LM401 - Understanding the Physiological and Psychological Components to Successfully Treat Patients with Severe Tinnitus

Abstract:
This presentation will supply in-depth knowledge of the physiological and psychological components necessary to successfully treat patients with severe tinnitus. It will address a two-pronged approach to treatment using both CBT and a Somatic prospective. Detailed discussion and explanation on the use of appropriate tools and strategies for both treatment modality approaches will be included to assist clinicians in their ability to provide effective counseling for their patients and clients suffering with tinnitus.

Summary:
Over 50 million people in the United States have tinnitus. Approximately 12 million people seek medical intervention, and 2 million people experience levels that are extreme and debilitating. There are a variety of therapies currently in use to treat tinnitus; however, many have never been scientifically proven as effective.

The American Academy of Audiology, the American Speech-Language-Hearing Association, and the American Academy of Otolaryngology--Head and Neck Surgery Foundation, all endorse the use of Cognitive Behavioral Therapy (CBT) to treat tinnitus. According to systematic reviews, CBT is considered the most effective evidence-based method of tinnitus intervention (Hobson et al, 2010; Martinez-Devesa et al, 2010).

CBT is a treatment that focuses on the relationship between thoughts, feelings, beliefs, and behaviors. It challenges negative or inaccurate thoughts and restates them in logical, positive terms. And while CBT is not typically within an audiologist's scope of practice, they can learn to teach the behavioral components of CBT, which are less training intensive.

This presentation will look at the autonomic nervous system (ANS), sympathetic nervous system (SNS), and the parasympathetic nervous system (PSN), and the role they play not only in creating the problem of tinnitus distress, but in supplying the solution for effective management.

Tinnitus is perceived within the auditory cortex as a threat; thus, the limbic system activates a fight or flight reaction through the SNS. To turn this threat off, activation of the PSN, the body's rest and digest response is helpful and warranted as the two systems or states cannot be operating simultaneously. The use of CBT and other somatic activities are helpful to activate the PSN, thereby shutting down the fight or flight reaction.

CBT is a top-down treatment approach that addresses the brain. It focuses on cognitive processing and thought patterns. It assists the individual in identifying automatic, dysfunctional, and unhelpful thoughts as they pertain to their experience of tinnitus. Assisting an individual to reframe their thoughts can be extremely beneficial as this helps rewire the brain's interpretation of sound.

A bottom-up approach to treatment focuses on addressing the physiological and sensory aspects of psychological distress. This involves stimulation of the PSN through the vagus nerves and works to regulate the nervous system. Using mindfulness, progressive muscle relaxation, deep diaphragmatic breathing, and grounding all assist to shut-off the SNS fight or flight reaction.

According to a study published in JAMA (Lugo, Trpchevska, et al, 2019) suicidal tendencies among tinnitus sufferers is higher than for people without tinnitus. Thus, we will also consider when to refer to a mental health professional.

This presentation will be highly interactive. Comments and questions will be encouraged throughout. Tools will be provided for the clinician to utilize within their practice. An intermediate level was chosen as a fundamental understanding of how an individual perceives and experiences tinnitus is important. This presentation will expound on the role of the ANS, SNS, and the PSN to assist clinicians in the counseling and rehabilitation process of treating individuals with tinnitus.

Brief Summary of Clinical Takeaways:
The clinical takeaway for this session is the neuroplasticity of the brain allows for brain rewiring and nervous system regulation using both top-down and bottom-up treatment modalities. CBT and somatic therapies are effective in shutting down the fight or flight reaction occurring in the auditory cortex of the tinnitus sufferer.