Photo credit: Andrea Piacquadio

by Daniel Fink, MD, Chair, The Quiet Coalition

Tinnitus, commonly called ringing in the ears, is technically the perception of sound when there is no external sound stimulus. Tinnitus can be perceived as a high-pitched whistling sound, but also as clicks or other noises. It can be quite annoying to have constant sound in the ear. Unfortunately, this “annoyance” can be severe enough to drive one to suicide, but symptoms are generally mild for most people.

There are many causes of tinnitus, from medications like aspirin to head trauma and ear infections, but the most common cause is excessive noise exposure. The exact noise dose required to cause tinnitus is not well-studied, unlike the noise dose required to cause noise-induced hearing loss, and it may vary from person to person. Some people develop tinnitus after a one-time noise exposure, others after years of noise exposure.

The only FDA-approved tinnitus treatment, a neuromodulation treatment marketed in the United States as Lenire, is receiving media coverage. The Washington Post and the winter 2023 issue of Tinnitus Today, the publication of the American Tinnitus Association, have articles about Lenire. Both pieces may be behind paywalls, so I will summarize what they say. This edition of Tinnitus Today also has an excellent article by tinnitus expert James Henry about theories of what causes tinnitus. However, the exact cause is still unknown.

Lenire (and another device called Duo, not yet approved by the FDA but available online) work by multi-sensory stimulation. Lenire stimulates the tongue and Duo stimulates the skin at the wrist. Apparently, dual stimulation for short times each day rewires the sound processing pathways in the brain, which somehow improves tinnitus. But these devices aren’t cheap. The cost of Lenire therapy isn’t clear, but Duo costs $249 per month, or $349 for enhanced services.

I developed tinnitus and hyperacusis after a one-time exposure to loud noise at a New Year’s Eve dinner in a restaurant in 2007. Fortunately, my tinnitus is mild and not life-altering. Until someone develops a cheap pill to treat or cure tinnitus, I’m unlikely to try Lenire or Duo or any other tinnitus treatment that might come along.

My interest is in the prevention of noise-induced auditory disorders, like noise-induced hearing loss, tinnitus, and hyperacusis (a sensitivity to sound that doesn’t bother others, but which may be perceived as painful). Avoiding noise exposure will prevent most cases of all three conditions. That’s simple and inexpensive to do. Avoid loud noise, leave the noisy environment or use hearing protection. That’s sound advice for everyone.

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