The use of the Cortisol Awakening Response as a biomarker of distress in people with tinnitus Update January 2017 This project is now complete and Dr James Jackson of Leeds Trinity University presented his results at our conference in September. At the start of the day the stress hormone cortisol is released into the body. This is a very important mechanism and manages the release of sugars into the bloodstream – something the body needs to ‘power up’ in the first hour of wakefulness. This is called the Cortisol Awakening Response (CAR). If an individual doesn’t follow the usual pattern of CAR and secretes less cortisol, this is an indication that they are under stress. Dr Jackson’s research has been looking at the levels of cortisol in tinnitus sufferers and this small study has shown that distressed tinnitus sufferers have low cortisol levels indicating ‘burnout’. Due to issues these particular patients have such as a lack of control over their tinnitus, an inability to relax and emotional distress caused by the tinnitus, their bodies have shut down cortisol production. Dr Jackson’s explanation of this is that if the patient feels they have no control over their tinnitus, this influences the stress they feel and hence the levels of cortisol released by the body. This suggests three important elements: Chronic tinnitus has real physiological changes in the body; it is ‘real’ and can be measured; The changes are caused by certain aspects of chronic tinnitus such as the level of distress and lack of control felt by the patient; If these changes can be measured, then the effectiveness of any interventions can also be measured. This small study has shown some very exciting results being able to distinguish between the most distressed individuals with tinnitus and those who have adapted more effectively or have learned to live with tinnitus. The aim would be in the future to move people from one group to the other with a physiological measure to determine if the intervention had worked. Funding for a larger study is now needed to replicate these findings in a more realistic sample.