Tinnitus is the term for hearing sounds in the ears or head without the presence of an external stimulus (Cima, 2017). It is not a disorder but a symptom of damage to the auditory system (Cima, 2017). Tinnitus is suffered by 1 in 10 people but the annoyance caused by tinnitus varies from person to person depending on the type and extent of their tinnitus (BTA, 2015). Although tinnitus is an auditory symptom it can have many psychological effects on the body, for example, an increase in stress levels. According to the lecturer’s handout (Millman, 2017) stressed individuals are more likely to be troubled by their tinnitus.
This essay will discuss the relationship between stress and tinnitus. According to Herbet et al (2015) stress is the internal state that occurs in response to circumstances or situations that exceeds a person’s ability to cope with them, it results in changes in a person’s homeostasis, however, Conrad (2015) argues that stress isn’t always bad for an individual’s health. Short-term stress is beneficial over a short period of time, as it increases motivation and improves performance, however, in the long-term it can have adverse effects on a person’s physical and mental well-being. The British Tinnitus Association (2015) uses the cognitive behavioural therapy model to explain the cause of stress, it suggests that it is not solely what happens that makes you feel stressed, but the way you think about these events. Szczepek and Kloet (2017) suggest that stress activates the hypothalamic-pituitary-adrenal (HPA) axis, which has been known as the body’s ‘stress system’ and controls the release of cortisol and other stress hormones. A study measured the level of stress-related hormones in 344 tinnitus patients and 89 healthy normal controls. It found that tinnitus patients had abnormally high levels of stress-related hormones (norepinephrine and 5-HIAA) than healthy individual hence people with tinnitus are more stressed.
In addition, in the study by Herbet and Lupien (2007) they measured the stress hormone cortisol to examine the reactivity of the HPA axis in tinnitus participants as well as in healthy controls. 18 tinnitus patients and 18 controls without tinnitus were exposed to an experimental psycho-social stress. They found that tinnitus patients developed an improper cortisol response to the stress task in comparison to the healthy controls and the HPA axis in tinnitus patients under stress seemed to be activated later and to a lesser extent than in the healthy controls, suggesting that stress and tinnitus are related. Furthermore, a cellular effect of stress involves changes in the pre and post-synaptic neural plasticity of the auditory system. The way a person reacts to their tinnitus varies greatly. Some individuals get on with it in a calm way without being distressed by it, whilst others might experience feelings of anxiety and may perceive it as the biggest stress in their lives (NHS, 2015). The British Tinnitus Association suggests, the reason why some individuals are stressed and others are not is because they focus their attention on it and think about their tinnitus in negative ways. People who are stressed about their tinnitus tend to think about it from a pessimistic perspective and they believe that they will never get peace and quiet.
When thought about it in this way it may cause the individual to feel overwhelmed and unable to cope. They found that stress makes tinnitus more noticeable and result in a vicious circle, it makes tinnitus more detectable which in turn leads to greater stress. Furthermore, the relationship between tinnitus and stress can be understood by considering the role of attention and motivation. If you direct your attention to your tinnitus you are more likely to perceive it as a threat to your wellbeing, this may lead to adverse effects of stress as the tinnitus will be much more noticeable and disturbing. Therefore habituation reduces stress levels as the individual learns to give less attention to their tinnitus. Although no direct cure for tinnitus has been found, there are a number of treatments that help the individual manage with the condition. It is important to treat the underlying cause of tinnitus in order to reduce the severity of it (BTA, 2015).
Since a relationship between stress and tinnitus has been found, the aim is to reduce the adverse effects of stress in order to alleviate the distress caused by tinnitus (BTA, 2015).The cognitive behavioural therapy(CBT) aims to reduce the unpleasant feelings of stress associated with tinnitus by using cognitive and behavioural treatment techniques (Varvogli and Daarviri, 2011). The therapy relies on a collaboration between a patient and a clinician in which they view the patient’s negative thoughts in regard to tinnitus and replace them with more positive and rational thoughts (Varvogli and Daarviri, 2011). Changing the way an individual perceives their tinnitus can lead to habituation and reduces the stress associated with it (BTA, 2015). Studies into the effectiveness of CBT in treating tinnitus suggest that CBT has a positive effect in the management of tinnitus.
Devesa et al (2010) randomly selected 468 patients with unilateral or bilateral tinnitus as one of their main symptoms. The authors assessed each report by the patients and found that the quality of life scores were improved in patients who had CBT as their treatment to tinnitus in comparison to no treatment or another intervention, however, they found no significant reduction of the loudness of tinnitus between CBT and other treatments. The results show that cognitive behavioural therapy is an effective treatment as it improves the quality of life of individuals by reducing the effects of stress associated with tinnitus. Evidence gathered in this essay suggests that stress and tinnitus are related, however, the direction of the relationship is still unknown, as it is impossible to deduce whether tinnitus causes stress or stress causes tinnitus. Evidence from clinical studies have identified a link between the two and found that coping strategies such as cognitive behavioural therapy are effective in the management of patients suffering from tinnitus.