar Group, located in the metropolitan Washington D.C. area.