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People With Tinnitus Deserve More Empathy From Primary Care

A survey of almost 500 people with tinnitus found that 1 in 5 reported thoughts of suicide or of harming themselves over the past year, while more than 8 out of 10 reported low mood or anxiety. A total of 7 out of 10 reported that their symptoms made them feel hopeless or helpless.

The findings come from Tinnitus UK’s Revealing the Struggle for Silence report, published to coincide with Tinnitus Awareness Week, 5–11 February.

“This doesn’t surprise me,” psychologist and tinnitus researcher Dr James Jackson, at Leeds Trinity University, told Medscape News UK. “Mental health is a real issue because tinnitus is a chronic stressor.” Jackson said earlier studies have demonstrated a significant risk of suicidal ideation and suicide in the first 6 months after the onset of tinnitus. 

Nic Wray, communications manager at Tinnitus UK, told Medscape News UK that the proportion of respondents experiencing thoughts of suicide and self-harm in this latest survey more than doubled from the previous one. “We're not saying that [our results are] entirely representative of everybody with tinnitus,” they added, explaining that the survey was based on self-selected participants responding to calls for input. But Wray feels it’s important to highlight the sometimes neglected mental health impact of the condition that affects around 8 million people in the UK.

Options for Help

Although there is no known cure for tinnitus, and its causes remain ill-defined and probably fall into several different categories, Wray emphasised that there are nevertheless options for help that are not always made clear to people consulting their GPs or audiologists.

“There's not a lot of medical education for audiology in general. In general practice, I think, people do underestimate the impact that it can have… I had somebody tell me that they'd had 8 minutes on tinnitus in their training,” Wray explained.

Many people with tinnitus tend to simply be told that nothing can be done about it, and so they are sent away just to live with the condition, without being informed of or given access to the range of help options that are available. These include sound therapies that can mask the tinnitus, hearing aids, and, often most effectively, psychological therapy that modifies a person’s attitude to their symptoms.

Managing the Mind

Jackson emphasised the significance of psychological options, such as mindfulness and cognitive behavioural therapy (CBT). He said that people can be initially resistant to the idea that psychological approaches can help them, leading to high dropout rates from psychological interventions, but those who persist can report substantial benefits.

“You'll sometimes get that awkward conversation with people”, Jackson said, “as people often think if they’ve got something wrong with their ears why are they being sent to a psychologist. But after a 2-month course of mine, about a third of the sample will actually get clinically significant reduction.”

While acknowledging that the therapy was helping to distract people from the tinnitus rather than physically changing it, Jackson emphasised that this can nevertheless be by far the most successful approach. “When people are in a more relaxed state [after psychological intervention], they're not looking for the unpleasantness and it sort of fades away,” he explained.

Calls for Action

Wray and Jackson both feel that more attention to and empathy for tinnitus is required from primary care professionals. It was only as recently as 2020 that the National Institute for Health and Care Excellence (NICE) published their first guidelines for the assessment and management of tinnitus in primary, secondary, and community care. As one of their three main calls for action, Tinnitus UK would like to see the current guidelines further developed to create a standardised national model for the management of tinnitus.

Wray explained: “I think we need research into what is the best practice. What is the best combination? There isn't a standardised pathway, so it would be good if we had that.”

A second call for action, related to the need for more research, was for a comprehensive review of secondary care services. 

The third calls for increased tinnitus education for medical professionals.

Both Jackson and Wray referred to a significant amount of research that is investigating the physical causes of tinnitus, albeit with relatively little funding given the large proportion of the population that is affected. But both emphasise that the condition is likely to have several different causes. So with no single cause, the prospects for finding cures will likely be complicated.

In the meantime, Wray hopes that the Tinnitus UK report might increase awareness of the significant impact that tinnitus can have on mental health, and encourage more GPs and other primary care professionals to be more alert to the need to direct people towards the assistance that is available.

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