TINNITUS 101 WHAT YOU ABSOLUTELY NEED TO KNOW ABOUT TINNITUS

Have you been hearing odd noises that no one else seems to be able to hear? Has the ringing, hissing or buzzing you hear driven you to distraction because you dont know whether you are going crazy or the sound is real? Youve given up asking people around you if they can hear anything because of all the strange looks they direct your way, so you never know whether the noise is real or if its just in your head. Well, theres good news and theres bad news. The good news is that you are not going crazy. The sounds you are hearing are real but they are not actually sounds. How can they not be sounds if you are hearing them? Well get to that soon enough. Whats important is that you know you are not alone and you are definitely not imagining this. The bad news is that you are probably suffering from a disorder known as tinnitus, which is quite common. While it is not a pleasant disorder, it can be treated and managed. It also does not cause deafness, so you dont need to worry. However, you do need to see a doctor but first, lets learn a little more about tinnitus, its causes, symptoms and what treatments are available.

UNDERSTANDING TINNITUS
Tinnitus is an auditory disorder that can have a severe impact on the life of an individual as it can prevent intellectual work, impair the quality of life and even lead to suicide, in highly severe cases. In such cases, the disorder is so disruptive that it is often accompanied by other disorders such as depression and phonophobia. Tinnitus presents itself as noise or ringing in the ears and is quite common, with some studies revealing that 80% of the adult population will experience this ailment at some point or another throughout their lifetime. However, most cases are quite mild and the condition can be improved through various forms of treatment. Unfortunately, though, there are approximately 3 million people whose tinnitus is so severe that they are seriously debilitated and cannot function normally on a daily basis. It should be mentioned the name tinnitus, while referring to similar sensations, is actually used to describe a variety of forms of this ailment, with different levels of severity and different causes. For this reason, treatments can vary significantly, mostly according to the underlying cause of the disorder, which usually requires the patient to be examined by a doctor.

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Tinnitus can also appear as one of the symptoms of other diseases, such as Menieres disease, vestibular schwannoma (acoustic neuroma), Wilsons disease, intracranial hypotension, Downs syndrome as well as a result of traumatic injury to the auditory nerve.

TYPES OF TINNITUS
There are, in fact, two broad categories of tinnitus, namely subjective tinnitus and objective tinnitus.

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How Do We Hear? Most people know that we hear through our ears but not much more than that. The more we understand about how our ears work, the more we will appreciate this sense that many take for granted. So, how is that we can hear? The ear is composed of three main parts: the outer ear, the middle ear and the inner ear. The outer ear captures sound waves and directs them towards the middle ear. Once here, they case the ear drum to vibrate and these vibrations are transmitted towards the inner ear through three tiny bones called the ossicles (malleus, incus and stapes also referred to as the hammer anvil and stirrup). The stapes conducts the vibrations through the oval window and into the fluid that fills this portion of the ear. The vibrations travel through the fluid in the cochlea, which is where the hair cells are located. The fluid moves to the top of the hair cells, which causes them to produce nerve impulses. The latter are carried to the brain, where they are interpreted as sound. We can distinguish between different sounds because every different pitch and tone will affect a different part of the inner ear.

SUBJECTIVE TINNITUS
Subjective tinnitus refers to a wide range of sensations that are the result of abnormal neural activity in the nervous system and isnt actually caused by the presence of sound. This is the most common form of tinnitus and is difficult to diagnose because it has no physical signs and there are no objective clinical tests that can be used to determine which type of subjective tinnitus the patient suffers from. Therefore, doctors have to rely on the patient's description of their condition, which can be misleading. This is because patients usually claim the problem is with their ears and generally the problem is elsewhere. Subjective tinnitus can have different forms. For example, it can present as high frequency sounds, like those made by crickets, a lower tone and it can either be constant or pulsatile. The latter refers to a sound that has the same rhythm as ones heartbeat. Tinnitus can also be present at all times or manifest only occasionally, but there has been no correlation yet between any specific triggers and the onset of an episode. Subjective tinnitus is the most common form of the disease and is frequently associated with hearing loss. In fact, approximately 90% of the patients who experience the onset of tinnitus have sensorineural hearing loss, 5% have conductive hearing loss and only 5% have normal hearing. Sensorineural hearing loss is caused by damage to the nerves of the inner ear, while conductive hearing loss is caused by loss of function in the external or middle ear.

OBJECTIVE TINNITUS
Unlike subjective tinnitus, objective tinnitus is caused by sounds generated in the body, which are then conducted to the ear. These sounds could be caused by a wide range of issues, such as muscle contractions or turbulence in the blood flow. The advantage of objective tinnitus is that it can be detected by an

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outside observer, using special tools that amplify the sounds.

SYMPTOMS OF TINNITUS
As has already been mentioned, tinnitus is an affliction whereby the patient hears noises that do not have an external cause. Thus, they are often referred to as phantom noises and can vary significantly. For example, if you experience any of the following: Clicking Whistling Hissing Roaring Buzzing Ringing

And cannot attribute the sounds to an external cause, you might have a form of tinnitus. The level of the sound can also vary, with some patients experiencing these sounds so loudly that they have difficulty concentrating or hearing actual sounds. These sounds can also differ in pitch, ranging from a low roar to a high squeal. There have also been cases of tinnitus reported where the sounds were more complex, such as the roar of an ocean. Tinnitus can be present in one ear, both ears or in the head as if the sound is originating in the brain.

CAUSES
The onset of tinnitus is difficult to attribute to a particular cause when being diagnosed due to the fact that it encompasses a number of different types of disorders. In many cases, the actual cause is never found. However, there are certain factors that most experts agree can eventually lead to the onset of tinnitus.

EAR PATHOLOGY AND HEARING LOSS

There are many factors associated with the development of tinnitus, including abnormalities and diseases of the ear, the auditory nerve, and different parts of the central auditory nervous system. Viral infections and damage to the auditory nerve from trauma, which can be caused by injury as well as a result of surgery, have also been found to lead to the onset of this disease. Due to the fact that the inner ear is so delicate, any form of trauma, no matter how mild can cause irreparable damage. The inner ear holds tiny, delicate hairs that move according to the pressure of sound waves, which causes ear cells to release an electrical signal through the auditory nerve to the brain. The brain then interprets these signals as sound. Any slight abnormality in the hairs of the inner ear, such as being bent or broken, can lead to random electrical impulses being sent to the brain, even in the absence of sound, which is what leads to tinnitus. Overstimulation and deprivation of signals to the auditory system have also been discovered to cause tinnitus. In other words, prolonged exposure to excessively loud noise, such as listening to music with headphones on for too

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long, or working in a loud environment, can lead to tinnitus. Unfortunately, most people aren't aware of the longterm harmful effects of exposure to loud noise. In terms of deprivation, this is usually seen in patients who are losing their hearing and it is almost as if the brain is trying to compensate for the lack of external stimulus by producing sound. Since we tend to lose our hearing as we age due to damage or deterioration of the cochlea, which is the portion of the ear that allows us to hear, tinnitus becomes more prevalent at this stage in life. Also, it has been found that anything that further degrades hearing, such as an ear infection or excess wax, can also aggravate tinnitus. Otosclerosis can also lead to tinnitus. It is a disease which causes the abnormal growth of bone near the middle ear and can result in conductive or sensorineural hearing loss. Otosclerosis most commonly leads to conductive hearing loss because it tends to affect the stapes, which is the last bone in the chain and is positioned right at the entrance to the inner ear. The growth pushes the stapes against the oval window, pinning it in place, making it difficult for sound to pass into the inner ear.

MEDICATION
Certain types of pharmaceuticals have also been found to lead to the onset of tinnitus, but only as a side effect and do not cause damage to the inner ear. Depending on the dosage and length of treatment, the effect can be temporary or permanent, which is why you need to consult with your physician if you suddenly start hearing ringing, hissing or buzzing when you start taking a new form of medication. The sooner you catch the problem, the less likely the chance of the effects being permanent. Additionally, there are some medications that are otoxic, meaning that they are toxic to the ear and can cause damage to the cochlea or auditory nerve and sometimes the vestibular system. Otoxic drugs include: Aminoglycoside antibiotics, such as gentamicin and tobramycin; Macrolide antibiotics, such as erythromycin the otoxic effects are reversible; Glycopeptide antibiotics, such as vancomycin and bleomycin Broad-spectrum antibiotics such as chloramphenicol; Loop diuretics, such as furosemide, bumetanide and ethacrynic acid; Platinum-based chemotherapy agents, such as cisplatin and carboplatin. Ototoxicity is dependent on the 2 dosage, with it occurring when doses greater than 60 mg/m are administered and chemotherapy is given every two weeks compared to weekly. Nonsteroidal anti-inflammatory drugs, such as Meloxicam Quinine and chloroquine, used in the treatment of malaria and other ailments; Heavy metals, such as lead and mercury; High doses of aspirin and other salicylates; Erectile dysfunction medication, including Viagra, Levitra and Cialis, has also been reported to affect hearing;

Before taking any medication, if you already suffer from tinnitus, you must inform your doctor to ensure you are not prescribed any drug that might aggravate your tinnitus. There are always plenty of alternatives available but your doctor has to know of your condition.

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OTHER CAUSES
In some rare cases, subjective tinnitus can be caused by an acoustic neuroma, which is a type of benign brain tumor that grows on the eighth cranial nerve, leading from the brain to the inner ear. These types of tumor grow slowly, over a period of years and seem to be most prevalent in patients between the ages of 30 and 60. The cause is largely unknown but there are cases in which these tumors are believed to be genetic. It is generally recommended that these tumors be removed if they present continued growth as they could lead to neurological problems. However, this form of tinnitus is quite rare and usually appears in only one ear, unlike the tinnitus caused by hearing loss, which manifests in both ears. Acoustic Neuroma in the Ear Any form of head or neck injury can also cause tinnitus because of the sensitivity of the inner ear. Depending on the location of the injury, tinnitus usually appears only in one ear, on the side closest to the injury. Additionally, some neurological disorders can have an effect on the inner ear, auditory nerves or brain function connected to hearing and can lead to tinnitus. Stress and depression are also commonly associated with tinnitus and have been found to aggravate it. Unfortunately, in the case of severe tinnitus, this leads to a vicious cycle because the constant unwanted sounds lead to preoccupation and focus on the disease, causing a distraction and making it hard to function properly, which in turn leads to an emotional response. This emotional response generally manifests as fear, anger or depression and certainly elevates stress levels.

Image courtesy of the Acoustic Neuroma Association

CAUSES OF PULSATILE TINNITUS

Pulsatile tinnitus is a form of tinnitus where the sounds are real and are similar to a rhythmic pulsing in the ear, generally in time with ones heartbeat. This condition is easier to diagnose since a doctor can actually hear the sounds as

well, by using special equipment. It is generally caused by brain tumors, irregularities in the brain structure or abnormal blood flow. Even though it is quite rare, pulsatile tinnitus is most often associated with blood vessel disorders, including: Head and neck tumors: a tumor pressing on blood vessels in the head or neck area can modify blood flow and lead to tinnitus; Atherosclerosis: as we age, the blood vessels near the middle and inner ear begin to lose their elasticity, which causes blood flow to become stronger and, sometimes, more turbulent. This makes it easier to hear the blood flowing as well as the heartbeat. Turbulent blood flow: any narrowing or kinking in an artery or vein in the neck can cause turbulent blood flow and tinnitus;

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Arteriovenous Malformation (AVM): a condition that describes the malformation of capillaries between arteries and veins can lead to tinnitus, but it tends to occur in only one ear.

TINNITUS AS A SYMPTOM
Tinnitus can also appear as a symptom of other disorders, including Lyme disease, fibromalgyia, hypothyroidism, hyperthyroidism and thoracic outlet syndrome. Tinnitus can also appear as a symptom of Mnire's disease, which is a disorder of the inner ear that can also cause vertigo, hearing loss and the sensation of congestion in the ear. This disease tends to affect only one ear. Sufferers can experience vertigo attacks suddenly or after a short episode of tinnitus or muffled hearing. The attacks can be frequent, over a number of days, while others can go for long periods of time without an episode. In some cases, the vertigo is so extreme that people can fall over due to a loss of balance. Mnire's disease is caused by a buildup of fluid in the compartments of the inner ear, where the balance and hearing organs are located. This fluid stimulates receptors in the balance organs, informing the brain of the bodys position but in Mnire's disease, the excess fluid interferes with the signals, causing hearing and balance problems.

RISK FACTORS
While everyone is at risk of getting tinnitus, including children, there are some factors that can increase the risks of a person contracting this disease. For example, since excess noise can lead to hearing loss and tinnitus, if you have been exposed to loud noise on an ongoing basis without ear protection, you are more likely to develop this disorder. And yes, that includes spending hours on end with your headphones on, blasting music or any other sounds. Additionally, it seems Caucasians are more susceptible to the disease, especially males over the age of 65. People with age-related hearing loss are also more likely to develop tinnitus because the brain has been used to receiving sound signals and attempts to compensate when their frequency is greatly diminished or disappears completely. Note that even deaf people can develop tinnitus but it is generally more prevalent in those who lost their hearing over time rather than those who have been born with a congenital hearing defect. People with post-traumatic stress disorder (PTSD) are also more susceptible to tinnitus. People who suffer from PTSD find that their tinnitus is especially aggravated by loud noises and it can make life extremely difficult.

COMPLICATIONS
While tinnitus is generally not life-threatening it can have a serious impact on ones quality of life, depending on the severity of the case. The more severe the tinnitus, the harder it is to live with. Many people experience extreme fatigue, stress, insomnia, concentration issues, memory problems, depression, anxiety and irritability. The problem is that tinnitus can be aggravated by all of these conditions, which is why treating them can make one feel much better. It might not help the tinnitus, but it will certainly stop aggravating it and make it easier to deal with on a daily basis.

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SHOULD I SEE A DOCTOR?

Experts agree that if you experience the sudden onset of tinnitus, you should visit your doctor because it can often be a symptom of a more serious problem. This is even more important if you are hearing the sounds only on one side. Despite the fact that most cases of tinnitus arent cause by serious issues, it is still better to have your symptoms assessed by a physician who can determine whether or not a more serious problem is causing your tinnitus. For example, you can experience sudden hearing loss with the onset of tinnitus, but there are various pharmacological treatments that can help restore your hearing, in part or fully. Likewise, there are certain tumors that can cause both hearing loss and tinnitus and these definitely need to be analyzed more closely. If you experience pulsatile tinnitus, meaning that the noise is keeping rhythm with your heart beat, there is a chance that it could be related to a problem in the vascular system, which is why you should have it checked immediately. This form of tinnitus can be the result of an aneurysm near the ear of because of a sudden spike in blood pressure. Additionally, it can also be a warning sign that you have suddenly developed high blood pressure. If, alongside tinnitus, you develop any changes in personality or are finding it difficult to speak or move, then you need to visit a physician to rule out the possibility of a stroke. When you visit your physician, make sure to describe your signs and symptoms as accurately as possible. In all likelihood, you are suffering from subjective tinnitus, which is the most common form, and is difficult to diagnose unless the doctor fully understands what you are experiencing. You also need to let your doctor know of any other health conditions you might have, especially hearing loss, high blood pressure or clogged arteries. In fact, be prepared with your full medical history as you never know what might prove helpful. Make sure to mention a full list of any medication you are taking, whether its pharmacological or herbal. Your doctor will ask you a series of questions, to help him or her gain a better understanding of yoru tinnitus and its severity, as well as what course of treatment to provide. In some cases, patients are sent to work with an audiologist (hearing expert) or might be required to see an ear, nose and throat specialist (otolaryngologist) for further examination. Some of the questions you can expect include: When did the symptoms first appear? Describe the noises you are hearing. Are the sounds present in ear or both of them? Is it continuous or does it come and go? How loud is it? How much does it bother you? Does anything help with your symptoms? If yes, what? Does anything aggravate your symptoms? If yes, what? Have you been exposed to any type of loud noise? If yes, was it long-term exposure? Have you had an head or neck injuries, or suffered from an ear disease?

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The more information you can provide your doctor with, the easier it will be for him or her to prescribe a treatment that will ameliorate your tinnitus.

TEST AND DIAGNOSIS

When you visit you physician, you need to expect a full examination of your head and neck. The doctor will use an otoscope to check the ears for wax, infection or any structural changes. A stethoscope will also be used to listen to all the blood vessels in your neck. Other tests may include: Hearing exam: you will be placed in a soundproof room, with a pair of earphones through which different sounds will be played into one ear at a time. You will have to indicate when you can hear something and then your results will be compared to the average for your age range. This will help to identify or eliminate possible causes for your tinnitus, including hearing loss; Movement: you might be required to clench your jay, move your neck, arms and legs and move your eyes. This is to see whether any range of motion has an impact on your tinnitus, which could mean an improvement or aggravation, and can help to discover if you have an underlying disorder that requires treatment. Diagnostic imaging: Magnetic resonance angiography or venography (MRA and MRV) can be used to determine whether any of your blood vessels are malformed. Likewise, computed tomography scans (CT scans) or magnetic resonance imaging scans MRIs) can be used to see if there are tumors or any abnormalities of the brain stem. Blood tests: the doctor might require a complete blood count with certain antibody tests to rule out various diseases and immune system disorders.

It is important that you describe the sounds you hear accurately to your doctor as they could help identify a possible underlying issue. For example: Clicking can be caused by muscle contractions around the ear, which can last several seconds up to a few minutes; Heartbeat sounds can be caused by problems with your blood vessels, aneurysms or tumors; Low-pitched ringing can be caused by Menieres disease; High-pitched ringing can be the result of trauma to the ear or very loud noises. It usually disappears after a few hours but, if hearing loss is involved, the tinnitus could be permanent. Acoustic neuroma can also cause high-pitched ringing, but only in one ear;

You might also hear other sounds, because earwax or foreign bodies that have become lodged in the ear canal can rub against the ear drum and cause a wide range of sounds. Likewise, otosclerosis can cause a low-pitched sound that can come and go or be continuous. Sadly, in many cases, the real cause is never identified and your doctor can only discuss treatment options to reduce the severity of the problem and provide you with information to help you better cope with the condition.

TREATMENTS AND DRUGS

The first step in treating tinnitus is finding the underlying cause. If that can be identified, more often than not, tinnitus symptoms can be greatly diminished by treating the underlying health condtion. For example, removal of

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impacted earwax can help decrease the noise. If your problem is caused by medication, then changing the drugs you are on could completely eliminate your tinnitus. With pulsatile tinnitus, treating the vascular conditions that are causing it through surgery or medication might help reduce the symptoms.

NOISE SUPPRESSION
If the treatment of the underlying problem does not reduce the symptoms sufficiently so that tinnitus no longer has a sever effect on your daily life, then your doctor might recommend some white noise devices, as this type of noise has been found to suppress the sounds and make them easier to ignore. Some of these devices include: White noise generators: these are devices which simulate noises like ocean waves or falling rain and have been found to have a beneficial impact on tinnitus. If you have trouble sleeping, you could purchase a white noise generator with pillow speakers. Hearing aids: these help with hearing loss as well as tinnitus; Masking devices: these are, essentially, portable white noise generators that are worn in the ear. Producing white noise on a continuous basis, they help to reduce the level of tinnitus symptoms; Tinnitus retraining. This is a method that generally combines counseling with a portable device. The latter delivers tonal music that has been specifically programmed to mask the particular frequencies of the sounds you are hearing. The goal is to get you to accept the tinnitus and overlook it, allowing you to function more normally.

MEDICATION
Unfortunately, tinnitus cannot be cured with any form of medication. However, by treating the complications, it makes it easier to live with and can also reduce the severity of the symptoms. Therefore, your doctor might recommend: Tricyclic antidepressants, such as amitriptyline and nortriptyline. Note that while these antidepressants have met with some success, they are generally used only in severe cases because they have side effects that are less than pleasant, including constipation, blurred vision and heart problems; Alprazolam (Niravam, Xanax) have been used to reduce tinnitus symptoms and they do have the drawback of being mildly addictive. In other words, they become a very bad habit, since they also cause drowsiness and lethargic sensations. The side effects also include nausea.

LIFESTYLE CHANGES AND HOME REMEDIES

There is no cure for tinnitus, and, in some cases, there is no treatment either, especially in milder cases. Thus, the only option is to try and get used to it, which some people do successfully and manage to lead fulfilling and active lives. There are certain adjustments that might help make the condition less annoying, such as: Avoiding irritants, such as nicotine or loud noises that could aggravate your tinnitus;

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Drown out the noise with a white noise generator, a fan soft music or even low-volume radio static. You can download plenty of tracks off the internet with ocean waves, falling rain and similar sounds that might also be of use. Just load them onto your MP3 player for times when you are not within range of yoru computer; Managing stress is imperative because it can aggravate your tinnitus. Whether you meditate, exercise, try other forms of relaxation therapy or just take some time for yourself to relax with a good book, you need to make sure you keep your stress levels under control; Reducing alcohol intake might help with pulsatile tinnitus because alcohol increases blood flow and can aggravate pulsatile tinnitus.

While it may seem hard at first, you will find that slowly you become accustomed to the sounds and life will become easier. Thanks to modern technology, you can always have an MP3 player handy with some soothing sounds to help you drown out your tinnitus symptoms when it becomes unbearable.

ALTERNATIVE MEDICINE TREATMENTS

There are a wide range of alternative treatments that have been tried to improve tinnitus symptoms with varying levels of success. These include: Acupuncture Hypnosis The Herb Gink Zinc supplements Lipoflavonoid, a vitamin complex supplement; Magnets Qigong Hyperbaric Oxygen Hypnosis

It should be noted that none of these therapies have been clinically tested and the results could be purely subjective. However, none of these therapies are harmful and it might be worth trying them out, after you have talked to your physician.

COPING AND SUPPORT

Some people suffer from tinnitus continuously and there is little that can be done about it. All that is left is for them to learn how to cope with the disorder. If you find yourself in this situation, then here are some ideas to help you cope and learn to live with tinnitus:

GET COUNSELING
Most doctors will recommend to their tinnitus patients to get some form of counseling from a licensed therapist or psychologist. These experts can teach you various coping techniques you can use to reduce the impact tinnitus has on your life. You can also resolve other issues cause by tinnitus that can also aggravate it, including anxiety and depression;

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EDUCATE YOURSELF
The more you know about your condition, the more ways you can discover to alleviate your symptoms. Sometimes, simply understanding the disorder you are suffering from and knowing it isnt life-threatening makes it easier to deal. Some people have a tendency to blow things out of proportion and if you are one of those people, knowing more about tinnitus will help you cope with it better. Plus, you never know when and what new discoveries might be made that can help you further reduce tinnitus symptoms, so its worth staying up-to-date.

JOIN A SUPPORT GROUP

Connecting with other people who are suffering from the same disorder might help you because they can reveal their coping strategies and technique. Also, knowing that you arent the only one out there can be more helpful than you realize. These groups meet either in person, or online in forums and you can choose whichever type of venue makes you feel more comfortable. However, you want to ensure any advice and information you are getting is accurate, which is why you should stick to groups recommended by your doctor, audiologist or therapist.

PREVENTION
Prevention is worth a pound of cure and that has never been truer than in the case of tinnitus. Since it cannot be cured, it is definitely a disorder we should all try to do our utmost to prevent from developing. While theres nothing that can be done in the case of certain types of tinnitus, taking a few precautions can greatly reduce the risks of developing other types.

HEARING PROTECTION
Since we have discussed the link between loud noises, hearing loss and tinnitus, it should be obvious that hearing protection should be your number one motto from now on. That means that if you work in an environment with on-going loud noises, including industries with loud machinery, where firearms are used, the music industry, construction and so on, you need to wear over-the-ear hearing protection. You will be glad you did when your colleagues can barely hear the person next to them when retirement rolls around.

KEEP THE VOLUME DOWN

We all love listening to music. Theres nothing greater than a wonderful piece of music. It can make you laugh, it can make you smile, it can make you want to jump out of your chair and dance and it can make you cry. However, instead of crying later on because you are losing your hearing and have developed tinnitus, try turning down the music. Long-term exposure to extremely loud music, with or without headphones has been proven to lead to tinnitus and hearing loss. Remember, you dont have to blow out the windows to enjoy music. So, save the neighbors and your ears and turn the volume down.

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STAY HEALTHY
As with any other ailment, keeping healthy and fit can help prevent the onset of tinnitus, especially pulsatile tinnitus. By exercising regularly and eating properly, you can improve your cardiovascular health, meaning that your blood vessels are less likely to suffer from malformations or other problems, which eventually lead to pulsatile tinnitus. Plus, think of all the other benefits of a healthy lifestyle, including more energy, a more positive outlook on life and a general state of well-being.

CONCLUSION
Tinnitus is a common disorder that has no cure, unfortunately, but since it is not life-threatening, one can learn to live with it. Therefore, with a better understanding of tinnitus as well as the various treatments discussed in the book, you will find it a lot easier to cope with the disease. And just because you have experienced an episode or two, it doesnt mean its too late to try and prevent its aggravation so take precautionary measures, if not to reduce your tinnitus symptoms, at least to preserve your hearing.

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