Treatment

No two cases of tinnitus are alike. A suitable, individual therapy therefore has to be found for each and every patient. The aim of all treatment is to enable patients not to perceive the distressing noises or at least to perceive them as less strong and less disturbing. Specialists speak of “uncoupling undesirable signals.” At the chronic stage, however, this uncoupling cannot at present by achieved by pharmacological intervention. What is needed is a holistic approach, which, in addition to competent therapy, requires continuous and active participation by the patient.

Tinnitus often has a specific cause (for example an acute acoustic trauma), which frequently damages the hair cells in the inner ear. At some point in time, however, tinnitus goes its own way. Then the brain no longer succeeds in filtering acoustic information out of perception as it normally does with other, unimportant background noises. The tinnitus then does not come “from the ear;” it occurs centrally – namely in the so-called limbic system, the seat of our emotional life, and in the autonomous nervous system and auditory cortex. For this reason, a tinnitus can persist even if the auditory nerve has been severed and no sound signals at all can be transmitted from ear to brain.

Chronic tinnitus can thus not simply be “switched off.” However, it has been shown that so-called tinnitus retraining therapy can teach patients to perceive it less intensively. The goal is habituation to the tinnitus and keeping it under control in everyday life. Luckily, this suppression of tinnitus works regardless of the possible cause.

Tinnitus retraining therapy does not promise a cure, but it can help enormously improve the patient's quality of life. One factor that contributes to successful therapy is that patients are no longer passive sufferers but contribute actively to their recovery or to improving their condition.

But what sounds so simple requires great commitment, and above all a great deal of understanding and yet more patience. Normally, tinnitus retraining therapy takes between twelve and twenty-four months. In any case, successful therapy is a team effort, involving interdisciplinary cooperation between doctors, psychologists, physiotherapists, orthopaedists, neurologists, and hearing aid acousticians – always with the determined cooperation of the patient.

Treatment follows a four pillar concept. It covers:

  • Counselling
  • Psychological accompaniment
  • Relaxation techniques
  • If need be: technical aids

Counselling

The most important pillar in tinnitus retraining therapy is individual counselling. This service is available to patients throughout the entire period of therapy. They are shown what causes, circumstances, and concatenations can lead to tinnitus and possibly to its intensification. Only with understanding and knowledge can they reassess their own situation, reduce fears, and attenuate suffering – and thus pave the way for further measures.

Psychological accompaniment

A second pillar is psychological accompaniment. Stress, inner tension, hidden conflicts, relationship problems, and depression frequently accompany and sometimes even cause the “vicious circle” of tinnitus. Discussion with psychological specialists can help identify stress-intensifying habits and develop strategies for overcoming them. Group work with other tinnitus patients is also be very helpful.

Relaxation techniques and audio therapy

Relaxation techniques make an integral contribution to tinnitus retraining therapy. They help with stress management and make it easier for the patient to handle his or her personal situation. Patients improve their ability to deal with the pressures of everyday life and enhance their quality of life. Ear training sensitizes them to the wide range of noise in our environment. By learning to no longer “listen inwards” but to turn their attention outwards, patients come to perceive disagreeable noises as less strong and disturbing.

If need be: technical aids

Maskers can help to avoid silence by generating permanent, quiet therapeutic noise. But must not be allowed to drown out the tinnitus. If habituation is to be successful, the tinnitus has to remain perceptible.