Tinnitus has no cure, but the part of it that ruins lives is treatable — and the treatments that work mostly do not touch the ear. In a Guardian explainer, Bianca Nogrady lays out how a sound with no external source becomes a condition that drives people out of work and out of their social lives, and why the interventions that help are aimed at the brain’s reaction rather than the noise itself.
The condition is common and poorly understood. At least a quarter of people report hearing tinnitus at some stage, in forms that range from a high mosquito whine to a low bass hum, sometimes tied to stress and sometimes permanent. The leading theory, per audiologist Dr Emma Laird of La Trobe University, is a change in the hearing pathway in which “the nerves in the hearing pathway are basically firing more than they should do” — activity the brain registers as sound.
What gets ruled out first
The first step is not treatment but exclusion. Laird looks for headaches and vision changes that could point to migraine or stroke, and for two configurations that warrant imaging: tinnitus in one ear only, or a sound that pulses with the heartbeat, which can indicate an acoustic neuroma. A full hearing assessment follows, because hearing loss after noise exposure is a common cause — and where hearing loss is present, hearing aids help by giving the auditory system other material to attend to. Even impacted earwax can produce the sound.
For many people, though, there is no physiological explanation. Roughly 2 percent find it extremely distressing: it disrupts mood, sleep and function, and, as Sydney psychologist Paula Sieradzki describes it, “most people make changes to their life, they’re not going out any more, some may give up work.”
Treating the loop, not the sound
Psychological therapy for tinnitus does not aim to silence it. The goal is to reduce the distress attached to it. Sieradzki’s framing is that tinnitus becomes a problem when the brain classifies an otherwise benign sound as harmful; the resulting stress response heightens the perception of threat, and the brain then selectively attends to the sound even when other noise is present. CBT has good evidence behind it and is endorsed by audiology bodies, working on the thoughts, behaviours and emotions that sustain what Sieradzki calls the tinnitus distress loop.
Acceptance and commitment therapy takes a different angle, changing the person’s relationship with the sound rather than the sound’s perceived meaning. Sieradzki is candid that acceptance is difficult for people who have spent years trying to get rid of it.
Physiotherapy targets the jaw and neck. Dr Peter Selvaratnam, a physiotherapist at the University of Melbourne, works on bruxism and clenching, which are common under stress: the trigeminal nerve serves the jaw, neck and the tensor tympani muscle in the middle ear, and projects to the cochlear nucleus in the hearing pathway. His techniques — tongue position, acupressure, breathing and mindfulness — are, by his own account, successful in teaching roughly 60 to 70 percent of patients to accept their tinnitus, with about 10 percent finding it disappears.
Sound enrichment tries to settle the auditory alarm system directly. Audiologist Kathryn Penno matches an external sound — a waterfall, cicadas, wind in leaves — to the tinnitus frequency, aiming at habituation rather than masking. She says it has to run continuously, including during sleep, because consistency is what allows the pathway to reorganise; most people show significant improvement after roughly three months, and the same tools work again when tinnitus recurs during stressful periods.
The common thread is that the sound is often not the ear’s problem at all. “There’s lots of literature to show that you can have normal auditory or hearing and have tinnitus that’s associated with these psychological impacts,” Penno says. Which is also why the advice converges on fit and consistency rather than any single method: “If you’re consistent with any therapy, you will get benefit, and it’s about finding the right fit for that person.”
One caveat worth carrying: the physiotherapy figures are one clinician’s own estimate, not trial results, and the article reports them as such. The stronger evidence base sits with the psychological approaches, which is a reasonable place for it to sit for a condition defined less by the signal than by what the mind does with it.
Read the full story at The Guardian.