22B. Integrative Therapy for Patients With Severe Tinnitus

Tinnitus is a common problem for which there is no universally effective treatment. The best available estimates indicate that 10% to 15% of adults report having tinnitus symptoms, but only 20% of those who report tinnitus suffer from it and subsequently seek treatment. Individuals with persistent severe tinnitus are unable to habituate to the tinnitus sound that most likely originates in the central auditory system (CAS) in response to peripheral injury. It is hypothesized that lack of habituation is secondary to abnormal processing of sensory information by the limbic system and autonomic nervous in patients with increased levels of cortical arousal and inadequate coping mechanisms. While commonly used sound-based and educational therapies provide a starting point for treatment, additional options are necessary particularly for those with significant non-auditory aspects of tinnitus (eg, anxiety, depression, interference with daily life) as well as for the estimated 1.2 million individuals who are not able to benefit at all from the current conventional treatments. Discriminating features of integrative medicine align well with what is known about those with severe tinnitus. First, they demonstrate diverse characteristics and thus benefit from individually tailored holistic approaches. Second, those with severe tinnitus tend to demonstrate greater distress and psychological vulnerabilities, which would predictably be ameliorated by patient-centered care. Finally, individuals with greater distress and psychological vulnerabilities have been consistently shown to benefit from cognitive behavioral therapy (CBT) and some mind-body approaches. Although use of nonconventional approaches for tinnitus has been quite limited, we have found significant success using a suite of integrative therapies that include (1) cognitive-behavioral therapy; (2) mindfulness meditation; (3) acupuncture; and (4) integrative health coaching (IHC). The synergy of these approaches, when combined with sound-based and educational therapies, allows even the most severely affected tinnitus patients to experience maximal symptom control.