Tinnitus: The long road to a cure
In an age where there are seemingly no limits on scientific endeavours, a cure for tinnitus is still, unfortunately, a dream that is some way off.
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By Sam Teesdale
While there have undoubtedly been advances in the management of the condition, tinnitus remains underfunded and somewhat neglected, in the context of wider modern medicine.
Tony Kay is the President of the British Tinnitus Association (BTA), the only charity in the UK dedicated solely to supporting people with tinnitus.
Tony explains how it’s wrong to think of tinnitus as having one day having a singular cure.
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As tinnitus has many possible causes, it is likely to have many different cures. (Image: Wix)
“Do I think there will ever be a cure? The answer to that question is cures - plural. Tinnitus is a complex condition. It's a symptom, not a disease on its own, so it has many different causes and therefore could have many different cures," He explains.
“Sometimes tinnitus can be cured if it's caused by something we can detect and treat. For instance, if it's due to high blood pressure and your blood pressure is reduced by a change in lifestyle, diet and or medication. The pressure comes down to normal and it may stop your tinnitus. Well, there’s a cure in that sense.
“When people state ‘there's no cure for tinnitus’, what they mean is chronic tinnitus. Tinnitus which seemingly has no direct cause, and there's no specific or meaningful switch off for it.”
Science has yet to provide an 'off switch' for chronic tinnitus. Chronic tinnitus includes a wide umbrella of different noises and sounds, detailed below.
Data & Analysis: Sam Teesdale
The Available Options
“The main treatment options for tinnitus are managing hearing loss, managing the tinnitus-related distress through talk therapy and using sound therapy," Tony says.
“A hearing aid may be important. If you're hard of hearing and you've got tinnitus, you're not hearing the sounds around you. If you put one in, it can reduce the impact of the tinnitus because you're hearing better.”
While physical treatments, such as hearing aids, can improve the quality of life for some, evidence suggests that psychological interventions are the most effective form of treatment.
Hearing Aids are a popular choice for people with hearing loss and tinnitus. (Image: Wix)
There has, in recent years, been a new standard of care when it comes to discussions concerning mental health, between practitioners and people with tinnitus.
Guidance released by the National Institute for Health & Care and Excellence (NICE), provides a clear guide for practitioners to follow when talking to people with tinnitus.
This framework places mental wellbeing at the core of patient care, as it aims to stop tragic stories, such as Glen Mitchell’s from happening again. Stories such as Glen’s, occur when a debilitating condition (such as severe tinnitus) intersects with poor quality care from doctors.
Tony describes how medical professionals, such as GP's, are becoming more sensitive to the issues surrounding tinnitus and poor mental health.
“In the past, the clinical conversation might have been there. Conversations such as:
‘You've got a noise in the ear, what does it sound like?’
‘A high pitched whistle.’
‘How often do you hear it?’
‘All the time.’
“But, the impact on the quality of life perhaps wasn't assessed adequately enough. The NICE tinnitus guidelines make it quite clear that you should have that conversation about how the tinnitus may impact their mental health.”
This change in guidance as to how practitioners should interact with their patients shows a marked and welcome move towards greater congruence between tinnitus sufferers and the professionals who treat them.
Tony discusses the importance of counselling, as well as support groups when it comes to managing the effects of tinnitus.
“Most tinnitus management options are of a combined approach, but the active ingredient in treatment is talk therapy and counselling. The therapy with the most amount of evidence is Cognitive Behavioural Therapy (CBT) because evidence shows that this type of therapy is more effective than any other.
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“I'm a big advocate for group support because you can't beat the power of individuals sharing. Alcoholics Anonymous is huge. I've got many patients who've told me if it wasn't for the AA, they wouldn't be here. It's exactly the same for tinnitus."
Aside from the more conventional forms of therapy and support, lies Hypnotherapy. It is a method of therapy that utilises Hypnosis and positive suggestions, to alter the way a person perceives their thoughts.
Lorraine McReight is a licensed hypnotherapist from Hebden Bridge and has extensive experience with treating individuals suffering from tinnitus. She details how she approaches tinnitus from the perspective of a hypnotherapist.
"The active ingredient in treatment is talk therapy and counselling"
Lorraine uses 'positive imagery and suggestions' to relax her clients (Image: Wix)
“I teach people relaxation techniques using hypnosis. Helping them with hypnosis is effective because hypnosis includes messages; such as the reduction of symptoms, as well as messages of acceptance.
“People with tinnitus often suffer from depression or anxiety, others often feel really angry. So, helping them with acceptance makes a huge difference to their symptoms because they're not fighting, and they're not angry - they're calmer.”
Although there is a relationship between mental wellbeing and tinnitus, Lorraine concedes that there is still a way to go in regard to how therapists and counsellors view the condition.
“There's a lot of people, even hypnotherapists, who don't really understand the condition.
“We're not medical doctors, so we can't claim to cure anything, but it makes a significant impact for most people. A lot of people just don't know about it - they think that because it’s a condition for which there is no medical cure, there's no effective therapy,” Lorraine explains.
Concrete, scientific evidence for the effectiveness of hypnotherapy as an option for tinnitus is sparse. However, there is little doubt that hypnotherapy works as a way of relaxation and reducing stress.
Chronic underfunding
Research shows that the average tinnitus patient costs the NHS £717 per year, equating to a yearly total of £750 million. Overall, this figure represents 0.6% of the National Health Service’s yearly budget.
This figure is surely set to grow, as the prevalence of tinnitus in the general population rises. The BTA estimates that 'the societal cost of tinnitus to the UK is in the region of £2.7 billion' every year. Therefore, the economic imperatives to find an effective cure for chronic tinnitus have never been higher.
Sadly, these economic incentives seem to fall on deaf ears among investors, in the effort to find a cure.
When comparing the amount of yearly research involving tinnitus, against research involving depression, it is not hard to see a gulf appearing between the two conditions.
(Data: PubMed)
The graph above shows there were over 40 times more studies involving depression than tinnitus, as of 2020. Although studies concerning tinnitus are slowly beginning to increase, the difference in interest between the two conditions is plain to see.
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The number of tinnitus-related studies appears to remain flat, while studies involving depression see a consistent and sharp annual increase.
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So, why does this vast gulf in research funding and research output exist?
Nic Wray has worked as a Communications Manager at the BTA for over 10 years.
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“Many people just don't understand how devastating tinnitus can be. I think, to some extent, medics are the same. Tinnitus has so little research funding, compared to other chronic conditions like anxiety, depression, and so on.
“There isn't a cure. It does come down to management techniques, but these management techniques don't necessarily work for everybody.”
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Don Mcferran, an ENT surgeon and tinnitus researcher, explains why the gap in tinnitus funding is so pronounced.
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“Tinnitus just isn't getting a big slice of the healthcare pie. Compared to what it's costing, it's not getting an equivalent back in research funding.
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“The main reason I could give for this is that there isn’t a ‘test’ for tinnitus. If we could say to patients, ‘your tinnitus is 7.5 on the tinnitus scale today.’ Then we would be able to see objectively whether our treatments were working for them."
He elaborates on why researchers in the medical and scientific community are reluctant to focus their efforts on tinnitus.
“The hearing/research people don't like tinnitus because it's got too much of a psychological side. There's a lot of anxiety and depression that comes with the condition. The mental health people don't like it either, because it's got the hearing and audiological aspects to it. So I think it does fall between two research camps.”
As Covid continues to dominate media and public discourse, it is easy to forget other, arguably less 'urgent' conditions. For many people, a cure for the condition simply isn’t a top priority.
The BTA estimates that there are 1.1 million people in the UK living with severe tinnitus. That’s 2 per cent of the entire adult population of the United Kingdom, living with a condition that can have a substantial impact on quality of life.
2% of the population and yet their stories are seldom heard in the media. As a society, we must do more to make their stories and struggles heard. For these people, a cure for tinnitus simply can't come soon enough.
"Tinnitus just isn't getting a big slice of the healthcare pie"