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CBT and Tinnitus: The Missing Link?


"Myself is against me", by Jason Rogers, licensed under CC BY 2.0


Tinnitus sufferers, rejoice! While there is still no cure for tinnitus, researchers are exploring treatments that are likely nearly as effective. If your tinnitus is causing you distress, it is worthwhile to put the problem in perspective and consider how new approaches to symptom management might benefit you. 


Tinnitus and Its Consequences

Tinnitus is a symptom that is experienced as phantom ringing, buzzing, or hissing in the ears. Some hear a single frequency, whereas others hear a cacophony of tones and timbres–sometimes too many to count. Some are lucky to have it long enough that they are no longer bothered by it. For some who are even luckier, it simply goes away one day and never returns. Those experiencing tinnitus for the first time often dread the idea of never being able to enjoy true silence again. There are few rules with tinnitus, and at its worst, it has been implicated in insomnia, depression, and even suicide [1].


Snake Oil and Psuedoscience

For most sufferers, it is a long and frustrating process of finding any sort of relief. A cursory internet search will turn up several Youtube videos instructing viewers to massage their ears or play a static tone through headphones, as this is supposed to “cancel out” the tinnitus–for a few seconds, that is. There is no cure in the form of a medication, supplement, or herbal infusion, and anything claiming otherwise is stealing your time and money [2].


Causes and Speculation

Part of what makes tinnitus so confounding is that it can have so many causes, from something as simple as the buildup of wax in the ear canal to more serious conditions affecting surrounding tissue and blood vessels. Most cases of tinnitus are thought to be caused by damage to the inner ear, specifically the stereocilia, the tiny hair-like structures that line the inside of the cochlea. Tinnitus is then the brain’s counterproductive attempt to compensate for this loss [3]. However, recent research has challenged this idea, speculating that tinnitus could also arise entirely from the brain. This is supported by the connection between tinnitus and something called “visual snow,” a gradient of static that saturates one’s field of vision similar to a fuzzy analogue television. Unlike tinnitus, there are no treatments for visual snow, let alone a cure, and it appears to have nothing to do with damage to the eye or vision loss. Because 63% of those who have visual snow also report suffering from tinnitus, researchers hypothesize that both symptoms arise from a common hypersensitivity or dysregulation of neural pathways [4].


New Treatment

Now, a new, non-invasive approach to tinnitus management has emerged that avoids the obstacles of other treatments such as deep-brain implants. In the latest study to be heralded by the health news media, researchers tested the efficacy of two treatments for tinnitus and tinnitus-induced psychological distress [5]. They compared parallel groups, one using an app delivering cognitive behavioral therapy (CBT) sessions though a chatbot, and the other combining the app with real meetings with mental health professionals. The study reported significant improvements for both groups as measured by questionnaires assessing each participant’s perceived severity of their tinnitus as well as secondary symptoms like depression and anxiety. What is so remarkable about the treatment used in this study is not just that it changed subjects’ attitudes toward their tinnitus, but that this made the tinnitus itself less noticeable. With the increasing availability of CBT resources and more research to come, this might be the closest we have to a cure.


References:

[1] Han, Kuy Man et. al. (2018). Tinnitus, depression, and suicidal ideation in adults: A nationally representative general population sample. https://pubmed.ncbi.nlm.nih.gov/29406247/

[2] National Institute on Deafness and Other Communication Disorders. (2023). What is Tinnitus? — Causes and Treatment. https://www.nidcd.nih.gov/health/tinnitus

[3] Cleveland Clinic. (2022). Inner Ear: Anatomy & Function https://my.clevelandclinic.org/health/body/24340-inner-ear

[5] Bardy, Fabrice et. al. (2024). Delivery of internet-based cognitive behavioral therapy combined with human-delivered telepsychology in tinnitus sufferers through a chatbot-based mobile app. https://www.frontiersin.org/articles/10.3389/fauot.2023.1302215/full Assessed and Endorsed by the MedReport Medical Review Board


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