Living with Tinnitus (UCLH web chat) 

For this year’s Tinnitus Awareness Week (8-14 February 2016) we are hosting a web chat with consultant clinical psychologist, Dr Laurence McKenna.  Dr McKenna is part of the audiology team at the Royal National Throat, Nose and Ear Hospital (RNTNEH). 

Our service is unique in that the psychology team work alongside their clinical colleagues – this fully integrated approach is the only one of its kind in the country and helps patients explore strategies for living with tinnitus. Dr McKenna graduated as a clinical psychologist from the Liverpool University and obtained a postgraduate diploma in cognitive behaviour therapy at Oxford University.  He sees patients at the RNTNEH and has undertaken research into mindfulness-based cognitive therapy which was supported by The British Tinnitus Association

Below is a transcript of the web chat.

9:30 UCLH: 
Good morning and welcome to our web chat. We will begin at 10:00am, but you can submit your questions now in preparation for the chat. Please note: your questions will not appear in the main chat window until after 10:00am.

Dr Laurence McKenna will be joining us to take your questions on ‘Living with tinnitus’ and will try to answer as many questions as possible within the hour long web chat.
10:02 Dr Laurence McKenna: 
Welcome to our web chat on the subject of ‘Living with tinnitus’. My name is Dr Laurence McKenna - and I am ready and waiting to take your questions. I am a clinical psychologist and my work is in helping people manage tinnitus and live a full life. I help tackle the emotional and behavioural impact of tinnitus. I cannot answer questions about the medical or surgical causes of tinnitus.
10:08 [Comment From Simon: ] 
Dear Dr McKenna, In October of last year i suddenly lost all hearing in my left ear and also developed severe tinnitus (in my left ear only). I am taking Zopiclone which helps me sleep albeit without it i cannot get any sleep at all (despite using a relaxation machine). My GP is urging me to stop taking Zopiclone but has no suggestion for a plan B. Can you suggest anything to help ? Would a BET device help ? I am at the end of my tether and would be grateful for any advice.
10:09 Dr Laurence McKenna: 
Disturbed sleep is one of the most common impacts of tinnitus. About half of people who come to a tinnitus clinic complain of poor sleep. It is interesting to note that many, but not all, of those people say they were always poor sleepers and that things are now worse. Zopliclone is one of the most commonly prescribed sleeping medicines. It certainly can help people sleep. It is thought to be less addictive than the older sleeping pills but it is not meant to be used long term. Antidepressant medicines can also help people sleep. For the vast majority of people insomnia is the result of a “busy mind” rather than a “busy body”. This is true even for people with tinnitus. Remember not everyone attending a tinnitus clinic complains of poor sleep. The busy mind is usually a reflection of emotional distress (maybe some anxiety or depression) and antidepressant can help with this – and therefore lead to better sleep. They do take a little time to work. The best way forward, however, is to take a psychological approach to managing the sleep problem. Cognitive behaviour therapy (CBT) is the treatment of choice. This can be more challenging than taking pills but if you can stick with it the outcome is likely to be better and longer lasting than with pills. Hopefully your GP can refer you to a CBT therapist.
10:16 [Comment From Gillian: ] 
Dear Dr McKenna I have had tinnitus since September and, as with many cases, it is associated with hearing loss which I had had increasingly for about two years previously. There is, apparently, a conductive element to my hearing loss as well as the more usual age related loss and my ENT consultant thought that this conductive element might be otosclerosis and accordingly asked for me to have more diagnostic tests to determine this. I am waiting to get the results of those more advanced tests. Should otosclerosis prove to the case, an operation to remedy the abnormal bone growth is possible but it is a delicate one and I am not keen to have it merely for the hearing loss but only if it could possibly alleviate the awful tinnitus. I note that your specialism is psychology and not ENT, so you may feel this is slightly outside your expertise to say, but I just wondered if you were aware of any evidence about the links between otosclerosis and tinnitus, as distinct from general hearing loss and tinnitus, and of any record of success of the operation in helping tinnitus sufferers.
10:18 Dr Laurence McKenna: 
As you point out I am a psychologist, not an ENT, and the question is outside my expertise. I have, however, come across people with otosclerosis who have tinnitus as well as hearing loss. I have seen some of those people get very considerable benefit in terms of tinnitus and hearing loss following surgery. As I understand it the surgery is delicate and no surgery is risk free. The surgery is, however, something that ear surgeons are very familiar with. You will need to have a careful conversation with your own surgeon about the risks and benefits; be sure to include a discussion about whether the otosclerosis is likely to worsen or not. I note that you have some age related hearing loss as well. The surgery won’t help that part of the problem – or the contribution of that to your tinnitus.
10:31 [Comment From Deanna: ] 
Dear Dr McKenna, I had pulse tinnitus for a month back in August and had it checked at the ENT hospital but they found my hearing very good and it did wear off, however I still have a very high pitched sound with my hearing mainly noticeable at night; is it normal? should there be other tests that I should consider?
10:31 Dr Laurence McKenna: 
Tinnitus is often associated with hearing loss. The presence of a hearing loss is important as it can make life generally harder. The use of a hearing aid can greatly reduce the everyday struggles created by hearing loss. This can mean less stress and that can help our experience of tinnitus. Furthermore, if you have a little more sound going into your ear it can help offset the tinnitus.

There are, however, a considerable number of people who complain of tinnitus and have no or very little hearing loss. At least this seems to be the case when hearing is measured using the usual hospital audiometers. Some scientists have suggested that if hearing is used with more sophisticated equipment then some otherwise hidden loss can be found. This is certainly of academic interest but the practical implications of it are probably very small for most people. The hidden losses are usually at high frequencies that we don’t use in our everyday lives.

I don’t know what investigations you have had but it sounds reassuring to know that your hearing is OK.
10:47 [Comment From Alice: ] 
My tinnitus gets much worse when I am stressed and anxious. Do you have any coping suggestions?
10:47 Dr Laurence McKenna: 
It is very common for tinnitus to become more intrusive in response to stress. This in turn can add to your stress. In my view, the way forward is to take a psychological approach to managing the situation. The evidence is that the best approach to managing stress and panic is cognitive behaviour therapy (CBT). If it is done well it is as effective, or more effective, than medication for things like anxiety and depression and its benefits are longer lasting. If we look carefully at the evidence about what approach is best in managing tinnitus then CBT comes out on top again.

Your GP should be able to refer you to a CBT therapist. Alternatively the British Association of Behaviour and Cognitive Psychotherapy can help identify someone in your area. I do acknowledge however that some CBT therapists will say they don’t know about tinnitus and are sometimes hesitant about taking tinnitus on. Only a few audiologists have trained in CBT. More education is needed. There are a couple of self-help books that focus on tinnitus and CBT. I often direct therapists who call me to these books. They can help the person with tinnitus as well.
11:07 [Comment From Joanne: ] 
Hello Dr McKenna, What does Cognitive behaviour therapy (CBT) actually do for the tinnitus suffer when you may not be depressed in general but it's the actual tinnitus that is causing the distress and impacting on your quality of life. Many thanks for your time.
11:08 Dr Laurence McKenna: 
It is I see many people who are suffering from anxiety or depression. Of course most people who have tinnitus do not suffer from these problems (and actually don’t even come to a tinnitus clinic). One of the big challenges is to understand why some people with tinnitus do become anxious or depressed and others don’t. The obvious answer is that it is something to do with eth quality of the tinnitus. This would certainly make sense but the science does not support that answer. There is a very poor relationship between measures of tinnitus and the degree of distress that people experience. This is a challenge but it is also potentially liberating; you are not stuck because you tinnitus that sounds one way rather than another.

The answer to why some people struggle and others don’t does seem to be to do with psychological factors. This is why we have had a team of psychologists working in our hospital for the past 30 years. The struggles can amount to formal anxiety and depression. In other words the emotional problems may arise as a consequence of the experience of tinnitus – rather than be the result of other life stresses. The struggles may not however amount to formal anxiety or depression. I do believe that the way humans process information can add to a person’s struggles with tinnitus even in the absence of anxiety or depression. CBT can help us be aware of the ways in which our usual information processing can cause struggles. Slowing things down helps. One of the latest forms of CBT is called mindfulness based cognitive therapy (MBCT) and I believe this can be very helpful for people with tinnitus even if you do not have formal anxiety or depression. Our group has studied the use of MBCT in tinnitus management in recent years. The results are encouraging. Tinnitus MBCT does not make tinnitus go away but can help people feel much better. The British Tinnitus Association (BTA) has sponsored this work.
11:16 [Comment From Mik: ] 
Dear Dr McKenna, I have had 24/7 tinnitus all my life or as long as I remember. Hearing aids from adult age onwards. I have understood that hearing aids should lessen hearing the sounds of tinnitus. In my case it has not; the hearing aids only bring all the other sounds to the same sound level as my tinnitus is. It gets quite noisy then :-p and what I do I use my hearing aids only when I have to. What I would like to know have you heard any other cases that are experiencing the same?
11:16 Dr Laurence McKenna: 
This sounds like a struggle. A careful conversation with your audiologist is needed. Hearing aid fitting and use is not my expertise. It may be, however, that adjusting the hearing aid settings might help (sometimes making them less perfect for hearing speech and allowing other sounds in can help – but this is obviously a compromise.) I have certainly heard of tinnitus “playing leapfrog” with other sounds, including those from hearing aids and sound generators. An approach such as Mindfulness Based Cognitive Therapy (MBCT) can help you struggle less with tinnitus and this might reduce the “leapfrogging”.
11:20 [Comment From Guest: ] 
I suffer with Vestibular Migraines or MAV for the past 4 years. I've never had Tinnitus before till my chronic daily headaches all started. Is it related and is this something I've now got to live me as it's awful along side my other daily symptoms. Thank you
11:20 Dr Laurence McKenna: 
I have certainly seen people with this cluster of problems. You need to talk to your audiovestibular physician (or neurologist) about the links and mechanisms. They may also be able to help you find a way managing the situation. There is sometimes a process of searching for a suitable medicine. Managing the stress of it all will also help. Migraine, chronic daily headaches and tinnitus can all be helped by stress management techniques.
11:30 [Comment From Malc Jeffries: ] 
I have constant Tinnitus as a high pitched whine, but I can generally manage in most situations with the exception of crowded rooms and 'high pitched ladies voices' (no offence meant) and I then feel very uncomfortable. Do you have suggestions to help with this?
11:30 Dr Laurence McKenna: 
Sensitivity to sounds occurs in about 40% of people with tinnitus. Sometimes this is a sensitivity to sound in general and sometimes it is to more specific sounds. There is a tendency for people with this problem to protect their hearing and avoid the “offending” sounds. This usually stops the problem from resolving or even makes it worse. If sounds are too loud (and go on for too long) they will damage your hearing. However, avoiding everyday sounds increases the “gain control” in the auditory pathway and you can end up just getting more sensitive to sound. Your audiologist or hearing therapist should be able to gradually increase you tolerance of sounds – this will almost certainly mean learning some sort of relaxation technique and using it while in the presence of the difficult sounds. Remember however that crowded rooms are just difficult for most people with (even a small) hearing loss.
11:33 UCLH: 
Thank you for joining us today in our live web chat. We hope you found the chat useful and some of your questions have been answered.

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