The Tinnitus Self-Treatment Revolution
How technology is bringing tinnitus treatment into the hands of the people that need it most
06 July 2020
Tinnitus is a lot more common than you might think. It is estimated that around 15% of the US population will experience tinnitus at some point in their lives, with 2 million likely to be extremely distressed by the sounds they hear. In the UK around 1 in 10 of us have tinnitus. There is no cure, and access to treatment is limited. For a condition as debilitating as tinnitus, I don’t think this is good enough. There needs to be more help at hand.
A young woman suffers from tinnitus
To illustrate the extent of the problem, I’m going to describe a common scenario for people with tinnitus.
You’ve started hearing noises. Over the last few weeks you were exposed to some loud noises at work and the ringing in your ears that you’ve had for a few months is getting a lot worse. It’s affecting your sleep and you’re struggling to concentrate. You’ve tried every online solution, every app and YouTube video. You’ve scoured internet forums. You need help.
You go to see your doctor, who refers you for a specialist opinion with an Ear, Nose and Throat (ENT) surgeon. If this is your first appointment, they might request some tests to ensure there’s no concerning cause. In most cases these tests will be normal. It’s nothing serious. You have nothing to worry about.
But this is something to worry about! You’re exhausted from a lack of sleep and are struggling at work. How are you going to cope with this for the next 6 months, let alone the rest of your life?
You persuade the ENT surgeon to refer you for Cognitive Behavioural Therapy (CBT). You wait three months (in many cases longer) and drive to the hospital for your appointment with the tinnitus therapist. It’s a 45-minute consultation and the first 15 minutes are spent talking through how your tinnitus started.
The remainder is spent talking through the therapy. There’s a lot to cover in half an hour and you can’t help but feel things are a little rushed. But you start to feel better about the tinnitus and are beginning to understand how the therapy can help. You leave with your questionnaires and behaviour exercises to do as “homework” before the next session
You return for the second and final session and go through the points that were discussed previously. You go through some of the exercises that you were asked to practice. You found that these had helped, and it’s becoming clearer now how CBT works and how it can help you to better control coping with tinnitus. However, the time goes quickly, and the session comes to a close.
As you walk out of the door, the enormity of what has just happened hits you. You have a condition that is permanent, you’ve just had all the treatment that is available to you, and you’re on your own. What next?
In the UK, this is a common scenario for those lucky enough to see an NHS tinnitus therapist. The number of CBT sessions provided will often be 1 or 2 and, although these can be hugely beneficial, this is often not enough.
There is always the option of paying to see a therapist privately. Hearing Therapists and Audiologists specialising in tinnitus management are hugely experienced and often achieve excellent results. Unfortunately, the cost and the time makes them a luxury many cannot afford.
The only remaining option is self-management.
Self-Management – What are the options?
There are a number of mobile apps that exist for tinnitus treatment. There is also a wealth of educational resources available. Online communities, such as Reddit, have active tinnitus forums. Management techniques and self-help treatments are discussed there regularly.
The British Tinnitus Association also provides a valuable resource for people with tinnitus. They provide a traffic light system for each treatment that has been advertised to work, showing both the safety of the treatment and its effectiveness. For my American friends, check out the American Tinnitus Association.
Up until recently the majority of these apps were used as masking devices. However, over the last few years we’ve seen a number of companies innovating with sound therapy, and there are perhaps three key players that have had an impact so far.
Tinnitus Calmer is a free app created by Beltone, an US-based hearing aid manufacturer. Its content is split into three sections – Sounds, Relax, and Learn. In Sounds, there are a large number of customisable sounds for you to make use of, and then save for use later. There is plenty to choose from, and this means that you should be able to find suitable sounds to help you with your own tinnitus.
Screenshots from the Beltone Tinnitus Calmer App
Relax is focused on you using techniques we know to reduce the stress associated with tinnitus. There are some basic meditations, breathing exercises, and suggestions to set up reminders for stress relieving activities, such as meeting a friend for coffee or spending some time outdoors.
Learn, as you might imagine, aims to teach users not only about tinnitus itself, but about other coping strategies that might be useful. For example, there is a small section devoted to CBT, and another with some easy to digest information for those whose tinnitus is interrupting their sleep.
Calmer is a great place to start for tinnitus self-management, and will introduce you to a number of techniques that you can begin to use to help cope with your tinnitus. There’s a lot of potential for new features to be added and more content, and I hope that Beltone will continue to add further sounds, meditations and relaxation sessions.
Editor’s note: ReSound, Beltone’s sister company, offers a similar app named ReSound Tinnitus Relief.
Immersive Therapy is a French company that has approached tinnitus therapy a little differently. They have developed an app called Diapason (which is the French word for tuning fork – aptly named I think!). The user is first prompted to fully explore their own tinnitus, in matching both the frequency, and the character and volume of the sound that they hear. The app asks questions about how the tinnitus is affecting the user’s life. The aim is to help gain insight into their tinnitus and understand how it is affecting them, before moving on to the therapy.
Screenshots from the Diapason for Tinnitus app
The main type of treatment that is delivered in the app is focused on sound therapy. The idea behind sound therapy is that your hearing system becomes accustomed to the sound of your tinnitus. Immersive Therapy has done a great job of “gamifying” this therapy, and the user is prompted to take control over their own treatment, completing a small amount each day at a time of their choosing.
Diapason also introduces elements of CBT into the treatment, by aiming to associate your tinnitus with positive thoughts (as opposed to negative – which is what usually happens when we think of tinnitus). This is rather different from the way in which CBT is usually delivered (face to face with a trained therapist) and this approach could work well for many within the app.
The overall idea is that in using the sound therapy, users will become habituated to the sound of the tinnitus over time, and as such the impact on their life will be reduced. The user interface is pleasant and does a good job of making sound therapy fun (a potentially boring exercise) and is therefore a great option for users looking to start with sound therapy treatment. However, there is a fee to access the full app, which at €149 (£133 or $169) per year is costly for some. There is currently no option to pay via a monthly subscription.
T-Minus is a free app that really stands out when it comes to personalised sound therapy. There is a huge variety of sounds that you can access, and in addition to the standard fractal tones and nature sounds, you can also choose from a number of live and unlooped recordings taken from around the world. T-minus provides excellent customisation for those wishing to combine sounds, add an overlying white, brown or pink noise, or increase the volume in a particular ear.
Screenshots from the T-Minus app
Learning meditation and mindfulness has never been easier. Headspace and Calm in particular are two companies that have done an excellent job of bringing these techniques to the consumer and helping you to incorporate mindfulness into your life. Multiple scientific studies have been done to demonstrate the effectiveness of this in a number of areas. Perhaps most relevant for people with tinnitus is that meditation and mindfulness have been shown to significantly reduce stress. This we know to help with tinnitus and reduce its overall impact. Other benefits include improved mood and sleep.
Screenshots from the headspace app
However, mindfulness and meditation have the most benefit for people with tinnitus when they are approached in relation to the tinnitus itself. This is known as targeted mindfulness. Unfortunately, there is no way to do this using the mindfulness apps currently available.
YouTube (and other online resources)
The internet is filled with resources that many find useful for managing their own tinnitus. A quick search on YouTube will give you thousands of videos, ranging from simple advice and explanations, to treatments such as sound therapy or CBT.
In this talk Josef Rauschecker illuminates the science behind tinnitus as well as the current state of treatment options. Closed captions are available on this video. If you are using a mobile phone, please enable captions by clicking on the three small dots.
For CBT alone there are a number of resources that you might find useful, and many find that the best approach is working through the videos and seeing what is beneficial for you. There are obvious drawbacks to a simple YouTube video, but provided that your expectations aren’t too high there is a huge variety to select from. The recommendation is that you don’t try them all at work—this might worsen your stress!
Where to start?
Due to the quantity of digital resources available, it is best to gradually work your way through what is available. Everyone is different and not everything will work for you, but much of it might help. The aim should be to work out what helps you, and how to best incorporate this best into your life. It can be frustrating to try lots of different things, to find that none of them helped you. Therefore, it is best to approach tinnitus self-management with an open mind, and not try too many things at once. Make a note on your phone of things that you have tried, and whether it works (such as different sounds on an app, or a technique described in a YouTube video). This way you’ll build a bank of techniques that you can use when you need them most.
Where next for tinnitus self-treatment?
We’ve found that despite limited access to treatment delivered by a healthcare professional for people with tinnitus, there is a wealth of resources and self-help options made available by technology. However, in the mobile market there is still plenty of space for innovation. Despite some excellent offerings for sound therapy and masking, no mobile app has convincingly brought all therapies that we know to work, such as CBT or targeted mindfulness. Many apps do provide an introduction to these, but the user must decide when and how to engage with them.
Much of the difficulty with tinnitus self-treatment is having to decide when and where to use each treatment. To solve this problem new products must bring together therapies we know to work and deliver them progressively so that they best complement each other.
Stay tuned for my next post on the future of tinnitus self-treatment. I will provide some background on what my team at Oto Health are working on.