Tinnitus is the perception of a sound without an external source. How boring is that as a topic? That is what we as the authors of this linked manuscript thought until we did research on this topic and delved deep into clinical treatment during the past decade and more. We learned that it is a highly complicated phenomenon, which is intellectually quite stimulating. It can be a debilitating dysfunction with huge socioeconomic costs, but there is hope! 

Having said this, many ENT doctors will tell you that there is no cure. Based on today’s knowledge, this is correct, but there are treatment options against the suffering and distress caused by tinnitus. One of the authors (CD) experiences tinnitus since about 15 years, but does not experience tinnitus related distress and does not suffer. Why not?

In our recent paper published in Communications Medicine, we analysed longitudinal data from two day clinics in Germany.  We investigated the co-development of tinnitus-related distress and depressiveness throughout treatment. Our two clinics have in common that we focus exclusively on tinnitus in a one-week treatment based on interdisciplinary treatment involving ENT doctors, psychologists, physiotherapists, physicians for medical rehabilitation and audiologists. Using the power of two large samples and recently developed statistical methods, we show a strong bi-directional relationship between tinnitus related distress and depression supporting simultaneous treatment of both conditions. Our approach took psychosomatic symptoms into account and stressed a core depressive symptomatology independent of assessment artefacts.

So, what it is the problem with tinnitus? In our view, it is comorbidity. Several studies from our institutions, but also from other clinics, provide evidence that severely bothersome tinnitus is associated with other disorders. The primary outcome measure for tinnitus is one of several validated and standardized tinnitus questionnaires. These questionnaires distinguish between compensated and decompensated tinnitus. The latter is characterised by cognitive, emotional and physiological impairment and can lead to severe psychological decompensation. Decompensated patients suffer also from other dysfunctions like chronic pain, anxiety disorders, psychosomatic impairments and affective disorders, most notably, depression. These are typical patients treated in our clinics. On top of these disorders, many of them lead hard lives with psychosocial stress factors such as financial problems, care of relatives, grief or traumatic childhood experiences. Describing them as persons who experience a phantom sound, does not do justice to them. Fortunately, supported by our longitudinal data, we feel safe to say that our clinical approaches have robust, longstanding effects even with only a week of treatment. We focused in our recent paper on depression, but we assume that we would get similar results for a bidirectional relationship between tinnitus related distress and all comorbidities.
Thus, in our view, the problem with tinnitus can be only addressed in an interdisciplinary setting with a personalized approach. Currently, there is a neglect for comorbidity in tinnitus patients, but also with patients with a different primary disorder and comorbid tinnitus. We argue for a comprehensive approach fostering bi-directional treatment effects. Our data show that the problem with tinnitus is not the noise itself, but distress related psychosomatic symptoms and mood. When we see patients in follow-up appointments, many state “tinnitus does not play a role anymore”. One piece of the puzzle to reach this perspective is acceptance. This does not mean that there are no problems or reasons for distress, but rather that a fulfilled and happy life does not depend on a sound.