Psychiatrists Are not the First Port of Call
In their review article (1), our psychiatrist colleagues state that patients with tinnitus can be treated meaningfully. In this setting, the treatment approaches are similarly multifarious as the affected patients are different. In our long years of experience, the following are helpful:
- A fundamental neuro-otological competence that includes the concrete auditory perception
- An understanding of psychosomatic approaches
- And, above all else, empathy for the symptom and the affected person.
As a rule, disorder-specific treatment that is audiologically based and considers the possible causes as well as the sustaining factors—psychosomatic or somatopsychic—will be successful (2, 3). Psychiatric help may be indicated if relevant psychiatric disorders determine the tinnitus (3)—but psychiatrists are certainly not the first port of call in tinnitus therapy.
In cases where all outpatient therapies have been exhausted, large effect sizes have been found for inpatient psychotherapy, which is quite common in Germany—even though its efficacy, as the authors noted, has thus far not been evaluated in randomized controlled studies.
In contrast to studies of apparatus-based approaches or psychotropic drugs it is difficult to imagine how tinnitus patients who require treatment and have been admitted as inpatients would be divided into a psychotherapeutically treated group and a placebo group. On examining results from suitable psychosomatic hospitals—which are accessible to psychiatrists—with regard to diagnostic evaluation that is related to symptoms as well as psychological, one will find not only notable and sustained improvements of symptoms (4) but also therapeutically very effective reductions in the accompanying symptoms of anxiety and depression, with large effect sizes (3).
By contrast, therapeutic approaches (such as neuromodulation) that promise suffering patients the complete extinction of their tinnitus with the help of medical apparatus, will mostly lead to disappointment, which in turn is also a serious adverse effect.
Dr. med. Helmut Schaaf
Prof. Dr. med. habil. Gerhard Hesse
Tinnitus-Klinik Dr. Hesse und Gleichgewichtsambuanz der Klinik Dr. Hesse
im Stadtkrankenhaus Bad Arolsen
Conflict of interest statement
The authors declare that no conflict of interest exists.
|1.||Kreuzer PM, Vielsmeier V, Langguth B: Chronic tinnitus: an interdisciplinary challenge. Dtsch Arztebl Int 2013; 110(16): 278–84 VOLLTEXT|
|2.||Hesse G: Die Neurootologisch psychosomatische Habituationstherapie. HNO 2009; 56: 686–93 CrossRef MEDLINE|
|3.||Schaaf H, Eichenberg C, Hesse G: Tinnitus und das Leiden am Tinnitus. Ein Plädoyer für eine störungsspezifische Betrachtungsweise und ein differenziertes Vorgehen anhand 287 ambulanter und 128 stationär behandelter Tinnitus Patienten. Der Psychotherapeut 2010; 55: 225–32 CrossRef|
|4.||Goebel G, Kahl M, Arnold W, Fichter M: 15-year prospective follow-up study of behavioral therapy in a large sample of inpatients with chronic tinnitus. Acta Otolaryngol Suppl 2006; 556: 70–9 CrossRef MEDLINE|