Tinnitus management

Tinnitus management


Tinnitus is characterized by persistent ringing, buzzing, hissing, or other similar ear noises. It is a symptom, not a disease. This sensation is typically heard only by the individual experiencing it and is not caused by an external sound. Tinnitus can be  temporary or chronic and can range in severity from a mild annoyance to a debilitating condition that affects daily


There are several potential causes of tinnitus, including exposure to loud noises, ear infections, head or neck injuries, age-related hearing loss, and certain medical conditions such as Menière’s disease (MD) or temporomandibular joint (TMJ) disorders. Hearing loss is the most common cause of tinnitus, but not all patients who suffer from tinnitus have hearing loss. In some cases, tinnitus may be a side effect of medications or result from high stress or anxiety levels.

Treatment options for tinnitus vary depending on the underlying cause and severity of symptoms. Some individuals may find relief through sound therapy, counselling, relaxation techniques, or hearing aids. More invasive treatments, such as cognitive behavioural therapy or surgically implanted devices, may be considered in severe cases where tinnitus significantly impacts the quality of life.

Comorbid conditions of tinnitus

Tinnitus is commonly associated with comorbid conditions such as anxiety, depression, insomnia, and hyperacusis. The constant presence of tinnitus can lead to feelings of anxiety and distress, as individuals may struggle to cope with the persistent noise in their ears. This can further exacerbate conditions such as depression, as the emotional toll of living with tinnitus can be overwhelming.

Insomnia is also a common comorbid condition with tinnitus, as the constant noise can make it difficult for individuals to fall asleep or stay asleep throughout the night. This lack of sleep can further contribute to feelings of anxiety and depression, creating a vicious cycle of negative emotions and poor sleep.

Hyperacusis, a condition in which individuals have a heightened sensitivity to sound, can also be associated with tinnitus. This can make everyday sounds seem louder and more bothersome, adding to the overall distress of living with tinnitus.

The self-perception of tinnitus

Tinnitus loudness cannot be measured. The Tinnitus Handicap Inventory(THI) is an internationally standardised questionnaire that assesses a patients subjective perception of tinnitus. It is a valuable tool in helping healthcare professionals determine the impact of tinnitus on an individual’s quality of life and can be used to guide treatment strategies for managing comorbid conditions associated with tinnitus.

Tinnitus Retraining Therapy (TRT)

Tinnitus Retraining Therapy (TRT) is a therapeutic approach that aims to help individuals manage and reduce the perceived severity of their tinnitus symptoms. TRT combines sound therapy with counselling to help patients habituate to the sounds of their tinnitus and reduce the emotional distress associated with it.
The sound therapy component of TRT involves using low-level, broadband noise to provide a constant background sound that helps reduce the perception of tinnitus. This sound is often delivered through devices such as hearing aids or sound generators worn by the patient throughout the day.

The counselling component of TRT helps individuals reframe their thoughts and feelings about tinnitus, promoting a more positive and accepting attitude towards the condition.

Counselling also aims to help patients develop coping strategies and stress management techniques to better deal with tinnitus-related anxiety and frustration.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is an effective treatment for tinnitus. CBT for tinnitus typically involves identifying and challenging negative thoughts and beliefs about the condition, as well as learning coping strategies to manage the symptoms.

One key component of CBT for tinnitus is cognitive restructuring, which involves replacing negative thoughts and beliefs about tinnitus with more positive and realistic ones. This can help reduce the emotional distress and anxiety that often accompany tinnitus, making it easier to cope with the symptoms.

Another important aspect of CBT for tinnitus is developing relaxation techniques and stress management strategies. Stress and anxiety can exacerbate tinnitus symptoms, so learning how to relax and manage stress effectively can help reduce the intensity of the ringing or buzzing
in the ears.

Tinnitus, the bottom line

Tinnitus is common. There is always something to be done for tinnitus. There is no “wonder drug” or treatment. A patient with tinnitus should never be told to live with it.

Tinnitus Questionnaire