What Do Diets and Tinnitus Therapy Have in Common?
By LaGuinn P. Sherlock, AuD
Most of us have been on at least one diet in our lifetime, to lose weight, to manage a health condition such as diabetes or hypertension, or to simply feel healthier. As you know, diets differ in the type and quantity of food you can eat. Some diets restrict certain types of food, such as food high in fat. Some diets are limited to a given caloric intake. Whatever the case, you must follow the diet to achieve the desired outcome (e.g., losing weight, getting off medication). Some diets are challenging and difficult to implement. Everyone has a different tolerance level for discomfort associated with a given diet (like giving up potato chips on a low-salt diet or pie on a weight-loss diet). Sometimes the desired outcome (e.g., losing 10 pounds) takes much longer (e.g., more than two weeks) than you want, which may affect your ability and motivation to follow the diet. Having realistic expectations about the outcome itself and the time course to achieve that outcome is important for maintaining adherence to the diet.
What do diets have to do with tinnitus? Well, in much the same way that there are different diets with different foods and schedules, tinnitus management strategies involve different “foods” and “schedules.” I will refer to the different strategies as “tinnitus diets.” The key to a successful outcome is finding the “tinnitus diet” that is right for you, one that is compatible with your lifestyle, your preferences, and your desired outcome.
Finding the right “tinnitus diet” starts with realistic expectations. Complete elimination of tinnitus is not realistic in most cases. However, a noticeable reduction in how much tinnitus bothers you, especially a reduction large enough that tinnitus no longer affects you every day, is a realistic goal. Several “tinnitus diet” options are available to help you meet that goal.
It is important to keep in mind that not everyone with tinnitus needs to be on a “tinnitus diet”. If your tinnitus is not affecting your ability to sleep or to concentrate, and if it isn’t making you feel irritable or depressed or anxious, then a “tinnitus diet” probably isn’t going to change anything. If, however, you are affected by your tinnitus, then dedicated adherence to a “tinnitus diet” should result in reductions in awareness of your tinnitus, annoyance with your tinnitus, and difficulty with sleep, concentration, and/or mood. You should also notice an improvement in your overall quality of life.
A number of “tinnitus diet” options can help you achieve the desired outcome, namely, reducing the effect tinnitus is having on your life. “Tinnitus diets” can be self-directed, peer-supported, or professionally directed by an audiologist or behavioral healthcare provider, in the same way that diets can be self-directed or under the direction of a physician, nutritionist, or related provider. The desired outcome and the ability to follow the management protocol are key to identifying the right “tinnitus diet” for you.
Almost all “tinnitus diets” include at least one of the following three components, which have been shown to be helpful in reducing the effect of tinnitus on day-to-day living:
- stress reduction strategies, and
- sound enrichment.
Counseling can be informational, interactive, or directive. Informational counseling can help you understand what tinnitus is and, more importantly, what it is not. A better understanding of tinnitus can help you change the way you think about your tinnitus. Interactive counseling may better address the way you think and feel about your tinnitus. Interactions with others who have learned how to manage their tinnitus may be beneficial as well.
The ATA website lists support groups and volunteers available to talk to you about your tinnitus (see appendix). Some tinnitus management therapies provide directive counseling, a type of counseling in which the healthcare provider offers specific advice, guidance, and recommendations. Some people respond better to this type of counseling, while others respond better to a more interactive and patient-centered approach. Non-tinnitus-specific counseling, such as cognitive behavioral therapy (CBT), can effectively reduce your reaction to tinnitus and consequently improve your overall quality of life. Also offered are online tinnitus management programs based on mindful meditation and CBT.
It is important to understand that if you have bothersome tinnitus, your stress response is being activated all the time when it shouldn’t be. The stress response is activated by the perceived threat of tinnitus and is the primary factor affecting your sleep, concentration, and mood. Therefore, it is critical that you identify strategies to reduce your stress response and use them as often as possible. Strategies include deep breathing, progressive muscle relaxation, walking, and listening to relaxing music (see appendix for more details).
Sound enrichment is another component of tinnitus management. Most people with bothersome tinnitus tend to notice their tinnitus often when in a quiet room. The goal of sound enrichment is to reduce the perceptual contrast between sound in your environment (external sound) and the sound of your tinnitus (internal sound). The contrast is much larger when you are in a quiet environment and is therefore difficult for your brain not to attend to it. The more noticeable the tinnitus is, the more bothersome it can become. Sound enrichment can be accomplished by using such things as fans, sound spas, and/or the use of hearing aids, ear-level sound generators, or cochlear implants. Enriching your sound environment will decrease the contrast and over time will help you habituate to your tinnitus so that you do not notice it all the time.
It is important to keep in mind that no single method of tinnitus management helps 100 percent of the people who use it. This is true also for other healthcare treatments and therapies. There are multiple approaches to tinnitus management, so if one “tinnitus diet” does not work for you, try another. “Tinnitus diets” differ in the content and style of counseling, the implementation of sound therapy, and the specific management strategies (e.g., stress reduction strategies) employed. The key to success is finding the “tinnitus diet” that works for you, which depends in large part on identifying your desired outcome. For example, one “tinnitus diet” might address anxiety really well (e.g., CBT), but not problems with hearing, or vice versa. The most cost-effective “tinnitus diet” should be attempted first.
Earlier I mentioned that “tinnitus diets” could be professionally directed by an audiologist or behavioral health therapist. Table 1 is a comparison of “tinnitus diets” directed by audiologists. The chart is not representative of all the “tinnitus diets” available, but those most commonly used are listed. Some of the “tinnitus diets” listed have undergone randomized controlled trials, some provide training for audiologists and allied health professionals, and some have material readily available to you online.
With regard to the “foods” in “tinnitus diets”, sound therapy is not essential but generally results in better outcomes. Hearing aids alone can be as effective as hearing aids combined with sound generators. The specifics of the counseling, which vary from diet to diet, do not significantly impact the outcome. In other words, generic counseling can be as effective as specialized counseling. What has been demonstrated repeatedly is that counseling of some sort plays a significant role in reducing the reaction to tinnitus.
Barriers to accessing audiological tinnitus management therapies exist, including affordability and accessibility. These barriers can be overcome by utilizing counseling/informational materials that are available online and seeking behavioral health counseling that may be covered by insurance. The affordability of hearing aids is projected to improve with changes in FDA regulations that allow for over-the-counter hearing aids. Although OTC hearing aids are not yet available, other lower-cost options such as direct-to-consumer hearing aids are currently available.
In summary, many “tinnitus diets” are available. No one diet works for everyone. The outcome of the diet may not be exactly what you hoped for, but by adjusting expectations, you have every reason to believe that the right “tinnitus diet” for you will improve your quality of life.
LaGuinn P. Sherlock, AuD, has been practicing audiology since 1991 and has worked with thousands of patients who have tinnitus, both clinically and in research. She has worked at Johns Hopkins Medical Center and University of Maryland Medical Center, and currently works for the Army Public Health Center at Walter Reed National Military Medical Center. Sherlock is studying the effect of tinnitus on concentration, using reaction time and short-term memory tests. She is former Chair of the ATA’s Board of Directors and is a current Board member.
https://www.uofmhealth.org/health-library/uz2255 (deep breathing exercise)
https://www.statnews.com/2019/08/12/chronic-pain-journey-five-things-understand/ (chronic pain is similar to chronic tinnitus)
www.ata.org/managing with hearing aids (how hearing aids might help)
Bauman, N. Tinnitus Practitioners Association. Retrieved from http://www.tinnituspractitioners.com
Henry, J. A., Schechter, M. A., Zaugg, T. L., & Myers, P. J. (2008). Progressive audiologic tinnitus management. ASHA Leader, 13, 14–17.
Jastreboff, P. J., & Jastreboff, M. M. (2000). Tinnitus retraining therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients. Journal of the American Academy of Audiology, 11, 162–177.
Sweetow, R. W. (2013). Integrated approach to tinnitus management. Audiology Online. Retrieved from https://www.audiologyonline.com/articles/integrated-approach-to-tinnitus-management-11598
Tyler, R. S., Gogel, S. A., & Gehringer, A. K. (2007). Tinnitus activities treatment. In B. Langguth, G. Hajak, T. Kleinjung, A. T. Cacace, & A. R. Møller (Eds.), Tinnitus pathophysiology and treatment (pp. 425–434). Amsterdam, Netherlands: Elsevier.