Can Biofeedback Help To Manage Tinnitus?

Patient undergoing biofeedback therapy

Tinnitus patients are frequently in search of some ease from symptoms of acute and chronic tinnitus, and tinnitus related distress. For some, this means seeking out every possible hearing avenue, while others opt for a slow, steady wade into the metaphorical waters. Biofeedback and biofeedback relaxation techniques are among the latest interventions aiming to offer relief to tinnitus sufferers, but can this form of chronic tinnitus treatment actually work? First, let’s take a closer look at this particular type of feedback training, and how it relates to tinnitus patients.

What Is Biofeedback Therapy?

Biofeedback therapy is an interesting therapeutic process that essentially teaches individuals how to modify their physiology to improve their physical, mental, emotional, and even spiritual health. This is achieved by encouraging people to take more control over the way their bodies function. In biofeedback sessions, patients are hooked up to sensors that (painlessly) take note of different reactions within the body, including respiratory rate, heart rate, muscle tension, and more. When these reactions are displayed on a screen, practitioners and patients can practice engaging different practices to ease the issues revealed during biofeedback sessions.

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This type of therapy requires the active participation of the patient, and is delivered with the ultimate goal of no longer training with the professional in question and moving toward learning how to manage reactions themselves. Individuals may be referred to a biofeedback practitioner as an alternative treatment, or as an adjunct therapy.

What Can Biofeedback Therapy Help With?

Biofeedback training can relieve a host of different issues. Because the therapy is designed to help people recognize their own bodily responses and respond to them in healthier ways, biofeedback relaxation techniques can be used to offer relief for numerous issues, including:

Although this is not a comprehensive list of all that biofeedback training can be used for, it does offer a window into the incredible versatility of the therapy, including its position as a potential tinnitus treatment.

Biofeedback Sessions: An Overview

Person getting a biofeedback test

In a given biofeedback session, a practitioner will place sensors directly against skin. These sensors are painless, and are used to monitor bodily signs such as heart rate, muscle activity, respiratory rate, and even electrical activity within the brain. These measures are then displayed on a screen to be disseminated by the practitioner and patient.

As the measurements from the patient’s body are evaluated, a practitioner can suggest the most effective strategies to alter your body’s function. This can be as simple as changing the position of your body or altering your breathing, or can be more involved, including engaging in mindfulness practices or muscle relaxation exercises.

Biofeedback for Tinnitus Patients

Tinnitus is a condition of the ear and auditory cortex. It is most often described as a ringing noise, though it has also been described as a buzzing or whooshing sound. Tinnitus can be measured as having a severe intensity or a more mild set of symptoms, and there is both acute and chronic tinnitus. Those with tinnitus may report a great deal of distress if the condition is not effectively managed, as chronic tinnitus symptoms can interfere with concentration, working, and learning, and can even negatively impact relationships. This training aims to lessen reactions to the onset of tinnitus, thereby improving quality of life.

The American Tinnitus Association does currently recognize biofeedback relaxation techniques as a prospective way to treat tinnitus. The recommendation for feedback therapy focuses more on improving general wellness in order to help with subjective tinnitus symptoms; essentially, this therapy can help tinnitus sufferers control certain autonomic bodily functions that can soothe anxiety and stress symptoms. Some have suggested that when patients suffering from tinnitus are better equipped to control stress and anxiety, tinnitus patients can experience relief from tinnitus symptoms and tinnitus related distress.

Although tinnitus loudness and tinnitus related distress is not directly related to biofeedback or neurofeedback training, stress that comes about as a result of tinnitus symptoms can be soothed by one or both training, which can help reduce negative responses to symptoms. Diet, physical activity, stress management, hearing protection, and mindfulness practices such as hypnotherapy can all also be used to manage tinnitus related distress and increase tinnitus sufferers’ quality of life.

The efficacy of biofeedback sessions have been evaluated for far more than tinnitus related distress. One study that looked at the potential applications of biofeedback training determined that patients reported substantial psychological benefits, including patients who had tinnitus. The study determined that the training was probably “efficacious” in serving as a chronic tinnitus treatment, to help ease the distress associated with tinnitus symptoms.

Biofeedback-Based Behavioral Treatment for Chronic Tinnitus: Results of a Randomized Controlled Trial

In this particular study, patients suffering from tinnitus were given biofeedback sessions over the course of 3 months, for 12 treatments total. Tinnitus loudness and a tinnitus handicap inventory was taken, to determine whether or not patients reported substantial psychological benefits and sustained changes to tinnitus symptoms. Patients reported that irritation resulting from symptoms, loudness ratings, coping habits, controllability, and improvements to depressive symptoms were all observed. According to this study, a biofeedback protocol was distinctly helpful for individuals with tinnitus.

Biofeedback vs Neurofeedback Training

Although the two are frequently used interchangeably, biofeedback sessions and neurofeedback training are two different animals, by virtue of the location of the sensors and the actions being monitored. While biofeedback focuses on the body as a whole–which may or may not include the head–neurofeedback focuses entirely on the brain, using brain activity to create a map of responses. Both can be useful for patients with tinnitus to help address typical neural activity patterns and biological reactions, to help ease some of the muscle tension and emotional responses to symptoms.

Neurofeedback therapy utilizes electrophysiological recordings, which allows physicians to visualize certain aspects of brain activity. Positive or negative feedback then allows patients to develop the ability to influence and ultimately manage their brain activity to encourage typical neural activity patterns related to tinnitus. Neurofeedback treatment studies have suggested that it is a promising means of treating tinnitus, though there are some limitations as a functional intervention for the condition.

One recent study evaluated tinnitus patients undergoing neurofeedback training sessions for one year. These patients reported reductions in their tinnitus handicap inventory that was considered significant or substantial, while the control group reported no changes whatsoever. Although this is only one study and the results are not conclusive as a result, ongoing research is being used to determine whether biofeedback therapy and neurofeedback training are useful techniques to successfully manage or reduce tinnitus symptoms.

Tinnitus Management

Woman getting an ear exam

Patients suffering from tinnitus will be best served by a qualified healthcare professional who can evaluate the individual for any possible underlying causes. Tinnitus symptoms are relatively constant, but the underlying cause of tinnitus onset varies considerably. Receiving an accurate diagnosis is important, but evaluating all possible underlying mechanisms is equally important, because it will inform possible treatment avenues. Treating the root cause is one of the best ways to resolve hearing loss and tinnitus.

Hearing loss is a common root for the onset of tinnitus, and when this is the case, tinnitus can be addressed by using a hearing aid. This is prime example of why a thorough examination and evaluation is important: tinnitus is not an isolated condition, and tinnitus patients need to look into more than just their ringing ears to determine how to ease symptoms, whether that means addressing the auditory cortex, seeking unconventional interventions, or addressing chronic infections to lower scores on the tinnitus handicap inventory.

The tinnitus handicap inventory is a standard questionnaire given to prospective tinnitus patients, to take a close look at all measurements related to ringing in the ears and underlying causes. This questionnaire can also help determine whether hearing aids, Tinnitus Retraining Therapy (TRT), Cognitive Behavioral Therapy (CBT), biofeedback therapy, neurofeedback therapy, sound therapy, and or other interventions are most likely to serve patients well. Many of these interventions can be used concurrently to form a wide-reaching treatment plan.

Many tinnitus patients report a significant reduction of chronic tinnitus symptoms and corresponding psychological symptoms and distress when tinnitus is managed effectively. Beginning with full evaluations, ongoing treatment orders, and continual monitoring for success or difficulty, tinnitus management often requires the aid of a team of specialists, including audiologists, primary care providers, and ear, nose, and throat (ENT) doctors. Working together, a team of these professionals can help get to the bottom of tinnitus treatment needs to improve symptoms, and even prevent further damage to hearing.

Biofeedback and neurofeedback treatment studies have demonstrated their value as interventions for tinnitus, just as sound therapy, TRT, CBT, and hearing aids have been proven to be useful. Utilizing therapy to not only manage symptoms, but manage responses to symptoms has the greatest chance of improving responses to tinnitus, improve quality of life, and effectively address this particular hearing condition. 

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