In this second blog on tinnitus, we will explore the benefits of several therapies in reducing and managing symptoms of tinnitus. As with any other type of condition, a combination of multiple treatments has been shown to offer the most effective and comprehensive treatment. Therefore, we will discuss the benefits of cognitive-behavioral therapy (CBT), tinnitus retraining therapy (TRT), masking devices, and biofeedback.

Clinical studies show that Cognitive behavioral therapy (CBT) helps in retraining the way we respond and react to our perceptions of tinnitus which can often be catastrophizing in nature. The application of CBT in the treatment of tinnitus presents a promising avenue, given its ability to mitigate anxiety associated with symptoms through the alteration of one’s cognitive outlook, helping the individual to accept the noises, which after a while may become less noticeable. 

During a therapy session, the therapist may apply cognitive behavioral therapy techniques such as cognitive restructuring, relaxation training, imagery techniques, and exposure therapy to the tinnitus sounds. In this manner, desensitization, acceptance of the condition, and exposure to the tinnitus sounds help retrain the brain to not perceive the tinnitus sounds as a threat or as a disturbance, where the individual will eventually hardly notice the tinnitus sounds.

Based on the assumption that tinnitus results from abnormal neuronal activities (explained in the previous blog post), Tinnitus retraining therapy (TRT) is a special type of treatment, involving a combination of more intense sound therapy and focused and in-depth counseling that aims to habituate the auditory system to the tinnitus sounds, retraining the way the brain responds and perceives tinnitus on a conscious and subconscious level. 

TRT therapy is divided into two main components: directive counseling and sound therapy. Directive counseling is done on an individual level, aiming to educate individuals about the auditory system and explain the mechanisms behind tinnitus. During sound therapy, a device is inserted in the ear to generate low-level noise and environmental sounds that match the pitch, volume, and quality of an individual’s tinnitus.

Masking devices are additional effective treatment options. How do these devices work? In an effort to diminish the experience of tinnitus, masking devices are utilized in a manner similar to hearing aids. These devices produce gentle white noise which works towards reducing one’s perception of tinnitus sounds. Moreover, they even provide relief from the distressing symptoms for some time after their usage has been discontinued – known as residual inhibition. Also, masking strategies, like setting a radio at low volume or turning on a white-noise machine in the background, can be a starting point before committing to a more expensive alternative.

Because tinnitus can be very stressful, and stress only worsens the condition, biofeedback can be yet another helpful technique to manage tinnitus. Biofeedback is a relaxation technique that uses electrodes attached to the skin to feed information about physiological processes such as pulse, skin temperature, and muscle tension into a computer, which displays the output on a monitor. By learning how to alter these processes and changing their thoughts and feelings, the individual reduces the body’s stress response to tinnitus.  

I have found that, apart from the above components, when I add hypnosis and the Bhramari yoga practice to the mix, outcomes have been beneficial.

If the onset of the tinnitus has been around a particularly stressful life event, then tackling the emotional distress using a trauma-informed approach is a key component of the treatment. Interestingly, many patients with tinnitus report lower levels of tinnitus when they are prescribed anti-anxiety medications, indicating a strong link with stress. The use of anti-anxiety medication cannot be a long term treatment due to adverse side effects. Hence, stress management is important.