March 16, 2020. That day is in my diary as the day I started to hear buzzing in my ears. And that buzzing has never gone away.
Having spent the previous nine years as an audiologist treating people with this problem, I knew instantly what it was – tinnitus, the perception of sounds such as ringing, buzzing or hissing in your ears or head without an external source.
Usually it happens due to some change in the ear, such as an ear infection, a cold or wax blocking the ear – or after being exposed to loud noise, such as live concerts or noisy machinery. Or it can be linked to hearing loss.
But it can also be triggered by stress and, although I can’t be sure, I think that’s the reason it happened to me.
I was in a job I didn’t enjoy and I felt very stressed. And then I developed Covid, and was soon furloughed, so suddenly I wasn’t as busy and I had more time on my hands. That’s when the buzzing started to affect me.
I woke up one morning with a buzz in my head, and instantly thought, ‘Well, I know what this is’. It was tinnitus.
It sounded exactly how I expected it to. I just thought it would be easier to push to the back of my mind.
But it’s one thing to understand the condition in theory – experiencing it is another.
My knowledge didn’t stop me feeling overwhelmed and afraid. I felt like a fraud – here was I, an expert who helps people with tinnitus, who was suddenly struggling to cope with it myself. Sometimes I got quite panicky.
Audiologist Dr Gladys Sanda woke up one morning with a buzz in her head
My symptoms affected my confidence, too. I would dread going to bed. I didn’t want to be alone with the noise. I’d have to play acoustic guitar music for hours in order to settle, and I’d always be anxious if my partner wasn’t with me.
Gradually, I found a way to cope by applying tried and tested techniques – and today, even though I still hear tinnitus daily, it no longer controls my life.
The distress is gone. When it spikes, I understand why – for example, during a recent family bereavement my tinnitus was roaring. But I’m not afraid of it any more.
It’s recognised that, as well as triggering it, stress can make tinnitus worse, as stress releases hormones such as cortisol and adrenaline that can affect how your brain handles sounds.
So I said to myself: ‘This is louder. I think I know why. I just need to look after myself and wait until this passes.’
I also think that my own experience of the condition has been my greatest teacher, so I really know how to manage tinnitus effectively.
I’m not saying you need to have tinnitus to be able to help other people with it, it’s just that now I have a different level of understanding.
Tinnitus affects one in seven people in the UK and, left untreated, it can impact many aspects of daily life, such as mood, sleep or concentration.
For a proportion of people with severe tinnitus (around 1.5 million), it is a persistent, life-altering condition that can also lead to anxiety and depression.
Most ear, nose and throat (ENT) doctors and audiologists tend to focus on symptom management – i.e. helping patients cope, rather than exploring why the tinnitus is causing such distress. This leaves many patients feeling overlooked and unsupported, according to research by the charity Tinnitus UK.
A common approach is to focus on correcting the resulting hearing loss with a hearing aid.
Yes, approximately 90 per cent of people with tinnitus have hearing loss, but often an aid doesn’t work.
Other approaches include retraining therapy – using sound therapy to retrain your brain to tune out the tinnitus – and cognitive behavioural therapy (CBT) to change the way you think about it.
Having spent years researching the condition, I believe that we need to see a radical shift in tinnitus care in the UK – one that prioritises a holistic, patient-centred approach. It’s important to not just correct the hearing loss (e.g. with hearing aids), but also address our emotions and thoughts – because how somebody perceives their tinnitus has a huge impact on how much it upsets them.
Even before I was affected myself, I’d developed a three-step programme to help patients overcome their tinnitus distress, informed by current research and clinical experience.
It prioritises the auditory system (ears), the limbic system (emotions) and the brain’s attentional system – in other words, how we naturally focus.
Dr Gladys Sanda now coaches people with tinnitus like her, in order to reduce its emotional impact
We have an area in our brain called the prefrontal cortex, and that’s kind of the decision-maker. So that determines what’s important and what we pay attention to. And we tend to focus on the things that cause fear – as our brain is always trying to protect us.
The first step is a physical assessment of the ear to check for obstructions, such as infections or wax. This could be done by a GP, ENT doctor or audiologist. If that doesn’t resolve the tinnitus, the next step is a questionnaire to ascertain the level of anxiety and stress a patient is experiencing, and how much the tinnitus is intruding on their lives.
The third step is a talking therapy that uses what I call ‘tinnitus coaching’. Unless you actively rewire your brain’s threat response (to the tinnitus), your nervous system will keep ringing the alarm.
We need to teach the brain that tinnitus isn’t a threat; we aim to turn negative associations with tinnitus into more neutral thoughts.
For example, someone might say: ‘I’ll never experience peace and quiet again’. You can then guide them to understand that peace and quiet are quite separate experiences – a walk in a forest is peaceful but not quiet, for example.
My tinnitus coaching is based on CBT, which is recognised as a highly effective intervention for tinnitus because it helps individuals reframe their thoughts and behaviours, which can reduce distress. Mindfulness is also used to help patients acknowledge their condition.
The goal of tinnitus coaching is not to eliminate tinnitus – as currently it can’t be cured – but to reduce its emotional impact, and it is very effective. (Only two of the 500 patients I’ve treated over the past ten years haven’t experienced improvement, and it emerged they had underlying mental-health conditions that really needed to be managed by a psychiatrist.)
I remember working with a 36-year-old woman who cried for the entire first consultation. She was always told that nothing could be done, and she felt helpless.
Initially, the tinnitus stopped her travelling as she did not want to ruin holidays for her partner; her quest to have children was paused as she wasn’t sure how she would cope; and she stopped writing, which was her passion.
We worked through the fear, made her confident that she could manage her reactions to the sounds, and got her living life again – with tinnitus. She planned a holiday (we had a coaching session while she was away) and, slowly but surely, her life returned to her. And she wrote a book.
Some people feel so much better after just two sessions, but for others it can take a year or more. How long progress takes varies with each individual. It depends on what is fuelling this tinnitus distress and how much we can address that, as well as how ready the individual is to shift from a mindset of wanting to find a cure to a mindset of ‘How do I learn to live well with tinnitus?’.
Currently, UK provision of tinnitus support is woefully lacking. Last year, a report by Tinnitus UK entitled Ringing the Alarm found that NHS patients face long waiting lists – up to three years for ENT appointments and up to a year for hearing-aid assistance and psychology, talking therapies or CBT referrals.
Even in the private sector, more than a third (36 per cent) of audiologists reported that tinnitus care was a low priority for them.
And not all psychologists in the UK truly understand tinnitus management. I’m proud to say I’ve now trained 50 healthcare professionals working with patients with tinnitus – in the NHS and in the private sector – since April last year.
I absolutely love my job. It feels incredible to help patients make progress. When I first see clients, they are often in tears and struggling to work, be a parent and just get on with life. I can’t wait for them to look back and think, ‘Wow, look how far I’ve come’.
That’s why it’s so frustrating when people tell them there’s nothing more that can be done – because there absolutely is.
INTERVIEW BY ADELE WATERS
FOUR TYPES OF TINNITUS THAT SHOULD NEVER BE IGNORED
Audiologist Gladys Sanda says the following types of tinnitus could signal more serious health problems and require prompt medical attention. She advises seeing an ENT specialist if you experience the following:
1. Tinnitus in one ear only, even if the sound seems harmless or mild. It could be a sign of a benign (non-cancerous) growth on the auditory nerve.
2. Asymmetrical tinnitus, where the sound differs between each ear. This can also indicate an underlying issue such as a benign growth on the auditory nerve.
3. Sudden hearing loss with tinnitus, which is considered a medical emergency. It’s not the tinnitus that needs urgent treatment – it’s the hearing loss.
4. Pulsatile tinnitus – a thumping or pulsing in the ear that matches your heartbeat. This could suggest a blood vessel problem such as a thinning of the bone between a vein and the middle ear. If your tinnitus intensifies during physical activity, it’s crucial to seek medical advice.
