For people with tinnitus, 2020 has been a difficult year. Access to effective treatment was already limited prior to the pandemic, with many people waiting months for therapy on the NHS. COVID-19 has forced ENT surgeons, audiologists and tinnitus therapists to greatly reduce the number of patients they see in person. This has had a knock-on effect on waiting lists and now accessing treatment or investigations is harder than ever before.
The same can be said for GPs (family doctors). Here in the UK there are over 1 million appointments with tinnitus as the primary complaint each year, meaning the condition provides much work for GPs, as well as ENT surgeons and therapists. However, GPs have been affected in the same way and to try to reduce the number of face-to-face contacts, you will be seen virtually if possible.
Is there a silver lining?
Over the past five years we have increasingly seen the digitisation of treatments that would previously have been delivered by a doctor or a therapist digitised. This means that you could access them from your mobile phone or tablet. A number of digital treatments for a variety of conditions are now well established.
-Big Health have created Sleepio, an online programme that helps improve sleep
– Bold Health offers an app called Zemedy that provides a therapy-based programme for people with Irritable Bowel Syndrome – a common condition affecting 10-15% of the adult population
–Woebot is a mobile app that uses therapy techniques to help people with depression and anxiety
These types of platforms greatly improve access to quick and convenient options for people with the condition and allow healthcare professionals to focus attention on patients with more serious presentations.
Because of the limitations to traditional care caused by the COVID-19 pandemic, we have now been forced to rethink many care pathways. Can we improve access to treatment for patients with common long-term conditions such as tinnitus, reducing the face to face burden of healthcare services?
Which therapies are currently recommended for tinnitus?
Research has demonstrated that if you have tinnitus, there is effective treatment available. Despite there being no cure, we know that certain therapies can greatly reduce the impact of tinnitus on your life. In March the National Institute for Health and Care Excellence (NICE) reviewed all of the available scientific evidence for therapies used in treatment of tinnitus. NICE is a UK based organisation that makes recommendations to healthcare professionals about which treatments to provide to patients.
This review found that a type of treatment called cognitive behavioural therapy (CBT) was consistently found to be effective in tinnitus management. CBT works by helping you change the way you think about the tinnitus and interrupting negative thought cycles. CBT was therefore recommended by NICE as first line treatment in the management of tinnitus.
The first type of treatment suggested by NICE is actually digital CBT. However, no digital CBT for tinnitus is currently available in the UK. So how do you access it? And who is working on creating a solution?
Who is making tinnitus CBT digital?
This is a really interesting field with two companies taking various approaches.
Oto is an early stage startup based in the UK. They realised that tinnitus treatment was inaccessible and complex, and set out to bring all the science backed therapies together into a smartphone app.
Oto provides tinnitus treatment in a progressive programme centred around CBT, but also utilises mindfulness, relaxation, action centred therapy (ACT) and sound therapy. You’ll undertake a short therapy session each day, delivered by a recorded voice. These are curated by the team to provide the most benefit. Their team consists of expertise from all walks of life, and includes doctors, therapists, audiologists, researchers, voice actors and sound engineers. They aim for Oto to act as a guide through your treatment journey, whilst simplifying the entire process.
The product is still in the early stages of testing, but you can sign up to download the beta from their website.
Hearing Power is taking a slightly different approach with their product. Tinnibot is a chatbot that allows you to access tinnitus CBT on your smartphone. It uses CBT techniques to take you through situations that are commonly encountered with tinnitus. You’ll start by setting a series of goals for your therapy, and the app will take you through this by checking in on you regularly and how you feel.
Tinnibot uses makes use of mindfulness therapy in a series of recorded meditations designed to gradually introduce the user to the concept.
What’s on the horizon?
This year we’ve also seen a number of researchers approaching tinnitus treatment differently. Although not strictly a digital therapeutic, scientists at the University of Minnesota significantly reduced the volume of tinnitus in 80% of patients by combining electrical stimulation of the tongue with sound therapy. This was the largest study ever undertaken in tinnitus research and shows promise for this type of treatment.
Another interesting area of research is in something called threshold sound conditioning (TSC). This is a type of sound therapy that detects the frequencies that have been damaged and “trains” them with personalised sound signals. This technique has been shown to be effective in hearing management and is has been used very successfully by the U.S. start-up AudioCardio.
How AudioCardio is using Threshold Sound Conditioning
AudioCardio works by understanding an individual’s lowest threshold of sound (minimum audible level) at several frequency ranges for each ear via their in-app hearing assessment. Once a baseline threshold has been established for each frequency range, the TSC algorithm (sound therapy) targets the most damaged range of frequencies per ear by stimulating the cells responsible for transmitting the “noise” from our environment into electrical signals. These electrical signals are then transmitted to the brain through the auditory system so that they can be interpreted and perceived as sound. The sound therapy is played at the barely audible or just inaudible level based on each hearing assessment. After consistent use, the inaudible sound therapy may become audible, indicating progress. AudioCardio’s sound therapy is then adjusted through subsequent hearing assessments for new hearing thresholds as customers make progress using the app.
AudioCardio was initially aimed at people with hearing loss. This condition often comes hand in hand with tinnitus, and it soon became apparent that TSC was helping with the management of tinnitus as well as a user’s hearing. AudioCardio is available now for download in the Apple App Store and Google Play Store.
2020 has been one of the most difficult years in recent memory for many of us all around the world. However, because of the changes that have been made to the way treatment is delivered, innovation has been forced through at a much greater rate. This means that at the end of the year there will be a number of new products available for people with tinnitus that might not have existed in the absence of the COVID-19 pandemic. Tinnitus is an isolating and at times debilitating condition, and up until now availability of effective therapy has been relatively poor.
I hope that both researchers and enterprises continue to innovate in this field and provide a greater number of options for digital treatments for people with tinnitus.
This article was written by Edmund Farrar, Co-Founder of Oto. Oto is a UK based start-up that aims to help the 350 million people with tinnitus around the world by providing convenient and effective treatment. The Oto app is currently available as a public beta, learn more at www.otohealth.ai.