A remarkable number of patients with tinnitus demonstrate withdrawal behaviour and have a negative view of life. Feelings of anxiety and depression result in patients experiencing the complaint as a major burden on their quality of life. In addition to psychological treatment, neurostimulation now also appears to be a very promising therapy. This is the result of research conducted by Hilke Bartels of the University Medical Center Groningen. She will be awarded a PhD by the University of Groningen on 26 November 2008.
Patients with tinnitus hear noises that do not originate outside but within the body itself. They can be squeaks, whistles or whooshing noises, or even rumbles, knocking or rustling sounds. It is estimated that 10-30 percent of the Dutch suffer from tinnitus. Four to five percent of these people feel seriously limited as a result; for example, they can't concentrate properly anymore, or have trouble sleeping. The complaint usually starts when people are between the ages of 40 and 60 and their hearing is not what it used to be.
For a long time it was assumed that the cause of tinnitus lay in the auditory organ itself. However, it is now clear that the brain is responsible: overactive parts of the brain in the auditory region emit continuous signals that are the cause of the ‘phantom noise'. This over-activity is usually the result of hearing loss. However, noise (buzzing in the ears after visiting a concert or discotheque), an infection or an operation on the ear, or a jaw or neck problem can also cause the symptoms. With the help of the image-forming technologies PET and fMRI, Bartels mapped the over-activity of the relevant parts of the brain. She was thus able to confirm existing theories about the complaint.
Bartels's research has revealed that a remarkable number of tinnitus patients are depressed and have a negative attitude towards life. They do not dare to share these feelings with others, which means they experience little social support, which in turn leads to withdrawal behaviour. This is also described as the so-called ‘type D personality'. No fewer than 94 of the 265 tinnitus patients investigated had such a personality type. These patients experienced significantly more psychological discomfort, the research revealed. Anxiety and depression appear to strengthen the effect of tinnitus. People with a type D personality in particular should undergo treatment that concentrates on the reduction of anxiety and depression, according to Bartels.
A psychological approach is not the only light on the horizon, however. Between 2001 and 2003, the UMCG started an experimental treatment regime whereby the relevant brain areas were continuously stimulated with the help of a pulse generator, a sort of pacemaker. An evaluation revealed that four of the six patients treated in this way had significantly positive long-term results. The patients indicated that the ‘noise' was reduced to manageable levels and awarded the treatment a mark of 7 out of 10. Neurostimulation with a magnet outside the skull also looks like an interesting treatment option. The tinnitus of 5 of the 24 patients who underwent this experimental treatment was temporarily suppressed.
Thus far no treatment has been shown to be effective for the majority of tinnitus patients. Current treatment options have either a medical, an audiological or a psychological basis. According to Bartels, a multidisciplinary approach is essential. She also calls for the use of validated questionnaires to chart the nature and the impact of tinnitus.
Hilke Bartels (Nijmegen, 1978) studied Medicine in Groningen. She conducted her PhD research at the ENT department of the University Medical Center Groningen (UMCG). She is currently working as an ENT intern at the UMCG and the Isala Clinics in Zwolle. The title of her thesis is ‘Tinnitus, new insights into pathophysiology, diagnosis and treatment'.