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Further information
Everyone knows the phenomenon: all of a sudden there is a buzzing, whistling or beeping sound in the ear. Such noises usually disappear quickly – but not always. “Each year, around 340,000 people suffer from tinnitus becoming chronic,” says Dr. Catri Tegtmeier, chief physician in the tinnitus clinic of the medical-psychosomatic clinic Große Allee in Bad Arolsen. This often means extreme stress for the psyche and body. These patients need help. Tolfioow spoke to Dr. Tegtmeier on the problem and modern therapy options.
“Often it doesn’t stop with tinnitus”
dr Catri Tegtmeier, chief physician at the medical-psychosomatic tinnitus clinic in Bad Arolsen.
Tolfioow: How does the treatment of acute and chronic tinnitus proceed?
DR. TEGTMEIER: Acute tinnitus heals spontaneously in 60 to 80 percent of cases. It is primarily treated with medication – often with infusions. It is also advisable to take a break from everyday life. The positive effect of rest to reduce stress factors is undisputed. There is something new in the treatment of chronic tinnitus: According to the current state of science, the noise does not necessarily have to be eliminated, but managed. Since tinnitus can have various causes, a multimodal therapeutic approach is necessary. Instead of a treatment focused on hearing, the focus is now on the psyche. The brain should learn to perceive the tinnitus as less important and harmless. Once the “sound in the ear” has lost its threat, it also subsides.
Tolfioow:When does tinnitus become chronic?
DR. TEGTMEIER: A chronification often arises when there is no success after the acute treatment. Anyone who pays too much attention to the noise in the acute phase favors a chronic course. The symptom becomes too important and has an increasingly strong influence on the way of life. A vicious circle of focussing attention and unpleasant sensations develops, which often cannot be broken by one’s own efforts.
Tolfioow: Does that affect the quality of life?
DR TEGTMEIER: Yes. In the limbic system, a structure of the brain in which feelings arise, tinnitus is increasingly evaluated as a warning signal and forwarded unfiltered to the auditory cortex in the brain. Ultimately, this means that the ringing in the ears is perceived as louder and more massive as an annoyance. This process is further amplified as the general level of arousal of the limbic system increases from sustained exercise. As a result, a noise in the ear that is otherwise suppressed from perception can come to the fore and increase the burden even more. Possible consequences: concentration, sleep or anxiety disorders, depression and reduced resilience. This often leads to social withdrawal and inability to work.
Tolfioow:Is there something like pain memory in tinnitus?
DR. TEGTMEIER: There are numerous parallels between chronic pain and chronic tinnitus: Even if the original stimulus is gone, there is a subjective perception. In addition, the tinnitus – analogous to phantom pain after the loss of an extremity – can persist even after the auditory nerve has been severed. From this it can be deduced that structural changes in the central nervous system, in the area of the central auditory pathway, also play a role in tinnitus. This is called “neural plasticity”. Such changes can also be found in chronic pain.
Second part of the interview
Tolfioow: What is the core idea of the multimodal treatment approach?DR. TEGTMEIER:Chronic tinnitus is a psychosomatic condition. It is always made up of organic or functional as well as psychosomatic factors, which can be weighted differently over the course of the disease. The therapy is based on a combination of neuro-otological (affecting the head senses; editor’s note) and psychosomatic treatment approaches. In addition to comprehensive information about the clinical picture, specific relaxation exercises are taught. The technical term for this is tinnitus counseling. The so-called tinnitus retraining therapy is carried out as part of the special hearing therapy. Noise generators similar to hearing aids can be helpful here. The aim of this method is to reduce the perception of the tinnitus with the help of a relatively quiet, continuous noise.
Tolfioow: In addition, the biofeedback method is also used. What is its use?
DR. TEGTMEIER:Tinnitus is often accompanied by physical symptoms such as nervousness and an inability to relax. In many cases, this leads to increased tension in the head and shoulder muscles. This is where biofeedback comes in. With special devices, bodily processes such as muscle tension and skin resistance, which are otherwise not perceived or only imprecisely, are measured, displayed graphically or acoustically and thus made conscious. Patients who have trained stress management and relaxation strategies receive understandable feedback on how well they are relaxing. The combination of biofeedback and behavioral therapy has proven itself. In addition, the perception of physical processes is trained and psycho-physiological connections are made clear, for example the influence ofstress on physical reactions. Another treatment module is threshold training. This means the targeted alternation of tightening and relaxing. Overall, biofeedback-based behavioral therapy is a very promising approach that takes various aspects of tinnitus stress into account and leads to significant and long-term improvements.
Tolfioow: How quickly are the successes of multimodal therapy evident?
DR. TEGTMEIER: It varies greatly from person to person. For some of those affected, comprehensive medical education about the harmlessness of the disorder, the teaching of relaxation techniques and possibly a hearing aid are sufficient. The more pronounced the physical and psychological symptoms are, the longer the treatment usually lasts. In the case of an inpatient stay, this is four to eight weeks. If you want to achieve lasting success, you have to implement what you have learned in everyday life afterwards.
Tolfioow: And what about the success rate?
DR. TEGTMEIER: A certain improvement can be achieved in almost all patients. However, if one has the expectation that the tinnitus will disappear completely, there is little success. Does this have to be fundamentally rethought? Yes. The goal is to live with tinnitus as well as possible. And up to 80 percent of those affected actually get used to the noise in their ears and hardly notice it anymore. This also leads to them feeling better overall and anxiety disorders or depression disappearing.
Facts
The Eerie Whistling – The Facts .CONTINUOUS RINGING
Tinnitus is the medical term for the perception of noises without external noise sources. The term derives from the Latin “tinnire” and means “to ring”. With very few exceptions, the unpleasant, mostly very tormenting noise can only be heard by the person concerned.
SYMPTOM INSTEAD OF DISEASE
Tinnitus is not an independent disease, but a symptom that can have various causes. Its diagnosis is therefore also an interdisciplinary task.
TO THE ENT PHYSICIAN
He is the first point of contact. In addition, an MRI scan of the brain and the confluence of the auditory and vestibular nerves should be made. Furthermore, examinations by a neurologist, internist, (orthodontist) are useful.
WHEN IT BEEPS
Triggers are noise trauma, noise-induced hearing loss, sudden hearing loss, stress, infections.
