Urgent needed knowledge and practice development – different kinds of Tinnitus

Tinnitus Syndromes – an extremely complex, knowledge limited multifaceted/multidisciplinary, not urgently worked with and perhaps forgotten area – which is handed over to CBT ordepressives as if there are no neurobiology/biopsychosocial to be of interests (except a few things as audiogram)?

NB very old text needed to be very much updated – which will be first when I have solved my own inpossible hard aggressive tinnitus syndrome associated (after 60 years with ”normal” manageable tinnitus) with mutifaceted dysfunction, something probably not very rare). while so far I have a large toolbox, which I will then also evaluate before making it public!

First, some recent argument inserted a year later then the text below:
Still, (2021 April) I have not known about proper examination/diagnosis work in Sweden (will be wrong here!) concerning symptoms included in the common use of the concept ”tinnitus syndrome”. With proper, I mean “response-able, profound bopsychosocial medicine examination based on excluding from a comprehensive differential diagnoses multidisciplinary list! (unfortunateky 2022-10-29 largely agreee to the above)

Perhaps impossible to carry out, but whom (patients and professionals) will benefit from a meaningless diagnosis based on lack of knowledge or, at best, too simple diagnosis base. Many patients get simplified diagnostic “stamps”, where some will enter a perhaps even more complex situation. The patient may over time by her/himself adjust to meet the expectation criteria. And some may be forced into adjustment. And more; only CBT for biological dysfunctions may even hide the real base for more or less hard, impossible symptoms – some permanent and some turning up without any observable reasons – by it self a hard challenge also attacking individuals´ Sense of Coherence (Antonovsky, 1987)

(Text from early 2020 bus still valid)
The below is quite hard, but highly needed, arguments within a almost (as more colleagues than I regard as) not existing specialist field. To understand more about the argument, the scientific paradigm the below rests refers to Evidenced based falsification of data or validation of the individual patient in front of us? | Biopsychosocial Medicine

When I write this, I do it based on a multidisciplinary scientific and clinical focus but
also based on severely handicapped patient position, which may explain the absence of scientific traditional material and references but contains clinical arguments for  a comprehensive multidisciplinary, ideographic approach within a field obviously forgotten or not sufficient care for.

I myself, have suffered for now eleven (long) months from severely not really bearable ”burglar alarm similar sound cluster” (Tinnitus Syndrome). I did not before have realized what biopsychosocial disaster it can entail.

The Tinnitus Syndrome fields obviously is not there for us needing biopsychosocial medicine care, while obviously there is an extremely lack of knowledge and practical experience what is normal for a clinical field (I would like to be wrong, if so, tell me!).

Since I can only work and write 10 to 15 minutes a few times a day – I am interrupt by increasing “inner storm” – I will below only briefly suggest what needs to be done – that is, my suggestions/comments below with a few references.

Background; I have tried to understand – from me new fields – based of a kind of survival reasons. This is done by doing internet searching to see, based on different possible areas/fields, what knowledge and different approaches in the tinnitus syndrome sphere I can find, see e.g. (when very much updated) http://carism.se/project/projekt-carism/a-multidisciplinary-overview-of-the-tinnitus-syndrome-fields/ when I have done a multidisciplinary systems well structed and readable version.

Important to understand that Tinnitus is not ”one thing” but very many. Also the dysfunctions (can be more than one cause!) can be “outside” the ear although it seems for you it is from within. Many websites list different causes, e.g. https://www.ata.org/understanding-facts/causes “Tinnitus is not a disease in and of itself, but rather a symptom of some other underlying health condition. In most cases, tinnitus is a sensorineural reaction in the brain to damage in the ear and auditory system. While tinnitus is often associated with hearing loss, there are roughly 200 different health disorders that can generate tinnitus as a symptom. Below is a list of some of the most commonly reported catalysts for tinnitus”.

I suggest you to have a look at the link (above) so you get ideas of its complexity.
I have found recently that there are emerging more and more similar work on the multifaceted Tinnitus Syndrome, which I will soon (I hope) here below make references to some!

Now my arguments:

  1. What is extremely important is to develop effective user-friendly biopsychosocial
    methods such as

    1. Primary Care can use without not very much extra education – enabling primary examinations and then further refer to relevant specialist
    2. A biopsychosocial medicine effective multidisciplinary approach enabling education and training of specialists in different relevant fields (there are many existing which apparently do not work with Tinnitus problem
    3. But also including the patient actively (see footnote ”the patient
      as ..”) for group education. When patient understand more the What, Why, How,.. they can meaningful take part (Sense of coherence, Antonovsky e.g. https://www.sciencedirect.com/topics/medicine-and-dentistry/sense-of-coherence)
    4. Specifically work hard of developing/improving examination instruments and tool, e.g. nowadays MRI can be included as well as a lot of other tools to optimize the clinical picture.
      It is especially important to make a functional classification system, e.g. as Gleason score in prostate cancer.
  2. From examination/investigation generates individual diagnostic hypotheses with ”a priori  repeated measurement single case design” predicated how interventions can to be tailored – reasonably adapted knowledge and application – from a biopsychosocial toolkit, which can be used through group training and, if necessary, individual supervision in addition to the clinical procedures considered/proposed as necessary.
  3. Through continuous follow-ups, including effective clinical patient dialogue, diagnosis is modified
    hypothesis while the individual´s rehab is carried out in the best possible way. If the patient is not functionally fully recovered optimally, then effective habilitation and adaptation to living and functioning as well as possible based on individuals’ circumstances.
  4. The above requires extensive coordinated applied research and development and its clinically
    knowledge applications.
  5. Given political and public interest for the above, how will this be launched based on existing clinical knowledge and services? Anyone having mandate prepared to take the lead? Critical is a competent coordinator which can be responsible for initial planning and start up!

You may say, we do have an audiologist profession! Yes, audiologist is not a seemingly new profession or? A Brief History of AUDIOLOGY https://hsl.lib.unc.edu/speechandhearing/professionshistory  but the question is audiology is a wide field and so is also Tinnitus Syndrome, which need to be much, much more attention!

Footnote: Very brief
”Patient who reasonably competent, trained resource and employee in his/her own rehab” is a further development through the years of the biopsychosocial manual ”Participation in life, MBiL” (https://www.avhandlingar.se/avhandling/92a79676af/) that I used in my field ”psychophysiological stress medicine”. As learning and training can be observed in psychophysiological data, it has almost always been easy to work with, as patients become highly motivated and resource where group training forms the basis. Even patients’ sense of context, see above, facilitates the clinical work. I have lacked the principle while trying to influence to competent between health care representatives and study association educators.


Always possible to mail to info@stressmedicin.se