Role of Psychiatrists in Tinnitus

Volume 5 Issue 8 August 2015

Consultation Liaison Psychiatry Focus: ‘ENT’

Tinnitus is an aberrant perception of sound without any external stimulus. Often underlying cause remains elusive and thus functional tinnitus is more common than organic one. Chronic tinnitus is so disturbing that it affects psyche of affected individual and impinges on the quality of life to varying degrees. Patients may complain of impairment in lifestyle, emotional difficulties, sleep deprivation, hindrance to work and social life and a general decrease in health status (Simpson & Davies, 1999). Some of the psychological disorders associated with tinnitus are anxiety, depressive disorders, hysteria, insomnia, anger, fear, despair, somatoform disorders (DSM-IV Axis I) and exhibit personality disorders (DSM-IV Axis II). Conversely, cognitive characteristics such as attention, processing speed, dysfunctional belief and catastrophic thoughts mediate or moderate the loudness of tinnitus.

Essentially, management of tinnitus is multidimensional. It requires not only assessment of underlying etiological factor and magnitude of structural damage but also psychological assessment of patients. Perceptual, emotional, and behavioral parameters are required because pharmacotherapy alone has produced unsatisfactory results in chronic tinnitus. Oto-psychiatric treatment ultimately aims at helping patients direct their attention away from the tinnitus and putting negative cognitive processes under control.

Cognitive behavioral therapy (CBT) focuses on sensory, perceptual and psychological factors together for amelioration of distress thus improving quality of life by restructuring thought patterns and habituation. Other form of therapies like Tinnitus Retraining Therapy (TRT) consisting of educational counseling and sound therapy is also used to treat this symptom. However, efficacy of this form of treatment remains to be proved by RCTs. Biofeedback, masking and relaxation therapies aim to teach the patients to focus on adapting to the tinnitus to improve quality of life but do not eliminate tinnitus completely.

Tinnitus should be understood as a neuropsychiatric or somatoform disorder syndrome. The treatment of tinnitus overlaps with that of the associated neuropsychiatric disorders (benzodiazepines, antidepressant, antipsychotics, and mood stabilizers). Present evidence at best supports the view that tinnitus is a neuropsychiatric disorder requiring help of a psychiatrist for its overall management.