Tinnitus – a constant, often intrusive sound perceived by the patient without an external source – is one of the most challenging complaints in audiology.
With over 25 years of experience in this fascinating field, my mission is not only to treat hearing problems but also to understand the human body and brain in their entirety.
Tinnitus is not a single, isolated issue; it is a complex interplay of physical, cognitive, and emotional factors. Recognizing and embracing this complexity is crucial, without creating the illusion of a quick fix.
My motto is: “Hearing is more than just the ears.”
The body as a starting point
The first pillar of tinnitus treatment is the body itself. Physical causes can lay the foundation for perceiving tinnitus. Examples include:
Clicking of small muscles in or around the ear
Blood flow noise from a vessel close to the ear
An earwax blockage, a cold, or neck and shoulder tension
In some cases, tinnitus is objective, such as with muscle spasms or vascular causes. This makes a thorough medical evaluation essential.
For instance, if tinnitus stems from neck or jaw tension or an earwax blockage, it is crucial for a specialist to investigate and address it where possible. However, this direct approach alone is often insufficient. Equally important is giving patients insight into the bigger picture: how other factors, such as stress and thoughts, contribute to their tinnitus experience.
It’s not just about addressing a physical trigger but also about showing how intricate and multifaceted hearing is. This broader understanding can help patients see that tinnitus is more than an isolated issue and that its solution requires a comprehensive approach.
The power of knowledge and perception
The second pillar focuses on information and interpretation. How someone thinks about tinnitus plays a critical role in how the complaint is experienced. Thoughts like “this shouldn’t be here” or “it’s only getting worse” amplify the complaint. This aligns with the fear-avoidance model of Vlaeyen and Cima, which describes how negative interpretations of bodily sensations can lead to fear and avoidance, worsening the complaint.
Current offerings such as apps and self-help books often focus on eliminating tinnitus. This creates false expectations that tinnitus can be ‘solved’ or even ‘cured,’ whereas the reality is much more complex.
The key is to teach people how to change their relationship with tinnitus, rather than trying to fight the sound itself. Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT) provide tools to accept the sound, change dysfunctional thoughts, and focus energy on meaningful life goals. Studies show that ACT and CBT are effective in reducing tinnitus-related stress and improving quality of life (Hesser et al., 2015; Cima et al., 2014).
The glass of life and balance
The third and perhaps most important pillar is finding balance in life. The metaphor of the glass is apt here: when stress, worries, and tensions fill the glass, tinnitus can be the final drop that causes the glass, or proverbial bucket, to overflow. The sound then becomes a symbol of a broader underlying issue of overload.
In this context, it is crucial to focus not just on tinnitus but on the entire system. How does someone feel overall? What are the stressors in their life? What role do sleep, movement, and relaxation play?
As professionals, it is our task to map all these factors. It is important to guide patients in recognizing the different ‘dials’ they can adjust. While direct causes like earwax or jaw tension can be addressed, we must also provide patients with insight into the bigger picture. By making them aware of the role of stress, thoughts, and balance in their lives, we help them not only to understand their tinnitus but also to appreciate the complexity of their auditory system and its connection to their overall well-being.
Control over the complaint, not over the tinnitus
In tinnitus treatment, the goal is not to gain control over the sound itself but to gain control over the complaint as a whole. This distinction is essential to help patients break the sense of powerlessness that often accompanies tinnitus. Powerlessness arises when people feel they have no control over their situation. This feeling can be exacerbated by the constant focus on the sound and the search for a solution that may not exist.
ACT and CBT help people replace this powerlessness with resilience and a sense of agency. By focusing on what is within their influence – such as how they deal with thoughts, emotions, and stressors – room for recovery emerges. The goal is not to eliminate tinnitus but to teach patients how to reshape their lives despite the sound. This shift in focus from tinnitus to finding balance and meaning significantly reduces the perceived burden of tinnitus.
Regional collaboration: The key to success
A holistic approach requires collaboration across disciplines. In our audiology center, we work together with:
Hearing aid specialists: to address hearing loss and related issues
General practitioners and ENT specialists: for medical diagnostics and referrals
Physical therapists and manual therapists: for physical causes such as neck and jaw tension
Psychiatrists, psychologists, and ACT trainers: to address the mental aspects of tinnitus
Creative therapists specializing in dance and movement: to use the body as a tool, employing breathing techniques and body awareness to help patients break free from the vicious cycle of stress and tinnitus
This multidisciplinary approach ensures that we not only address the symptoms but also tackle the deeper causes and triggers.
Conclusion: The power of an integrated approach
Tinnitus is not an isolated problem but a complex interplay of physical, cognitive, and emotional factors. A quick fix does not exist – what works is a thorough, scientifically grounded, and multidisciplinary approach. The goal is not to eliminate tinnitus but to teach people how to live with it and rediscover balance in their lives.
By collaborating with general practitioners, hearing aid specialists, physical therapists, and psychologists, we create a network that truly helps people with tinnitus move forward. This approach requires time, patience, and expertise but ultimately delivers the most sustainable results.
Baguley, D. M., & McFerran, D. J. (2011). Tinnitus: A multidisciplinary approach. Wiley-Blackwell
Cima, R. F. F., Maes, I. H. L., Joore, M. A., et al. (2014). Specialised treatment based on cognitive behaviour therapy versus usual care for tinnitus: a randomised controlled trial. The Lancet, 379(9830), 1951–1959
Hesser, H., Gustafsson, T., Lunden, C., et al. (2015). A randomized controlled trial of Internet-delivered ACT for tinnitus distress. Behavior Therapy, 46(5), 661–675.
Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85(3), 317–332.
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