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For individuals who experience tinnitus, know someone who does, or have an interest in this topic, this article might pique your interest.. It is a pure scientific article about six possible tinnitus contributors. Defining each topic, summarizing ongoing research, and exploring potential new research directions for each topic is discussed. It is a summary of the questions and answers addressed by a panel of researchers that took place in February 2021, at the Annual Mid-Winter Meeting of the Association for Research in Otolaryngology.
People often define tinnitus as “ringing in the ear”. Tinnitus is actually any sound you hear in your ear, that does not have an external source. It could be ringing. It could also be buzzing, or pulsing, a high-pitched tone. Tinnitus could be in one ear or both; sound like it is close or far away. For some, it is life-altering, while others tolerate it easily. For instance, some people need treatment and feel like they can’t live with it, while others sleep like babies even though they have ringing in their ears. Its cause is unknown and a curative therapy for it does not exist. Let us look briefly at theories on tinnitus and each of the six topics and see where the potential blind spot of past research may lie.
Is the problem in the peripheral auditory system (bottom-up) or is it a central cognitive (top-down) impairment? Does bottom-up from the peripheral neural activity trigger a top-down mechanism? Is it a two-step process? Future task: Could medications that address the bottom-up trigger, prevent the top-down impairment?
Numerous studies report impaired or altered executive attention, selective attention, and working memory in chronic tinnitus. The negative emotions experienced during tinnitus cause a consumption of cognitive resources: individuals increase vigilance towards the tinnitus tones. Future tasks: researchers may reconsider how individual environmental or hereditary differences in attentional/cognitive states could contribute to suffering more or less from tinnitus tones.
There is a growing list of studies that show a close relationship between distress and tinnitus. The presence of insomnia, hearing distress, and anxiety are the best predictors of tinnitus severity. It is important to distinguish between oxidative stress, stressful acoustic trauma, and mental stress, which has not been considered adequately. Future tasks: understand how bottom-up mechanisms may be linked to the role that distress plays in tinnitus.
Studies of patients with tinnitus with hyperacusis and patients with tinnitus but without hyperacusis, suggest that there may be sub-categories of tinnitus. You will recall that hyperacusis is an exaggerated reaction to some sounds. For instance, some individuals will hardly notice clanging silverware, while it will be irritating and even painful to others. Is it possible that for patients with tinnitus and hyperacusis, the enhanced distress level they exhibit affects wider frequency ranges? Future task: Consider that in patients with tinnitus and hyperacusis parallel bottom-up changes exists that differentially affect top-down circuits.
The brain is constantly trying to optimize information transmission from the periphery into the brain. Some believe that a brain is a prediction machine that informs its memory-based predictions through sensory updating. So, tinnitus is the result of a prediction error between the predicted and the actual auditory input. Future task: Could tinnitus be a side effect of the brain’s effort to improve hearing?
Deafferentation is the disruption of sensory nerve impulses by destroying or injuring the sensory nerve fibers. Is tinnitus caused by damage to the central auditory system, perhaps triggered by central deafferentation (probably mostly due to cochlear damage) or is it in the auditory cortex? Future tasks: The need to challenge the widely-held thought that the conscious percept of an auditory stimulus required a proper maturation of a baseline.
Look at cognitive behavioral therapy; a brainstem auditory implant; vagus nerve stimulation may have too many side effects; diet and physical activity, and acoustic stimulation are a few of the more promising areas of therapy development.
At Hears to U, we look at the big picture, and the whole body awareness, and try to find a type of therapy that works with your lifestyle, predicaments, and how tinnitus presents to you. If reading this paper or discussing therapy with us interests you, please feel free to schedule with us. We are happy to help and hear from you. Cheers,
Hears to U has previously covered theories on tinnitus, but research is continually underway worldwide, and we aim to keep you updated on the latest findings.
For those unfamiliar with tinnitus, it is the perception of sound (a ringing, buzzing, or another sound in one or both ears) in the absence of an external source. Sufferers “hear” the noise, but others do not. It can be acute or chronic and its severity can vary from mild to severely bothersome. That severity can change over time. Some individuals become accustomed to it and consequently report a reduction in symptoms. Others say the noise gets louder or more frequent over time. The cause remains unknown, and although there is no cure, it is possible to manage it.
The authors felt that a greater of understanding of the nerve, or neural, mechanisms underlying the disease was needed before more effective therapies could be developed. However, these changes experienced by the sufferers made it difficult to account for such variations in a research study. The various theories on tinnitus lead the authors in several directions. Changes in the peripheral and/or central nerve pathways for hearing have been attributed as one cause of tinnitus. Another theory blamed hearing loss for the development of tinnitus.
Tinnitus often occurs with other disease processes, like hearing loss. Tinnitus and hearing loss have complex relationships. A majority of tinnitus sufferers have decreased hearing sensitivity, but only about half of those with clinically diagnosed hearing loss also have tinnitus. Some believe that because hearing loss deprives a system used for stimulation (we constantly “hear” something), the tinnitus “sounds” fill that gap. However, that does not explain why about 20% of tinnitus sufferers have “normal” hearing and about 50% of those with hearing loss do not develop tinnitus. Complicated—to say the least.
The study hoped to identify objective biomarkers for tinnitus and to investigate anatomical connectivity changes within the white matter of the brain (where the nerve fibers are located) that may be associated with tinnitus. The study authors believed that they would be able to detect distinct pattern changes in the nerve pathways attributable to either tinnitus or hearing or both (if both conditions were present). This turned out to be true. The study suggests the possible existence of tinnitus-specific neural networks.
It supported the findings of other studies while adding new findings. The study was able to propose a possible mechanism to describe how tinnitus persists, involving areas of the brain playing a large role than previously discussed. It is important to note that this proposed mechanism applies only to people with both tinnitus and hearing loss. It is unclear what trauma or plasticity (pattern change) would induce the onset of tinnitus alone with no hearing loss.
For those who are suffering right now, this study, unfortunately, does not point to a pill or a therapy to make it all go away. To be fair, that was not the point of the study. The study added to our understanding of the condition, and the more that is known, the greater the likelihood of a “cure” or a therapy. If you are interested in reading the full article, contact us at Hears to U. And we are happy to work with you and your tinnitus.
Cheers, Karen M.
Tinnitus is a condition where individuals perceive sound without an external source.Managing tinnitus is difficult because it has no medical cause and it is highly individual. Each person with tinnitus has a different experience. It is estimated that around 10% of Americans live with tinnitus, and a portion of this group experiences burdensome or chronic tinnitus. Meaning that tinnitus causes various functional impairments in sleep, concentration, cognitive performance, and thought processing. It is also associated with an increased risk of psychological difficulties, including anxiety, depression, and reduced quality of life.
CBT is a psychological intervention that addresses unhelpful thought patterns and emotional reactions caused by tinnitus. The American Academy of Otolaryngology-Head and Neck Surgery, the intervention with the strongest research evidence is CBT. Despite the evidence, accessibility to CBT is limited because few healthcare providers have the knowledge and expertise to provide this therapy.
To overcome this barrier, an internet-based CBT was developed; initially in Swedish and later translated into German and English. The efficacy of internet-based CBT has been indicated in 9 clinical trials across Europe and the UK. However, no clinical trials had been done in the US. To address this, an internet-based CBT was adapted for the US to improve cultural and linguistic suitability. It was also translated into Spanish to serve the large Spanish-speaking population.
158 participants were recruited with 79 in the experimental group (these would receive CBT intervention) and 79 in the control group (who were monitored weekly). Each person participated for 8 weeks and then had a follow-up visit after two months. The study participants were randomly assigned to one of the two groups. Over the eight weeks, each participant’s tinnitus was measured weekly using the TFI (tinnitus functional index), while secondary outcomes (anxiety, depression, insomnia, tinnitus cognitions, and general quality of life) were measured using standardized questionnaires.
Participating in internet-based CBT led those with tinnitus to significantly greater improvements in tinnitus distress compared to weekly monitoring. This adds to the body of evidence regarding the feasibility of audiologist-guided internet-based CBT. The maintenance of these results was observed during the 2-month follow-up visit . Those in the experimental group, (undergoing CBT) resulted in a significantly greater reduction in negative tinnitus cognitions and insomnia.
There was not a significant reduction in anxiety or depression (this had been the case in other studies). This may be related to the exclusion of persons with severe mental health conditions, possibly reducing the ability to see an intervention effect.
Compounding the debilitating nature of severe tinnitus, accessible, evidence-based interventions are still lacking. The COVID pandemic highlighted the need for eHealth approaches to overcome the limited in-person contact and support available for people with tinnitus. These results have been encouraging and further work is indicated in view of making such an intervention applicable to a wider, more diverse population.
This is certainly encouraging news for those who suffer from tinnitus. If you have questions or wish to read the article, please contact us at Hears to U, Audiology.
Karen M.
We will discuss the types of habituation therapies that are available and what we like to do in our clinic in Minnesota.
An easy example of habituation is when you first walk into a bakery you smell the delicious smells of baking. If you worked in the bakery or were there for a long time, you would no longer smell the bakery as you have habituated to the buttery deliciousness. In this case, it is not a bad response of smelling deliciousness as we would like to keep smelling. But you get the point.
Because we don’t like tinnitus and the constant ringing in our ears, we want the sound to go away. The more we want the sound to go away and that it doesn’t go away we have a response that is less than desirable. The response can increase our stress, cause anxiety, and distract us from the good things in life. Because of the constant ringing, if not mindful of the stressful emotional response, it can turn into other undesirable, unhealthy outcomes.
We want to learn how to live with tinnitus in a mindful manner. In this definition, we talk about habituation as a psychological response to something that causes emotion or disruption in a person’s behavior. We would like the emotional response to be of calming nature to not worry about what is being heard in the case of tinnitus.
Habituation in tinnitus is then the addition of some other “sound” that floods the response to ignore the undesirable sound of the tinnitus.
1. Noise maskers – these can be played through apps, the phone, and other such products that can play noise including a fan. Noise maskers can also be in hearing devices or blue tooth streamers. They can also be on the level of modulated noise that sounds like ocean waves. Ocean waves in some devices can modulate faster or slower. Noise can be unfiltered and hence called white noise or of different filters such as pink, Brownian, blue, and so on. We notice that many people we have worked with chose the noise masker like the modulated “ocean” type noise.
2. Notch noise – is like the name implies, a notch in the noise centered around the area where the origin of tinnitus is being perceived. There is some evidence from Signia, a hearing aid manufacturer that this has been known to help tonal tinnitus.
3. Fractal tones – are non-harmonic tones that have been approved to help habituate tinnitus. They sound like chimes but have no musical value and are produced in a non-expected manner. The fractal tones are mostly inside the Widex brand hearing aid.
4. Environmental relaxing sounds – are also known to help people with tinnitus. This is a form of mindfulness and listening to the sounds around them instead of focusing on the tinnitus. Widex brand hearing aids now have relaxation tones with some mix of fractal tones. A good option.
5. Hearing aids – also help many people who report having tinnitus. And with the hearing aid, there are different tinnitus features that can help as mentioned above. Like noise types, notch types, fractal tones and even streaming from apps’ environmental sounds.
6. Filtered music – is also been known to help tinnitus. Right now we are looking for new technology here.
