Advances made in Understanding and Treatment of Tinnitus

Stimulation with Electricity

Direct electrical stimulation of the inner ear has shown promise for treating tinnitus. Early research showed that the delivery of electrical current to the cochlea by an electrode reduces tinnitus in some patients. (Aran et al.. 1983: Kuk et all.. 1989)

Furthermore, many patients who receive cochlear implants to treat profound hearing loss also report that their tinnitus is reduced when implants are activated (Tyler 1995, Miyamoto and Bichey 2003.) (Cochlear implants stimulate the cochlea with an electrode array). Research has now begun with the intent of creating cochlear implants specifically for tinnitus (Rubenstein et al.. 2003).

Habituation

Smalls, visual images, tactile (touch) sensations, and sounds that do not change and are unimportant are eventually ignored. For example, rarely do we think about the pressure of clothing on our skin, unless it is brought to our attention. Often the sound of the refrigerator in the kitchen is not heard until the motor turns off. This unconscious decrease of attention is referred to as habituation. Many people with tinnitus do not attend to the sound that is, they have habituated the tinnitus. Hallam (1989) proposed that people who have difficulty with their tinnitus have failed to habituate it. This theory also implies that people with continuous tinnitus usually have less difficulty than those with intermittent tinnitus. It also suggests that counselling can help reduce the fear or importance of tinnitus.

Attention

Tinnitus is also considered an attentional problem. Objects that are unusual, important, or are prominent tend to 'grab' our attention. Treatment that makes tinnitus appear less important, unusual, or prominent could be advantageous.

Cognition

Some researchers think of tinnitus as a cognitive, or thinking problem. For example, believing that we could not make a putt on the golf course, or that we could never learn to ice skate could very easily influence our chances of success at those endeavours. Some people with tinnitus develop negative thoughts about their tinnitus, for example, that it is a precursor to hearing loss or that it represents the beginning of a terrible disease. This negative thinking can make it more difficult to adjust. A variety of cognitive therapies have been developed to help people rethink their thoughts about tinnitus (Sweetow 1986).

Learning

 Learning theory suggests that rewarded behaviour is more likely to occur again. For example, if our partners are very appreciative when we buy them flowers, we are more likely to buy them flowers in the future. The reverse might also be true. If you received 'bad news' the last five times you answered the doorbell (i. e. report of a car crash) you might automatically have a negative reaction the next time the doorbell rings. That is a learned response. (Jastreboff and Hazell 2000).

Counselling

Many early counselling procedures focused on providing information to patients (Hallam 1989: Tyler et al.. 1989: Jastreboff and Hazell, 1993). Newer procedures evolved from cognitive therapy and are effectively helping people cope with pain and depression. Based on the pioneering work of Hallam (1989) abd Sweetow (1984) a new, well-defined protocol, cognitive-behavioural therapy, has been implemented and tested by Henry and Wilson (2001a.b). There is even newer research into counselling treatments that focus on aspects of a patient's life, not just on the tinnitus, and require active participation by the patient (Tyler et al.. 2004).

Sound Therapies

The use of low-level sounds to help patients with tinnitus has evolved into a variety of sound therapies. Jack Vernon (1977) was a pioneer in this area, being one the first to suggest such an approach. There are now many types of sound therapy, all of these therapies aim to reduce the contrast and decrease the prominence of the tinnitus.

Background environmental sounds and music have been used by patients for many years. Tinnitus Masking Therapy, using both partial masking and complete masking was introduced in the 1970's and '80's (Hazell and Wood, 1981: Hazel et al.. 1985) Jastreboff and Hazell (1993) developed Tinnitus Retraining Therapy, where a noise is presented at a 'mixing point' to blend with the tinnitus. A new sound therapy uses specially processed music and noise are combined. Of course, all sound therapies are accompanied by some form of counselling.

 It is exciting to see so many researchers now considering the challenges of tinnitus, and so many clinicians sincerely willing to help tinnitus patients. Tinnitus is a complex problem, which is why the search for a cure requires systematic and innovate research.

We now have a solid understanding of many of the psychological and physiological aspects of tinnitus. New treatments being studied, including magnetic brain stimulation and direct electrical stimulation of the inner ear, may one day actually 'switch off' the tinnitus.