Tinnitus

Dr. Pellionisz’s background bridges otology and psychiatry: research on neuromodulation for tinnitus, and clinical care of the anxiety, low mood and insomnia that so often accompany it. The sound itself may not disappear; the suffering attached to it usually can be reduced.

Who this is for

• Chronic tinnitus that has become intrusive, distressing or exhausting.
• Tinnitus accompanied by anxiety, depression or insomnia — or that worsened during a period of stress or low mood.
• Tinnitus with sound sensitivity (hyperacusis).
• People who have been told that nothing can be done.
• People whose hearing has been evaluated and who now want help with the burden the sound imposes.

How we evaluate

Tinnitus deserves a hearing evaluation first; where that has not been done, the practice coordinates with audiology and otolaryngology. The psychiatric evaluation then measures how much the sound is intruding on sleep, concentration, mood and daily life, identifies the anxiety, depression or insomnia that amplify it, and reviews medications and other factors that can make it worse. The aim is a clear account of what is driving the distress — because that, more than the sound, is what treatment changes.

Treatment

• Cognitive-behavioral therapy for tinnitus. The best-supported treatment for reducing tinnitus distress, targeting the attention, alarm and avoidance that keep the sound in the foreground.
• Treating what travels with it. Depression, anxiety and insomnia each make tinnitus louder and harder to bear; treating them is often the most effective tinnitus treatment available.
• Sound and hearing. Sound therapy and hearing aids, arranged through audiology, for those who benefit.
• Medication. No medication removes tinnitus, but medication for the conditions that accompany it can change how much it matters.
• Neuromodulation. Dr. Pellionisz leads research on image-guided TMS for chronic tinnitus. [State whether TMS for tinnitus is offered clinically, through a trial, or by referral]