What is evidence-based tinnitus treatment?
This is any treatment or therapy that possess empirical evidence to suggest that the method is effective at reducing tinnitus severity across a treatment population.
Within the field of tinnitus research, treatment methods are usually evaluated by comparing them to each other, within patient populations who are not aware of what treatment method they are receiving, this is referred to as a clinical trial.
An alternative method of evaluation is to see how large numbers of patients react to treatments over a long period of time without a comparison intervention; this is called an observational trial.
Currently there are a number of therapies that have been shown to be effective at reducing tinnitus severity in patients to a statistically significant degree.
Examples of these include psychological therapies like cognitive behavioural therapy (CBT) and a variety of modern sound-based therapies.
How does sound therapy work?
The most common form of tinnitus (primary tinnitus) is caused by the central hearing system becoming more active than it should be due to hearing loss.
This may be a compensation mechanism for the hearing loss that manifests too vigorously in approximately 10 percent of adults.
The increased activity of the hearing system causes the patient to perceive a phantom noise which is often described as being located within the head or ears.
Some sound therapies strive to counteract this compensation by stimulating areas of the central hearing system that are specifically affected by hearing loss.
This often causes the tinnitus perception to become less noticeable over time.
Alternatively, sound therapy can be applied in order to stimulate the brain to filter the tinnitus signal from conscious awareness.
This usually results in the patient becoming much less aware of their tinnitus signal in a similar way that humans are unaware of the noise of their own breathing.
This state of unawareness is called habituation.
How effective is sound therapy?
Most patients will experience an obvious improvement in symptoms after 12-16 weeks of use. However, to induce a sustainable improvement most individuals will need to engage in a therapeutic process for between 20-40 weeks.
How long does it last?
Once habituation has manifested, and the patient experiences their tinnitus to be mostly burden free, it is usually a very sustainable state.
However, any event that causes an individual to lose hearing rapidly (e.g. ear infection, trauma, noise exposure etc.) can induce relapse.
Also, negative life events that evoke high levels of anxiety can also make tinnitus temporarily more obvious.
Is it costly?
Psychological therapies, like CBT, are usually charged on a sessional basis with most patients receiving approximately six appointments over a course of therapy. This can typically cost between £300 and £600 depending on the practitioner.
Sound therapies vary in price with ‘over-the-counter’ systems and applications costing less than £50 and bespoke systems that target the pitch of the tinnitus costing up to £4000 for a course of therapy.
What sort of tinnitus therapies work for different people?
A mixed methods approach, combining both psychological and audiological therapies, is usually the most effective way of inducing a sustainable change in tinnitus symptoms.
How can you judge which therapies work best for different patients?
The effectiveness of tinnitus therapy is determined using a combination of patient reporting.
These reporting methods include validated questionnaires that examine tinnitus severity, assessing the sound characteristic of the tinnitus signal (e.g. how difficult it is to mask the pitch of the perception etc.).
These measures and questionnaires would be recorded prior to treatment and would then be repeated at regular intervals throughout the therapeutic regime in order to determine what progress is being made.
It is also important to qualitatively assess how the patient is feeling about their tinnitus awareness overall (i.e. are they sleeping well, able to concentrate etc.).
What are the immediate benefits that can be felt from receiving tinnitus treatment?
Most sound therapies provide a patient with ad hoc or as-required control over the perceptual awareness of their tinnitus.
This can be very effective at reducing anxiety and the negative emotional reaction to tinnitus perception.
This can lead to an obvious improvement in sleep quality, ability to concentrate and capacity to engage in socially enjoyable activities.
How can getting tinnitus treated help boost self-confidence and self-esteem?
Tinnitus is often lamented as being an incurable condition that could result in a potential life sentence of misery. This is most often the case for individuals who have recently developed the condition and naturally are more prone to worrying about the future.
This catastrophic thinking often leads to a deterioration in quality of life.
The misconception that the condition cannot be improved, unfortunately, often leads to patients experiencing significant anxiety and/or depression.
It is important for patients to note that most medical conditions are not curable. For example there is no cure for asthma, diabetes or arthritis etc.
This, however, does not mean that these conditions cannot be treated, supressed, controlled and quality of life improved.
The relationship between cure and treatment is also true for most forms of tinnitus.
It is when a sufferer first experiences their tinnitus perception being controlled that they can start to think and feel about the condition in a more positive frame.
This change in perspective serves to cultivate a belief in a more truthful and optimistic prognosis that quality of life can be restored.
Can tinnitus ever be cured?
Tinnitus can be caused by any pathology or trauma that reduces hearing acuity rapidly.
In certain cases, if you treat the underlying pathology or issue e.g. ear infection or blocked wax pushing up against the eardrum, then the tinnitus will resolve.
However, because of the many different factors that influence the way that someone experiences and reacts to tinnitus it is unlikely in the immediate future that there will be a single treatment option (i.e. sound, gene or drug therapy etc.) that would resolve tinnitus completely in all patients.
It is more likely that some treatments will work well for groups of patients, and that they will get sufficient relief from their symptoms to live more positively with their tinnitus, just as many patients can do now.
Tinnitus can be caused by any, or all of the following:
- exposure to loud noise
- a side effect of medication
- ear or head injuries
- diseases of the ear
- ear infections
- emotional stress
Tinnitus often occurs in conjunction with an auditory impairment, for instance after an acute loss of hearing or loss of hearing due to aging.
Read more about tinnitus here.
The Tinnitus Clinic is a CQC registered service which provides adult audiology rehabilitation for hearing loss, tinnitus and hyperacusis. We also undertake ear wax removal by microsuction which the safest method of wax removal and the only method recommended by the British Society of Audiologists.
Musicians and others who experience regular exposure to loud noise levels can come to us safe in the knowledge that we understand their position and can provide specialist ear protection suitable for their profession. (http://thetinnitusclinic.co.uk/tinnitus-treatment/ear-defence )
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