Chronic tinnitus - high quality of life despite ringing in the ears

By Isabel Michael 07.02.2022, 18:35 Uhr, ntv.de

In the acute stage, nagging ringing in the ears can often still be treated well, so that some patients even get rid of it again. However, if tinnitus lasts longer than three months, it becomes chronic. With some methods, those affected can still feel free of symptoms.

Ringing, beeping, rattling, hissing, humming or hissing: almost everyone is familiar with ringing in the ears. They usually go away within a few hours or days. If this is not the case, you should consult a doctor. In acute therapy, cortisone is then often used as a tablet or infusion.

However, sometimes the treatments in the first three months are not enough to make the tinnitus go away. Then it becomes chronic. The constant noise in the ear even leads to downright depression and other mental illnesses in quite a few patients.

The emergence of tinnitus

Tinnitus sufferers perceive noises that are not triggered by the environment. Only rarely is it an objective tinnitus that can also be heard from outside. Tinnitus is often triggered by damage to or diseases of the ears, such as a middle ear infection, sudden hearing loss or noise trauma. Cardiovascular diseases, cervical spine disorders, psychological problems such as depression or internal diseases (e.g. poorly controlled diabetes) can also lead to tinnitus. Sometimes the cause remains unclear.

The fact is, however, that more than 90 percent of all cases of tinnitus are accompanied by a more or less severe hearing loss. The missing frequencies are then tried to be compensated in the hearing center of the brain by amplification mechanisms, which leads to the noise in the ears. “On the way to the brain, there are intermediate stops on the emotional level, such as the limbic system. This gives the noise an evaluation. As a rule, it is evaluated negatively and this then creates the psychological strain,” explains the director of the tinnitus center and chairwoman of the German Foundation Tinnitus and Hearing Charité, Prof. Dr. med. Birgit Mazurek, in an interview with ntv.de.

Suffering that is avoidable

Around 1.5 million people in Germany suffer from chronic tinnitus. Most of them do not feel that their quality of life is restricted by the ringing in their ears, but 8 to 13 percent suffer greatly from it. “The patients have a very high level of suffering. Hearing and the ability to concentrate are reduced, the patients sleep less well and have more fears. It can also lead to depression,” says Mazurek.

The extent to which tinnitus is perceived at all and is perceived as stressful also depends on the psychological stability of a person: “If an acute stressful situation occurs in addition to hearing loss, such as losing a job, then these mechanisms are switched on and ringing in the ears is suddenly perceived,” she explains further.

Dealing with the tinnitus in particular, once it is there, therefore plays a decisive role in determining the extent to which it actually represents a burden in the end: “If the patient notices ringing in his ears, he can ignore it. Then the tinnitus goes away. However, if the affected person pays attention to the tinnitus and listens more and more to himself, the ringing in the ears is perceived more intensively because the swelling of the limbic system decreases,” emphasizes the doctor. This mechanism is reminiscent of the phenomenon known as phantom pain.

What really helps with chronic tinnitus

You can’t completely get rid of the ringing in the ears after it’s been there for several months, says Mazurek: “In the chronic stage, the ringing in the ear persists and doesn’t get any quieter. You can get used to it and push it into the background to make the tinnitus less noticeable. It’s no longer about the cure, it’s about living with it better.” It can only be worth working with a hearing aid if you have hearing loss. “If the patients hear better again as a result, they can also hear better over the noise in the ear, so that cognitive deficits are also improved. If there is deafness and the auditory nerve is functioning, one can consider an implant. This is a special form of stimulating the auditory nerves,” says the tinnitus expert.

The first choice for chronic tinnitus is behavioral therapy in individual or group sessions, for which there is already a lot of scientific evidence. This can be done by a psychotherapist or in a special tinnitus center. The goal is to learn strategies for dealing with tinnitus so that it is perceived as less stressful. “In the end, the ringing in the ears is still as loud as before, but the patients perceive it differently. They notice the tinnitus less or not at all because they have accepted it more,” explains Mazurek. Psychological comorbidities such as anxiety and depression, which often occur due to the annoying ringing in the ears, can also be treated effectively within the framework of psychotherapy. Drugs such as psychotropic drugs can also be of good service here.

According to the “chronic tinnitus” patient guideline, tinnitus retraining therapy and tinnitus coping therapy (TBT) only help some affected people to better deal with tinnitus after long-term use. According to current scientific studies, a noise device (noiser) is not required. If you suffer from tinnitus as a result of problems with the cervical spine or the jaw and chewing muscles, physiotherapy treatment may help. Many patients also benefit from self-help groups. Relaxation exercises help to avoid or reduce stress, which in turn has a positive effect on tinnitus. According to Mazurek, all other therapy methods, such as treatment with cortisone and ginkgo bilboa, are no better than placebo treatment in the chronic stage.