One of the most common misconceptions about tinnitus is there is nothing to be done; you just have to live with it. About 207,000 New Zealanders are affected by the condition, which is often described as “ringing in the ears” but can also be experienced as buzzing, hissing, whooshing, clicking, humming, sizzling or shrieking sounds. These can range from just annoying to seriously disabling.
Now, a research team led by the University of Auckland has developed a smartphone app that has been shown in trials to reduce the impact of tinnitus in two-thirds of its users. The app, called MindEar, offers a suite of tools that can be tailored to an individual’s needs.
Audiologist Fabrice Bardy says MindEar works by harnessing the brain’s natural ability to filter out irrelevant sounds. A combination of sound therapy, mindfulness exercises and cognitive behavioural therapy (CBT) helps train the brain to tune out tinnitus.
“We know that CBT has the most evidence for efficacy as a tinnitus treatment but it’s not widely accessible,” says Bardy. “Generally, when you have tinnitus you’re connected with an audiologist and usually they’re not trained to provide CBT. Also, most psychologists won’t have any interest or knowledge about tinnitus.”
There is a link between the sounds we hear and the emotions we feel. Happy music lifts our spirits, for instance, and a ringing alarm activates a flight or fight response. But if an everyday sound isn’t important, then our brain tends not to focus on it.
The example Bardy uses is chatting to someone while driving in a car and not paying any attention to the engine noise. If there is suddenly a strange sound that might be a problem, our focus is drawn to it at that point.
The aim of CBT is to decrease the fear response to tinnitus noises and reframe any negative thoughts about them so they fade into the background.
“Tinnitus doesn’t have to become your best friend, but we want to create something more neutral and reach the point where the person is able to accept the presence of the sound,” says Bardy.
CBT doesn’t work for everyone, which is why the app also has a sound therapy component. Generally, this employs white or pink noise, or even relaxing music, to “turn down” the tinnitus.
“A candle in a dark room will look very bright,” says Bardy. “But if you turn on the light, the contrast will decrease. That’s sort of what we do with sound therapy. By adding another sound, you diminish the contrast between the tinnitus and the environment.” Tinnitus may be caused by injury to the ear – such as exposure to loud sounds – but Bardy found many of his patients could link its onset to an emotionally distressing or difficult time in their life. In those cases, stress management techniques may be useful.
Via a chatbot function, MindEar users are guided towards the therapy most likely to help them. In trials, two-thirds of participants saw an improvement after 16 weeks using the chatbot approach.
Subscribers pay $129 a year to use MindEar, which equates to the cost of a single session with a CBT therapist.
“We wanted to create an affordable treatment option,” says Bardy, who is excited about the potential the app has to reach large numbers of tinnitus sufferers. “As a clinician, I’d be very happy if I could provide care to 300 to 500 new people a year. Last year with this app, we provided care to 40,000 people.”
Bardy is now working on larger trials in the UK and will continue to fine-tune the app. He advises anyone who has recently developed symptoms to visit their GP before downloading the app. “It’s important to eliminate the possibility that this could be a medical condition. In a small percentage of cases, it could be a benign tumour known as an acoustic neuroma. Or there may be some wax impacted in the ear canal, causing a blockage. But if it turns out that you are experiencing tinnitus, you should start on therapy as fast as possible.”
