Medical

"Polytherapeutic" tinnitus treatment app delivers impressive results

"Polytherapeutic" tinnitus treatment app delivers impressive results
There's hope for a wider range of tinnitus sufferers, as a new polytherapeutic smartphone app has delivered excellent results in tests over three and six months
There's hope for a wider range of tinnitus sufferers, as a new polytherapeutic smartphone app has delivered excellent results in tests over three and six months
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There's hope for a wider range of tinnitus sufferers, as a new polytherapeutic smartphone app has delivered excellent results in tests over three and six months
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There's hope for a wider range of tinnitus sufferers, as a new polytherapeutic smartphone app has delivered excellent results in tests over three and six months
Tinnitus can have a range of causes, but the symptoms of ringing or hissing noises in the ears are generated in the brain
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Tinnitus can have a range of causes, but the symptoms of ringing or hissing noises in the ears are generated in the brain
The white-noise-only app delivered clinically meaningful improvements for some users, but the polytherapeutic was more effective, and more reliably effective across the group
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The white-noise-only app delivered clinically meaningful improvements for some users, but the polytherapeutic was more effective, and more reliably effective across the group
Top: screenshots from the polytherapeutic app. Bottom: screenshots from the White Noise Lite app
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Top: screenshots from the polytherapeutic app. Bottom: screenshots from the White Noise Lite app
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The ringing, rushing sound of tinnitus is a complex condition. It's caused by a range of factors, so there's no known one-size-fits-all treatment. But researchers are reporting excellent results with a combination treatment in a smartphone app.

Some 5% of people experience tinnitus at some point in their lives – I'm one of them. It can develop after repeated exposure to loud noise; that's probably where I picked it up, thanks to a long association with drums, live music and loud motorcycles. But it can also arise thanks to wax buildup, the effect of medication, inflammation due to illness, the growth of tumors, or even circulatory system issues.

Sometimes it's barely noticeable, other times it can be impossible to ignore. This phantom noise can go away and come back, it can change from a high-pitched ring in your left ear, like the sound when an old TV is turned on with no sound, to a high-pitched hiss in your right, as if somebody's left a high-powered guitar amplifier on over your shoulder somewhere. It can make it hard to sleep, intruding upon the silence of the night, or it can flare up and make it hard to hear conversations. This is because, whatever the initial cause of tinnitus, the symptom itself is generated by the brain. It can cause stress and anxiety, and it can worsen in response to them in a vicious cycle.

There have been many treatments proposed, and some have shown promise in certain types of tinnitus patients, but a team of researchers at the University of Auckland has found it's getting strong results with a smartphone app that takes a kitchen-sink approach, combining a number of different treatments in one.

The "digital polytherapeutic" combined "goal-based counseling with personalized passive and active game-based sound therapy." It was personalized for each subject after an assessment by an audiologist, who tailored the digital tools in the app to the user's own experience of tinnitus. The Auckland team tested its app against a popular passive white-noise sound therapy app called White Noise Lite.

Top: screenshots from the polytherapeutic app. Bottom: screenshots from the White Noise Lite app
Top: screenshots from the polytherapeutic app. Bottom: screenshots from the White Noise Lite app

The primary measurement of effectiveness was the Tinnitus Functional Index, a standard scale used to quantify a person's experience of tinnitus, in which a change of 13 points is regarded as a clinically meaningful difference.

Thirty one chronic sufferers of moderate to severe tinnitus used the polytherapeutic app for 12 weeks, and 30 used the white noise app. The group using the polytherapeutic reported an average improvement of 16.36 points after six weeks, and 17.83 points after 12 weeks, with some 55% of participants experiencing a clinically meaningful improvement after six weeks, and 65% at 12 weeks.

These results were significantly better than the white noise app, although that also made a difference for some users. The average improvement for white noise users was 10.77 points at six weeks, 10.12 at 12 weeks, with 33% of this group experiencing clinically meaningful improvements at six weeks, and 43% at 12 weeks.

The white-noise-only app delivered clinically meaningful improvements for some users, but the polytherapeutic was more effective, and more reliably effective across the group
The white-noise-only app delivered clinically meaningful improvements for some users, but the polytherapeutic was more effective, and more reliably effective across the group

"This is more significant than some of our earlier work and is likely to have a direct impact on future treatment of tinnitus,” says Associate Professor in Audiology Grant Searchfield, lead author of a paper published in Frontiers in Neurology. "Earlier trials have found white noise, goal-based counseling, goal-oriented games and other technology-based therapies are effective for some people some of the time. This is quicker and more effective, taking 12 weeks rather than 12 months for more individuals to gain some control. What this therapy does is essentially rewire the brain in a way that de-emphasizes the sound of the tinnitus to a background noise that has no meaning or relevance to the listener."

We contacted Dr. Caitlin Barr, CEO of Soundfair Australia, a hearing equality organization that also runs Tinnitus Australia, a non-profit focused just on tinnitus, for an independent opinion on this study and the polytherapeutic's potential to make a genuine change for the average tinnitus sufferer.

"Tinnitus is a symptom," says Dr. Barr. "It's like a sore elbow, it can be caused by many different things. So the same treatment won't work for all those causes. There's people whose tinnitus is psychological, they can experience it as their body's way of flagging stress, or they've allocated a trauma response to the presence of that sound. The treatment, therefore, is more successful if it's more psychological, and based on cognitive behavioral therapy, getting a person to kind of step back from what they're experiencing and encourage their brain to attribute no feelings to the experience instead of negative feelings. It's relatively new, but there's lots of evidence around CBT being applied in the tinnitus space with success.

"But if it's more a physiological cause," she continues, "a sudden hearing loss, for example, where the brain is trying to recalibrate the way it's interpreting sound, then sound therapies are likely to be a more successful treatment modality. But we can't always understand the causes clearly, there's so many gaps in our knowledge about tinnitus, so it's very difficult for researchers and sufferers alike to find a panacea. That's what's exciting about this research; a combination approach means that you're more likely to help more people.

"It's a very small study," says Dr. Barr, "so obviously, they've got a lot more work to do. But it's a promising initial finding. The other digital-based options I've seen take a stronger psychological or sound therapy bent – this is the first one I've seen that combines them quite neatly. Professor Grant Searchfield is highly regarded around the world in the tinnitus space, he's absolutely an international expert, so there should be some confidence alongside that."

Tinnitus can have a range of causes, but the symptoms of ringing or hissing noises in the ears are generated in the brain
Tinnitus can have a range of causes, but the symptoms of ringing or hissing noises in the ears are generated in the brain

But, adds Dr. Barr, whatever the apparent effectiveness of app-based therapies, it's critical that tinnitus sufferers take their symptoms to a specialist with specific knowledge in this field before embarking on any kind of therapy.

"The self-help idea, I think, is problematic for tinnitus," she says. "There are medical causes, like a tumor growth, for example, on the auditory nerves. You need someone that can triage these things and tell you if you need medical attention. Go to an audiologist, that would be my first suggestion – but going to someone with a specific interest or expertise in tinnitus is even better. There are tinnitus organisations in many countries, and that's where a group like Tinnitus Australia or the American Tinnitus Association can help, we keep a register of specialists who know more about tinnitus than your average audiologist."

The Auckland team is working on attaining regulatory approval for the polytherapeutic app, and hope to have it clinically available within six months or so. They're looking to commercialize it under the business name True Silence Therapeutics.

"The key message for tinnitus sufferers," says Dr. Barr, "is that there's hope. You don't have to spend a lot of money, there are low-cost and accessible options that can do something for you. They might not fix it entirely, but they might. As you say, some people in the control group saw improvements."

The study is open access in the journal Frontiers in Neurology.

Source: University of Auckland

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6 comments
6 comments
Mayhem
Hopefully, not a lot of people will do an internet search for CBT as a way to mitigate symptoms of tinnitus... Seriously, though, mine began when I was five (likely either from standing too close to a compressor-driven train bell or next to the 440 hemi powered Gremlin X drag car my uncle was building) and has only gotten worse due to various exposure to weapons fire, explosions, motors big and small, wind buffeting my motorcycle helmet, and punk rock music. I don't think a mobile phone app is going to help.
Mike Spirawk
I hesitate to call BS on this but it’s clear to me as a sufferer of significant tinnitus that it breaks no new ground in actually reducing the noise symptom. Managing psychological response to the symptom, which this seems to help with, is vital to literal survival of a sufferer so I don’t want to downplay its importance. The stress response to this including chronic sleep deprivation can cause very real and life-threatening long term physical damage However once things like ear wax are quickly eliminated as potential causes all the people with true tinnitus are still left with zero options or hope for improvement in symptoms.
SplineDoctor
I have tinnitus about 22 years ago, it's a constant high pitch hissing in my right ear. Actually, when it came first, doctors said "there's nothing to do", so I just got used to it. Most of the time it doesn't bother me because the brain is very flexible to compensate sensory problems. It gets annoying only when I'm tired and there's not enough ambient noise. Mine is caused by Ménière's disease, so I guess that this therapy won't work for me. But could be useful for others.
ljaques
Mine started as a result of taking far too much aspirin to fend off bodily pain (afraid of pain killers) after I sobered up. Both ears are affected and it has been with me for most of 37 years. Every once in awhile I notice that it's not there for a day or two. I tried the herbals (garlic, ginger, gingko, pumpkin, bromelain, CBT capsules, and the $34 tinnitus combo) to no effect. I lowered my blood pressure, and I quit smoking, all to no avail.
How do we get the software, and what's "not too much money"?
Mats Erik
"White Noice" do diddly squat for my riding open helmet 1700 cc monster bike 20 years ago, got me high pitch brain piercing tinnitus.
I found evil-perish-with-evil therapy works best for me, full blast surround system November Rain chocks left nerve totally no tinnitus, right a faint distant.
Right ear is where I have to focus my efforts, will find a cure.
Got to say, this severe tinnitus some of us got - has to be a way burn out some part of the brain to get rid of it. It is almost too hard to live with
Eggster
As I sit here, fresh out of the shower, my ears are singing at a very high frequency. I experience this off and on, but I find it often happens after a change in ambient temperature - after a hot shower or coming inside on a cold winter day. I've never come across any other reports of a temperature based reaction, so I have no idea how it might cause it. Mercifully, it is such a high frequency that it less intrusive than the typical case.