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Tinnitus! Understanding the Psych Connections

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The non-stop ringing, buzzing, and pulsating in your ears. No matter what you do it doesn’t go away. And when you figure out it’s internal noise, so blocking your ears doesn’t work, you wonder if you’ll go mad. Tinnitus: the gift that keeps on giving. By the way, did you know there’s a psych connection at play?

Emotional exhaustion is a huge predictor of tinnitus severity. In fact, exposure to high stress has the same incidence of tinnitus as exposure to occupational noise.

I’m guessing that three-quarters of all mood or anxiety disorder wrestlers have had a go with tinnitus at one time or another. Heck, I have. So when I found the article, “Psychopathology of Tinnitus,” in Psychiatric Times, I had to bring you a recap. The piece was written by neuropsychiatrist Zeina Chemali and psychiatrist Romy Nehme.

As we get into the material, always keep in mind the high relief-factor of gaining insight into that from which we suffer. For me, it’s right up there with remedies.

Oh, one more thing: remember how I handle these recaps. No “Drs. Chemali and Nehme said…” But you know the bulk of what you’re about to read comes from their work.

What Is Tinnitus?

Tinnitus is the perception of noise in the absence of any corresponding sound source. It typically presents with ringing, roaring, hissing, or pulsating in one or both ears, as well as the head.

There are two types of tinnitus: objective and subjective. The very rare objective tinnitus consists of a sound heard by the patient and doctor. These can be abnormal sounds of blood flowing through our arteries (bruit), benign humming of blood flowing downward from the brain through the jugular veins (venous hum), or a brief and irregular twitching (myoclonus) of the soft palate or stapes bone in the middle ear. Pretty interesting, don’t you think?

The most common tinnitus, subjective, is only experienced by the patient.

Some 50 million in the US are impacted by tinnitus. And .5 – 2% seek urgent medical assistance for an acute and unbearable presentation or worsening of an existing condition. The numero uno cause of tinnitus is hearing loss. But, of course, having tinnitus doesn’t necessarily mean you’re losing your hearing.

Now, things get very interesting from our side of the fence when we come to learn that tinnitus plays with many brain areas beyond the auditory system and pathway. Yep, electroencephalogram (EEG) studies have shown funny goings-on in brain areas such as the anterior and posterior cingulate cortex, orbitofrontal cortex, and insula.

But there’s more. PET scans and functional MRI have shown involvement in cortical and subcortical areas, as well as the amygdala and hippocampus.

All of the above are involved with the mood and anxiety disorders.

Tinnitus & Psychiatric Disorders

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Let’s take a look at some disorders of particular interest to us and their ties with tinnitus…

  • Affective Disorders: There’s a high prevalence of depressive disorder in tinnitus patients. Indeed, a decrease in depression was associated with a decrease in tinnitus.
  • Anxiety Disorders: Anxiety is more prevalent among the tinnitus clinical population.
  • Personality Disorders: Tinnitus distress is associated with high neuroticism (term worth knowing), high stress reaction, higher alienation, worse social closeness, worsened well-being, and externalized locus of control (another term worth knowing).
  • Stress: Emotional exhaustion is a huge predictor of tinnitus severity. In fact, exposure to high stress has the same incidence of tinnitus as exposure to occupational noise. Some have reported that their first awareness of tinnitus coincides with a significant stressful event.
  • Sleep: Insomnia is a common complaint of tinnitus patients, particularly trouble falling asleep. Screening for obstructive sleep apnea is a must-do when evaluating tinnitus. Bottom-line: achieving restorative sleep is a major player in tinnitus management.
  • Cognitive Impairment: Tinnitus affects executive function and attention. Tinnitus patients tend to have slower cognitive processing speed and longer reaction times on brain speed testing.

So it seems tinnitus causes poorer quality of life, especially in those with disabling hearing loss. But on the brighter side, reducing tinnitus intensity has a direct positive impact on quality of life.

So how are we going to do that?

Tinnitus: Treatment

As with any other ailment, the best tinnitus treatment outcomes are generated by addressing the underlying cause. Okay, so if someone is struggling with tinnitus that’s caused by, say, hearing loss, a drug, malformations of blood vessels, stroke, cervical spine and temporomandibular joint (TMJ) issues – they’re to be addressed with appropriate interventions.

When it comes to idiopathic (unknown cause or mechanism of origin) tinnitus, a comprehensive evaluation needs to be conducted to identify issues of relevance. These include depression, anxiety, substance use, and insomnia. Treating these issues, which may require medication, may well reduce the intensity of tinnitus.

Speaking of meds, studies have shown that antidepressants such as nortriptyline (Pamelor), sertraline (Zoloft), and duloxetine (Cymbalta) can be helpful in treating tinnitus. Bupropion (Wellbutrin) and mirtazapine (Remeron) have been known to cause problems. Benzodiazepines such as alprazolam (Xanax), clonazepam (Klonopin), and midazolam (Versed) have been reported to be effective. But you may regret opening that can of worms.

Other interventions that have produced positive results are psychotherapy (CBT), mindfulness exercises, meditation, acupuncture, and transcranial magnetic stimulation. I’m sure there are supplements, as well as herbal and home remedies, that are touted to be beneficial. But I’ll leave that to your due diligence.

If you’re looking to learn more about tinnitus and its treatment, head over to the American Tinnitus Association website.

Let’s Wrap It Up

Well, that’s going to do it for this go-round, people. If you don’t know from personal experience, tinnitus can be a real piece of work. And important to us, it has very real connections with the mood and anxiety disorders.

Sorry to say, tinnitus isn’t a quick-fixer-upper, but by learning all we can about it, we can manage.

Knowledge is power (but useless without action).

Be sure to read the full article in Psychiatric Times: “Psychopathology of Tinnitus.”

And how could we ever forget those hundreds of Chipur titles?