A paper called ‘Why is there no cure for tinnitus?’ has been published in the science journal Frontiers in Neuroscience. This post briefly looks into some of the findings of the paper.

Tinnitus is unusual in the sense that for such a common condition there are very few treatments, and even the treatments that do exist focus on reducing the effects of tinnitus rather than eliminating it.

Obstacles

There is no single reason as to why there is no cure for tinnitus, but the paper authors identified a series of obstacles in developing one:

  • It is unclear how common tinnitus is – varying studies suggest different percentages of the population live with tinnitus. Without definitive numbers it’s difficult to engage with the pharmaceutical industry.
  • There is no certain definition of what tinnitus is. It also has multiple sub-types which may require different treatments.
  • It is unclear what the exact cause of tinnitus is, which can make developing an effective drug difficult.
  • There is a lack of funding and a lack of research. Tinnitus research by nature is multi-disciplinary, and there are very few research centres where cross-specialty work is available.

Current treatments

Currently psychology-based interventions such as cognitive behaviour therapy are cited as the most efficient treatments. Such treatments seem to be effective in improving the quality of life and relieving tinnitus related distress yet have little effect on tinnitus loudness. Despite psychology-based interventions helping relieve the distress of tinnitus, most studies suggest that people desire a pill that could reduce tinnitus loudness and annoyance or even eliminate it completely.

Studies also suggest there is currently a disconnect between how patients and clinicians feel about current treatments for tinnitus. A US study showed that the majority of audiologists saw treatment success as decreased awareness of tinnitus, and stress relief, whereas most patients viewed success as reduction of loudness, and complete elimination of the sound.

Developing a drug

Developing a drug that could meet patients’ desires would also bring with it some financial benefits. At the moment, managing tinnitus carries a significant financial burden to healthcare systems. In 2016 an estimated £717 was spent by the NHS per patient managing tinnitus. If a drug was made that met the desires of those wishing to control and potentially eliminate their tinnitus, it is predicted that it could make $689 million in its first year (£550 million.)

Eliminating tinnitus, and relieving the financial strain put on the NHS sounds great, but when we talk about completely eliminating tinnitus we run into another problem. People with normal ears, normal hearing and no tinnitus have been known to experience phantom noises when inside sound proof environments. This makes the concept of completely eliminating tinnitus difficult, as experiences like that will never be eliminated; perhaps a more realistic aim should be remission? To avoid issues such as this the authors of the paper suggest that greater focus is required on definitions, sub-typing and outcome measures.

Conclusions

The researchers conclude that to move ourselves closer to a cure the following research aims need to be met:

  • Understand what causes tinnitus.
  • Have a robust idea of what we want the outcomes of a cure to be – complete elimination, or remission?
  • Have meaningful sub-typing, and understand how each type needs to be treated.

To achieve this, the work and research needs to be interdisciplinary, international and engaging to both researchers and clinicians.

Reference:

McFerran DJ, Stockdale D, Holme R, Large CH, Baguley DM. Why is there no cure for tinnitus? Frontiers in Neuroscience. August 2019 [online] https://doi.org/10.3389/fnins.2019.00802