Tinnitus Management Mini-Festo - We've got to do better!

(manifestos get such a bad rap these days ??)

Tinnitus care is in a strange place. Audiologists are labeled as the “experts,” but the truth is, our current approaches often fall short when it comes to addressing tinnitus distress. We have devices and decades-old methods, yet we’re often missing the bigger picture of what people really need. This mini-festo isn’t meant to be the final word on the future of tinnitus care, and far from it. It’s an invitation to rethink how we, as a field, approach one of the most common yet misunderstood conditions we treat.

The Current Problem

The core challenge in tinnitus care lies in a fundamental mismatch: traditional approaches focus on the sound of tinnitus itself, while the true burden for many patients stems from tinnitus distress. This distinction is critical yet often overlooked. Audiologists frequently default to auditory tools—hearing aids, maskers, and other devices—because those are the solutions we’ve been trained to provide. While they can help, they fail to address the emotional and psychological struggles that many patients experience.

A patient may feel temporary relief from a masking device but find their distress remains—or even worsens—when the underlying psychological aspects go unaddressed. The field of audiology has made significant progress in moving away from recommending lipoflavonoids, vitamins, and supplements for tinnitus management. Yet many of us still, like our patients, look for the silver-bullet tinnitus solution.

When audiologists do engage with the emotional side of tinnitus, they often rely on outdated psychological strategies that fail to reflect modern advancements in areas like Cognitive Behavioral Therapy (CBT) or Acceptance and Commitment Therapy (ACT). Even these more established frameworks can lack the depth and adaptability needed to tackle the complexity of tinnitus distress.

Consider, for instance, the use of sleep hygiene as a recommendation for insomnia, something commonly suggested to tinnitus patients who struggle with sleep. Everywhere I've worked in tinnitus management has had a sleep hygiene handout for patients who complain of sleep trouble 'due to tinnitus'. Research shows that while sleep hygiene may include helpful general tips (avoiding caffeine late in the day, maintaining a consistent bedtime, etc.), it has no solid evidence base as a complete treatment for insomnia and is often used as a placebo in studies (Stepanski & Wyatt, 2003; American Academy of Sleep Medicine, 2021). If this standard, well-meaning advice for insomnia falls short, we have to ask: how many of our common “tips” for tinnitus might also be insufficient placeholders for more robust interventions?

Imagine a scenario where a magic pill is developed to eliminate tinnitus entirely. Patients would flock to ENTs, obtain the pill, and for many, the relief would be life-changing. But what about those still stuck asking, “What if the pill stops working?” or “What if my tinnitus comes back?” For them, the real issue isn’t the tinnitus itself but the distress and uncertainty around it. Without that magic pill, audiologists end up addressing these emotional and psychological challenges using tools designed primarily for auditory relief, not psychological support.

Failing to consider tinnitus distress holistically leaves patients in a cycle of unfulfilled expectations. Some arrive at our clinics after years of frustration, having tried devices, supplements, and other treatments that fell short. They don’t need another gadget; they need someone who understands the interplay between tinnitus and distress—and can guide them toward meaningful, evidence-based strategies for coping.

The Need to Shift Focus

A crucial shift in tinnitus care is moving from addressing tinnitus itself to addressing tinnitus distress. The sound may persist, but the distress it causes is a psychological experience, one that requires psychological tools to manage effectively. This isn’t a minor detail; it’s central to improving patient outcomes.

I recently worked with a patient whose tinnitus began after a sudden sensorineural hearing loss. While we both acknowledged that his tinnitus was tied to this hearing loss, our focus wasn’t on the sound. Instead, we explored why on some days his tinnitus felt manageable, while on other days it consumed him entirely. He noted that the sound itself didn’t change; rather, his perception of it did.

I once told a fellow audiologist that I was reading textbooks on psychology. Her reaction was priceless—like I’d just announced I was opening a goat farm in my living room. She asked, “Why would you do that?” My answer was simple: My patients were struggling, and I didn't think the tools I kept using from audiology literature were helping enough.

A useful principle in modern psychological frameworks states: Pain + Non-Acceptance = Suffering. If we apply this to tinnitus, Tinnitus + Non-Acceptance = Tinnitus Distress. Many patients try avoidance, suppression, or distraction, which may offer momentary relief but ultimately perpetuate distress. These strategies don’t address the root of the problem, reinforcing a cycle of avoidance and frustration.

This might sound familiar to those who use CBT in tinnitus management. Yet even traditional CBT frameworks have evolved. The Unified Protocol, for example, integrates emotional regulation and transdiagnostic principles into CBT. Are we relying on outdated methods when more effective strategies are available? Think of how a clinic would look if it still advertised Neuromonics devices in 2025—we might be clinging to solutions past their prime.

Interestingly, many of these modern approaches, including the Unified Protocol, trace their roots to Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT). Emphasizing acceptance, emotional regulation, and mindfulness, these therapies align naturally with tinnitus care but remain underutilized in audiology. Focusing on tinnitus distress, rather than the tinnitus sound itself, opens the door to deeper, more effective support—letting patients regain control and reduce the suffering they associate with their condition.

Challenges in the Status Quo

Resistance to adopting psychological tools in audiology stems from discomfort with crossing into what feels like someone else’s territory, as well as an overemphasis on technology as the ultimate marker of expertise. Many practices still gauge how “serious” they are about tinnitus care by the devices they offer or the cutting-edge gadgets they promote. I recall a time when I was instructed by a boss to prepare for the rollout of a new tinnitus device that had no evidence or clinical trials behind it. Why? Because the company’s board was full of “important people,” and that was apparently all the justification needed to prepare to adopt an unproven tool.

A telling example of this broader discomfort arises with question 24 on the Tinnitus Reaction Questionnaire (TRQ)—“My tinnitus has led me to think about suicide”—which can trigger alarm if a patient answers anything but zero. While suicidality might seem far outside our scope, the fact remains that some people do contemplate suicide because of tinnitus. Ignoring or avoiding that reality doesn’t reduce the risk; it only leaves us unprepared. Yes, there’s a suicidality question on the TRQ. No, it won’t spontaneously combust if someone circles anything other than zero. But it does mean we need to have a genuine conversation about mental health—something that still makes many of us squirm like we’re wearing shoes two sizes too small.

Frameworks like the Collaborative Assessment and Management of Suicidality (CAMS) can offer insights. We wouldn’t adopt CAMS in its entirety as audiologists, but understanding its principles can guide us in establishing protocols and communicating effectively when patients disclose suicidal thoughts. A simple yet profound step is to collaborate on a safety plan with at-risk patients. While some see a written safety plan as a liability—evidence that the patient is at risk without an immediate mental health referral—it’s arguably an even bigger liability to provide no plan at all. A safety plan respects patient autonomy, clarifies the audiologist’s role, and indicates when to bring in specialized mental health support.

Recognizing and addressing these challenges is key to evolving tinnitus care. We can stay within our scope while acknowledging that tinnitus distress has mental health components deserving structured, thoughtful responses. By doing so, we provide more comprehensive care and move beyond a status quo that often fails those who need our help the most.

A Vision for the Future

There isn’t one perfect future for tinnitus care. Some may prefer a device-based approach that aims to “fix” tinnitus so completely they never see the patient again. I’d discourage that view, but it does exist. My vision, however, centers on integrating modern psychological strategies into our approach. Rather than focusing solely on the sound, we’d expand our skill sets to include robust counseling, emotional regulation tools, and interdisciplinary collaboration. This means staying updated with evolving CBT strategies, as well as exploring ACT, DBT, mindfulness-based practices, and more.

With this, tinnitus care becomes a blend of audiology expertise and patient-focused psychological strategies, recognizing tinnitus distress as more than just an auditory issue. Patients receive a thorough path rather than a one-size-fits-all device or a quick-fix promise. Still, this vision is only my perspective. By putting it out there, I hope to spark a bigger conversation among audiologists about what tinnitus care could—and should—look like.

And because this wouldn’t be a LinkedIn post without a bit of self-promotion, I’ll mention my book, Quieting the Storm: A Guide to Tinnitus Management, aimed at helping patients navigate practical strategies. I’m also working on a series of books for audiologists on applying updated psychological tools—like ACT, DBT, and mindfulness—to tinnitus management. The goal isn’t to replace mental health professionals, but to show how we can incorporate these insights within our scope to more effectively help patients.

Do we want to rely on technology alone, or do we want to embrace a deeper, more meaningful approach that truly addresses the heart of our patients’ experience? Each of us has the power to shape the future of this field for the better.

Tinnitus management can stay confined to devices and outdated approaches, or it can evolve into something broader—an approach that acknowledges the intricate reality of tinnitus distress. There’s no single “correct” path, but we owe it to ourselves and our patients to question whether our current methods genuinely serve them. If you feel resistance to these ideas, ask yourself why. Are we clinging to familiarity, or are we fully committed to aiding those who trust us with their care?

Ultimately, this mini-festo isn’t about dictating one path forward; it’s an invitation. Let’s speak openly about the trajectory of our profession, learn from one another, and develop the willingness to move beyond our comfort zones. Whether you see the future in a groundbreaking device or in expanded counseling methods, the real point is to spark a conversation, challenge old assumptions, and move toward a more effective, human-centered approach to tinnitus care.

References

American Academy of Sleep Medicine. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline.

Stepanski, E. J., & Wyatt, J. K. (2003). Use of sleep hygiene in the treatment of insomnia. Sleep Medicine Reviews, 7(3), 215–225.