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There is no permanent relief or treatment. Lots of snake oil.

That's not what this recent book [1] says, at all. In Ducth, but [2] is a translation of the main point in an interview. As far as I'm aware, this guy is rather far away from snake oil. What is true though is that not all audiologists are caught up yet. Which is a bit weird because I already read about multidisciplinary approach working a couple of years ago IIRC. Which does obviously not mean it works for everyone, but also not 'there is no permanent relief'.

[1] Bart Vinck: Tinnitus, een schaduw van geluid

[2] Can tinnitus disappear completely?

"Absolutely, it happens very often. It's to say: we all hear sounds in our heads, only we don't experience them consciously. After all, the brain forgets sounds that are not relevant, just like I don't feel the glasses I'm wearing now.

"Our brain does nothing but sort out stimuli: this is important, that is not important. Logical too, otherwise we would go crazy with all the stimuli constantly coming in.

"My message is not to learn to live with that beep, but to train your brain to classify that sound as harmless, allowing you to forget about it. Feel free to call it an auditory reset of your brain." What does such a treatment look like?

"It has been proven that a multidisciplinary approach works well. Through an intense therapy bath, we try to reset the brain so that that beep or squawk is no longer threatening: patients receive 20 hours of therapy over four days.

"You also have to find other ways to vent tension and take care of yourself. Physiotherapists and osteopaths additionally work on the physical problems. Our patients often suffer from other psychosomatic complaints: they clench their jaws or have tense neck and shoulder muscles.

"Some 96 percent of our patients report afterwards that the impact of the tinnitus has been greatly reduced. Unfortunately, psychotherapy is barely reimbursed."

> "My message is not to learn to live with that beep, but to train your brain to classify that sound as harmless, allowing you to forget about it"

This is essentially what I do. I've had it tinnitus for some 20 years now. Both ears, a constant high pitched ringing.

Most of the time I honestly don't notice it, even in quiet rooms. As soon as something reminds me about it, or I'm trying to listen for something quiet, or certain high pitch sounds go off (my least favourite is flashbang like effects on TV or in games), it'll come back with a vengeance. So e.g right now because I saw this HN post, it's feeling especially loud.

It'll probably be about an hour before I'll forget to think about it (for want of a better description), and I go back to not noticing it.

Same, I have had tinnitus since a child. The more you focus on it, the worst it gets. Best to accept that you have it and once you do the issues goes away (mostly), I still wake up sometimes noticing it, but it goes away.

I think this is a good approach to many mental & physical ailments, however it is easier said than done.

Meditation helps with this. Befriend the tinnitus. It is easy to let go of something for which you have only equanimity.

Same here. Your reply sounds like I could have written it. Until I started reading this thread, I don't remember when the last time I noticed my tinnitus was. Maybe a week or two ago I noticed it and just thought "oh right" and went back to ignoring it.

Same for me. I’ve had mine my whole life probably due to ear infections as an infant.

As a small silver lining, my tinnitus now serves as an audible “alarm system”: too much stress in my life? Drank too much coffee? Overdoing it at the gym? All of these will raise the ringing volume and signal me to make changes.

Exactly the same for me. I’ve had it for as long as I remember and chalk it up to going to too many punk rock shows as an angsty teen (and never wore ear plugs because I was “too cool”).

It’s always there for me but I usually forget about it and only notice it when something draws my attention to it.

According to an app I’ve used on my phone (Mimi Hearing Test), I have about 14db HL in each ear.

Somewhat related, but I just cannot follow conversations in a noisy environment, like a pub. All the background noise and chatter just washes out the voices of people I’m around.

Anyway, I now bring earplugs every time I go to a show.

> chalk it up to going to too many punk rock shows as an angsty teen (and never wore ear plugs because I was “too cool”).

The invulnerability of youth.

I used to do sound / PA stuff for live bands for some local events for older teens. One time we realised the kick drum was moving towards the edge of the platform it was on, with every kick. Dumbass that I was, a ran on stage with my trusty roll of duck tape, but without ear protection, and proceeded to duck tape the kick drum legs to the stage to provide extra resistance to movement. While the band was playing. I'd had a little bit of tinnitus before then, but that particular incident made it much worse, unsurprisingly enough.

Same for me, yup. Wasn't paying attention to it and... I did the dumb thing and read these comments. Oh well.

As for the loud show thing I was already wearing ear plugs back in 1980, never got into the blasting the speakers/headphones, and now I have both significant high frequency hearing attenuation and a 25 year old case of nicely balanced tinnitus. Oh well.

Same here. But when I’m sick with a cold or flu it’s amplified a lot. It bothers me alot when I’m sick.

I'm in a similar boat. Generally it is background noise until it isn't and then it is a REAL drag. If I am ill or stressed or both it can flare up and then I'm in for a few days of utter suffering.

Or talking about it, so now I'm very aware of my tinnitus again. Oops!

This is my experience, too. Also, probably for similar reasons, my tinnitus comes back into my awareness when I get very tired or sick.

The very first time I noticed it at all was during a bout of the flu.

Forgot to mention that, but: same here. Both ears, multiple rather clean tones (i.e. sine waves) n both ears, different tones per ear. I always assumed I was 'lucky' to get it even before puberty when the brain is more plastic still, so learned to ignore it. Stress and other things can bring it back though.

> So e.g right now because I saw this HN post, it's feeling especially loud.

Exactly..

I think my tinnitus is so easy to ignore because it's perfectly even and at extremely high frequencies I probably can't even hear any more. Which is what I assume the cause is.

Honestly I didn't think I had real tinnitus because I don't notice it for more than a moment for weeks at a time, at least not enough to be bothered, although I've have it as long as I can remember. It's not all that loud, but after concentrating on it for a while it's been there constantly and consciously for a good 10min already and it's not going away!

Yeah--I've had tinnitus for at least 13 years now. No idea when it started because it sounds enough like cicadas that it flew under the radar for an unknown period. I first became aware of it one day when I realized "hey, this isn't cicada season, this isn't cicada country". I grew up in cicada country and learned to tune them out.

Fellow cicada blamer here....no cicadas on airplanes.

> Unfortunately, psychotherapy is barely reimbursed

Is this correct and not physiotherapy? Psychotherapy (if send via gp and dianosed) is at least 75% reimbursed if done at a non-contracted practitioner unless you have the shit-insurance, then it's only 50%.

I don't know the details of it, but note this is in Belgium.

I’ve had tinnitus for something like 5 years now and mine varies from day-to-day. Mine seems to be somewhat connected to diet. I think salt might be a trigger. If I have a French Fries or some other salty snack, I’m in for louder ringing an hour or two later.

I seem to remember that high blood pressure could worsen tinnitus, so that might have something to do with it.

Dad went through acute hearing loss twice. They banned salt during recovery. Your tinnitus is related to blood circulation in the ear. Reduce salt.

Have you any citations for this? This is exactly the sort of stuff people are to about about when referring to snake oil

Citations? I remember the prescriptions and Doctors' notes for the diet itself. He had to endure through IV drug treatments at home, was not able to sleep for 17 days because of the given drugs.

I remember cooking everything without salt (then buying reduced sodium salt for some time because he missed the taste of it to a certain degree), stop buying sparkling water, how my father tried to cope with the remaining tinnitus after the hearing loss mostly reversed (>95% IIRC), and how it increased and decreased over time.

He still doesn't drink sparkling water, we still cook with reduced salt. If we deviate from this, his tinnitus increases, yet he tries to hide it from us.

Do you need any more citations?

Mom also has tinnitus, but hers is different, not affected by diet. She uses an advanced hearing aid which counters it using sound somehow. She is relieved to a certain point with it.

There are different kinds, reasons. Need to understand each case.

You've provided more than enough "citations" for your contribution and I learned a thing or 2 from it. Thank you for sharing it.

To address the gp point, your original comment would have been fine without the last 2 sentences (unless of course diagnosing tinnitus is your occupation):

> Dad went through acute hearing loss twice. They banned salt during recovery. Your tinnitus is related to blood circulation in the ear. Reduce salt.

The first 2 sentences was you sharing your experience but the last 2 sentences were you making a diagnosis of someone else's condition based off of a comment (rather than a physical exam and/or some lab tests) which I imagine is why @maccard asked for citations.

You're welcome. I'm glad that helped.

I have written the comment like that, because the GP provided an example relating his tinnitus to salt intake, and I know that scenario from my dad, so I have written that with confidence. If I was not sure, I'd not write a comment at all. :)

Health and metabolism are serious subjects, and I have more than enough experience to not make any recommendations based on low-confidence information. Otherwise, I suspect that my wife would crucify me with cold blood (she's an MD).

Not to impugn your own expertise and experience, but realize that the internet (and generally HN) are literally filled with people who a) say the same thing; and b) spout off a firehose’s worth of nonsense, ask the time.

citations let your reader judge your ethos and credibility in the absence of personal knowledge of you.

Could you elaborate on the sparkling drinks? Do you know of a rationale?

I think because of the level of sodium they contain

Thanks. I looked that up and some Dutch site claims a can of coke light might contain 35-40mg of Sodium(Natrium) of a daily budget of 1500mg.

Why wouldn't they just said "drinks containing sodium"? I've been googling for tinnitus and sparkling water looking for information on this and didn't find much at all.

Not sparkling drinks, but sparkling water in general. In our country, sparkling water is way more stronger than most European brands like Pellegrino or Perrier, hence they contain a lot of sodium. In the range of 100-140 mg/l, just looking to two different brands’ bottles.

Blood pressure can be a cause, I'm sure. Also, I'm sure that extends to any pressure in your ear (say for instance, you constantly clench your jaw or grind your teeth).

I've heard ambient pink noise (not in headphones) helps, but anectdotally only.

I’ve also noticed this as well. Diet, lack of sleep, and some OTC headache relief (acetaminophen+nsaid) will increase my perception of tinnitus. Especially if I pull an all nighter, I will need about 1 week for the perception of the sound to return to normal.

Same thing for me.

I started to hear it at night when the room was quiet 7 years ago, and then progressively all the time. The first year was hard, I saw a few specialists who told me there was nothing to do about it. In the end I accepted it and now it doesn't bother me anymore.

The more you are upset about it and the worse it is.

I only wish I could be able to hear the silence again, but there are worst things in life. My hypothesis is that it was always there but somehow the filter I had for it stopped working. A bit like eye floaters.

Aren’t in ear headphones with noise cancellation better than not using them and instead raising the volume to overcome background noise?

If the “sound” is an internal perception, then noise cancelling headphones would not help at all. They might make it worse by quieting any background sounds that could otherwise help cover up the internally produced sensations.

It depends on your tinnitus itself. My tinnitus gets crowded out by a loud environment, I don't tend to hear it. I only hear my tinnitus when there's no sound. So for me, noise-cancelling headphones do give some temporary symptom relief.

Wearing a Bose QC 35 is so important for me when I go to sleep, because the ANC also blocks out sound and blocks out my tinnitus to some extend. It's a bit of a skill to sleep with them (you can get audio feedback of the ANC mics) but I've mastered it and improved my sleep game a lot because of it.

But active noise cancellation removes (perceived) sound. Wouldn't that make it worse, then?

The way I experience it is as follows.

Normally:

- Tinnitus: 100%

With ANC:

- Tinnitus: 50%

- Bose ANC: 50%

I like the ANC sound more than my tinnitus.

I haven't noticed my tinnitus becoming worse or less worse.

Oh, by “the ANC sound”, do you mean the white noise floor of the ANC?

In that case, have you tried something like the Bose Sleepbuds? Same idea, much more comfortable to sleep with.

Bose recently retired their 2nd attempt. The team behind those have a new one coming out in January, https://ozlosleep.com I'm pretty interested... hard to tell how long the pre-sale discount lasts

It doesn't seem to have ANC, so it doesn't noise cancel, it only masks. And if ANC is the same as masking then they'd need to put that in their marketing.

Also: yep, that's what I mean by it, the white noise sound.

My tinnitus gets worse afterwards if I'm subjected to noise (as in an airplane). Noice-cancelling headphones is a must for me at this point if I'm to experience prolonged increased sound levels.

My experience is that noise cancellation (and transparency mode) in the AirPod max made my tinnitus much worse over time. Got rid of them. I recovered somewhat from whatever they did to me but not fully.

I had tinnitus from loud music for 20+ years prior to that and was always very careful with sound levels because it sucks.

A friend of mine similarly reported that the in ear Apple headphones caused temporary tinnitus when in noise cancellation mode (including transparency mode) but not when those features were off.

Previous discussion: https://news.ycombinator.com/item?id=35023808

> I’ve had tinnitus for about one year now. There is no permanent relief or treatment. Lots of snake oil.

Half of the 200+ post comment section reads like those bottom of the barrel YouTube ads with the AI generated voices: "Try this secret trick to cure your [condition]." It seems to always happen when someone comes here to ask for opinions on disease, food, health or fitness. People, don't go to HN for medical or nutrition advice.

So far, we've already seen: Magic audio tracks, shocking the tongue, steroids, and Ambien, and those are only the top few root subthreads.

Tinnitus may have a psychological component. Many people, in this thread, talk about reducing or removing alcohol and having improvement. Alcohol does very weird things to sleep and the stress cycle.

One of the things that occasionally freaks people out is that magical talismans, regardless the magic.. actually work - at above placebo! In fact, even fake magical talismans.. work.. at above placebo..

Psychological things are very real and can be measured but can be influenced in funny ways. Something may genuinely fix or help the issue and not actually treat the direct symptom.

The fake magical talisman is the placebo, so it cannot be superior to the placebo. At least I'm not sure of any useful study to demonstrate anything about real talismans if you're not using the fake one as a placebo.

We don't know the workings of tinnitus, so tinnitus itself is in the realm of "magic", so there is likely not going to be objective solutions.

However, people still have to live with it, and it causes stress. What are you going to do, nothing, just because there's no treatment that lives up to the standards of hackernews readers?

The statement that there is no permanent relief or treatment is false, and it's delivered with the same confidence as some of the snake oil advice.

Have you tried playing that tone and shifting it's phase to cancel the imaginary signal?

Phase is a physical property of sound waves that cannot influence a signal originating from the brain or cochlea.

Doesn't mean you can't match it.

Yea, but he proposed shifting the phase of the physical signal (16.5khz) which supposedly matches the frequency of the imaginary signal.

I still think it's unlikely to work.

I understand, and there could very well be some psychoacoustic cancellation when stimulating with a matching tone. But any effect will be regardless of the phase of the signal, because phase cancellation is a physical effect of sound waves that occurs before they are converted to neural activity (where tinnitus originates from).

In simpler terms: tinnitus does not have phase, at least not in the same way a sound wave does.

Neutral activity itself definitely takes phase into account somehow, since you can hear the phase difference of two same-frequency tones being played independently into each ear, without any kind of sufficiently strong mechanical connection that would explain it.

I experimented with this when I was young and I concur - it's really like this. Astonishing but that's how it works.

I think though that the brain is also considering the spacial relationship of the sound to the listener. Hearing the sound from an external source rather than "inside your brain" does provide relief in my experience.

It's fun to test what happens when you play the same wave through your headphones but one channel is inverted.

Funny enough lots of stereo widening magic relies on a physical property of sound not existing when it's in your head.

If you ever wire a loudspeaker channel the wrong way around, it feels very weird as a lot (but not all for a stereo mix) of the sound will cancel with the other channel in the middle of the speakers and you can move your head through this dead zone.

I've never tried it with headphones, but I suppose even though destructive addition isn't going to happen it might affect things like intended spatial perception.

Happened once when prepping for a language aural exam. With no immediate fix and the start of the exam pending, we moved some desks instead!

AFAIK when there is not enough external sound input, the brain amplifies the signals from the inner ear in an attempt to compensate which leads to hyperactivity in the auditory nerve and auditory cortex, which can be perceived as tinnitus. So you cannot cancel a 'signal' that doesn't exist. This is my understanding and I may be wrong.

What I've done is to tune a sine wave to match the frequency of the tinnitus, then notch that frequency in white noise, and blast the result for a few minutes. My tinnitus has not been permanent, it's just the rare occasion where I forget earplugs for a concert, and come home work ringing in an ear.

This technique makes the ringing go away for a while, but it creeps up again after some time. Thankfully, it has always completely gone away after a day or two.

> Eventually the body will “habituate” if it does not go away.

This has been my experience. If I "notice" it, then I hear it until it goes away again. Of course, one thing that causes such notice is reading anything about it. :(

I've had tinnitus since a few years ago. It went away since maybe 9 months ago. It came back this morning in the same second I read the title of this post.

There was an old peanuts cartoon[1] where Linus suddenly becomes “aware of his tongue” - and Lucy gets angry because she comes aware too. A lot of spam ads I see these days reference tinnitus - and that’s when I notice it.

[1] https://www.gocomics.com/peanuts/1963/02/03

Were you born premature? Did you get any head damage or injuries growing up?

Do you notice any difference when you stretch, and specifically, are looking up and have your head back? I've noticed the ringing stops for me at that point. But I also have a high pitched, 24x7 bi-lateral ringing. I've had it my whole life.

It took me 6 months as well, noise-canceling headphones give me some temporary relief, not full though. My tinnitus came after a night out during a time in my life where I went out a lot.

There was one treatment - I think it was posted on HN - that played sounds slightly above and below the frequency, which provided temporary or permanent relief.