Psychotherapy for the treatment of tinnitus

Psychotherapy can help in the treatment of tinnitus. In Germany, around 10 to 20 percent suffer from ear noises.

(23.09.2010) In Germany, about 10 to 20 percent of the population suffer permanently from tinnitus aurium (lat. „the ringing of the ears“) or tinnitus for short. Forty percent have experienced such an ear noise at least once in their lives, with about one-third of older people being affected by constant tinnitus. A standard therapy that promises success, there is not yet. However, individualized treatments have already been successful in the past, helping many patients.

The Professional Association of German Neuro-Specialists (BVDN) currently points out that tinnitus retraining, a type of habituation and adaptation therapy, has recently achieved positive treatment results and that, under certain circumstances, psychotherapy should be used to combat the annoying ear noise. Therapist and patient try to get to the root of the disease and work together to develop methods to minimize the noise. Thus, psychotherapy can be quite helpful in chronic tinnitus patients. Accompanying relaxation methods are also considered useful in this context. Because stress is the most common trigger of tinnitus. In particular, if chronic tinnitus occurs together with other mental illnesses such as depression, psychotherapy offers a good treatment alternative, according to BVDN chairman Frank Bergmann. Because in these cases, the psychotherapeutic approach can treat not only tinnitus, but the entire clinical picture.

Tinnitus triggered by sudden noise, also called acute hearing loss, requires a different treatment. Here circulation-enhancing drugs are the first choice, to avoid that the single occurrence becomes a chronic tinnitus. The longer the tinnitus lasts, the higher the likelihood that it will persist permanently. While in most cases the sounds perceived by the patient have no external source perceptible to others, there is also objective tinnitus. This relatively rare form of tinnitus is based on an externally perceptible or at least measurable body-own sound source. For example, objective tinnitus may be coupled to the pulse rate, which is referred to by the experts as pulse-synchronous ear noises. “The sound is real. Often, the doctor can also hear it when he puts his stethoscope on the neck or behind the ear”, explains Professor dr. med. Erich Hofmann, Director of the Department of Diagnostic and Interventional Neuroradiology at the Fulda Hospital. This is a propagated noise from the blood vessels, the expert continues.

Here surgical interventions are usually required, but also promise a relatively large success in treatment. For example, patients with calcification of arteries (arteriosclerosis) leading to narrowing in the carotid artery can be helped with a stent. If, in those affected, a connection between the carotid artery and the adjacent vein is the cause of objective tinnitus, physicians may “use a catheter (...) to glue the affected vessels in such a way that the short circuit between artery and vein is removed”, explains Prof. Hofmann. Certain tumors that cause ear noises can be treated relatively well according to the expert. But there are also cases of objective tinnitus for which no treatment is known. This is more often the case, for example, when the carotid artery passes through the middle ear in patients from birth and this causes objective tinnitus. The causes of pulse-synchronous ear noises as well as the diagnosis and therapy with the aid of imaging techniques will be a focus of the annual conference of the German Society of Neuroradiology (DGNR) “neuroRad 2010” in Cologne.

Among the experts, the classification of tinnitus as a separate disease is considered problematic. Because the ear noises are usually symptom of another disease. Therefore, if therapy focuses only on tinnitus repair but not on the cause, it is unlikely that the patient will be helped. So it is hardly surprising that none of the numerous treatment methods so far could prevail as scientifically sound and promising. Because depending on the cause of tinnitus it requires a correspondingly different treatment. The psychotherapeutic approach, however, offers a good alternative in this regard, as the likelihood of finding the cause of tinnitus is relatively large. (Fp)