«With tinnitus, life circumstances are often noteworthy in the preliminary stages.»

Dr Frigg, does tinnitus always manifest itself as whistling? 

No, there, it can also manifest as noise, whirring, ringing, knocking, or hissing – and even rather strange noises such as engine noises. Tinnitus is often associated with a certain degree of hearing loss.

Is the noise always perceived as too loud? 

How loudly those affected perceive ear and head noises varies greatly. Some people hear a rather quiet sound, which can be a little louder depending on the situation. Other sufferers hear a permanent loud noise. About 30 to 40 percent of tinnitus sufferers also suffer from hyperacusis; they perceive relatively moderate noises and sounds as too loud, unpleasant, or even painful.

Should ringing in the ears and head be medically clarified in any case?
If the noises persist for more than a few days, I strongly recommend a somatic clarification. Although tinnitus rarely has somatic causes, it is essential to rule those out.

What are the somatic causes of tinnitus? 

Inflammation of the inner ear can lead to tinnitus, as well as a tumour that presses on the auditory nerve. Damaged blood vessels in the inner ear due to diabetes can promote tinnitus. With hypertension, the increased basic tension on the blood vessels can manifest as tinnitus. Ear and head noises can also occur if the inner ear has been damaged – for example, by a blast trauma or listening to music that is too loud.

Can ear and head noises also disappear on their own?
Ear and head noises caused by too loud music, or a blast trauma can fully disappear after a few days. However, it persists in many people who have developed tinnitus without a somatic cause.

How does a sudden onset of tinnitus without a somatic cause occur?
Some people develop tinnitus almost overnight. For those sufferers we see here in an inpatient setting, the living conditions are often noteworthy in the preliminary stages. Most of them have a history of long-standing overexertion – privately, professionally, or both together.

Can tinnitus without a somatic cause also develop gradually?
Some sufferers have been hearing a sound for years or decades and have come to terms with it. For a long time, such people were not in acute need of treatment because tinnitus was not a permanent burden for them. However, if they find themselves in a challenging or overwhelming life situation, the tinnitus typically becomes louder – and remains that way.

What are the typical accompanying symptoms?
If the noise is so loud that it is permanently at the forefront of perception, it creates chronic stress. This can cause accompanying symptoms such as difficulty falling asleep and staying asleep, exhaustion, nervousness or inner restlessness, concentration difficulties, irritability, or mental instability. Depressive symptoms, up to suicidal thoughts, can also occur.

Which therapy is beneficial?
After the detailed ENT clarification, a multimodal therapy approach is expedient for most patients. Solution-oriented psychotherapeutic adjunctive therapy is not only important for inpatients; I also recommend these for outpatient therapies.

When is drug therapy needed?
Drug therapy can be used to stabilise acute psychological and somatic complaints. Short-term therapy with cortisone preparations such as prednisolone is useful, for example, in cases of acute idiopathic tinnitus. In cases of chronic tinnitus, drug treatment is not the focus; here, it is more about behavioural therapy and physiotherapy measures.

To what extent can physiotherapy lead to improvement?
In chronically stressed people, muscles are often affected, especially those in the neck, neck, and jaw area. If you loosen these muscles, it can modulate tinnitus.

What do you recommend if you have also been diagnosed with hearing loss?
Hearing loss should also be treated. Those affected should seek hearing acoustics advice and try a hearing aid. In certain cases, a hearing aid can help to reduce tinnitus.

Why?
In cases of unilateral gradual hearing loss, the brain and central nervous system try to remodulate themselves in a frustrated compensation, which can lead to tinnitus perception. If one compensates for the hearing loss with a hearing aid, the central nervous system adapts again. This improves hearing and speech comprehension – and may reduce tinnitus.

Is healing not a goal of therapy?
We can't promise healing – you have to be honest. In the case of chronic forms, the aim is to relieve the fixed perception of the disturbing noise. At the clinic, we support our patients in developing strategies for everyday life. Those affected can learn to live with their tinnitus.

What can be achieved with cognitive-behavioural therapy?
With behavioural therapy methods, we try to ensure that those affected learn to deal with their symptoms. To this end, we work with our patients to develop a subjective concept of the illness. The aim is to understand psychological and somatic connections and thus reduce the feeling of being at the mercy of the symptoms. Self-care and the experience of self-efficacy are central.

What can those affected do to reduce their suffering?
Our clinic offers a specific hearing therapy in which other senses are trained, and mindfulness-based methods such as MBSR (Mindfulness-Based Stress Reduction) are learned to modulate tinnitus. Music therapy or relaxation techniques such as autogenic training, yoga or progressive muscle relaxation can also be used to shift the focus to such an extent that the affected person perceives the disturbing noise as less intense.

Are there preventive measures to prevent tinnitus from developing in the first place?
We live in a society that equates performance with "being worth something". For most of our patients, the idea that they are only worth something if they perform and are perfect at all times is a central issue. If you are chronically overworked, you should react early. However, admitting to yourself that you are at the limit and need help is difficult. That's why most people don't react until the process is relatively advanced.

What does this mean for therapy?
People who come to us as inpatients feel a lot of pressure. Most of them have realised, at least partly, that things cannot go on as before. It is important to show them that a stay at the clinic alone is not enough to improve their long-term well-being. If our patients continue in everyday life as before after inpatient therapy, there is a huge chance that they will not get rid of their tinnitus at all or that it will get worse.

What is most important for the time after the inpatient stay?
We advise our patients to continue what they have learned as an inpatient after discharge on an outpatient basis; for example, relaxation techniques in combination with solution-oriented psychotherapy. To get a grip on chronic tinnitus, fundamental changes are needed in everyday life – professionally and privately.