Tinnitus Treatment Options in Singapore

Tinnitus, characterized by the perception of noise or ringing in the ears, affects a significant portion of the population. In Singapore, medical treatments are designed to address both the symptoms of tinnitus and any underlying causes. Understanding the various medical approaches to tinnitus treatment in Singapore can help sufferers seek appropriate interventions and improve their quality of life.

Understanding Tinnitus

Hearing sound works by sound waves entering your ear canal. These waves vibrate your ear drum, which in turn, moves three small bones, striking the cochlea. The snail-shaped cochlea is full of small bundles of hair cells and fluid. As the fluid ripples, the hair cell bundles vibrate, releasing neurotransmitters. This creates an electrical signal in the auditory nerve cells, which travel to your brain. When the hair cell bundles are damaged inside the cochlea, this can cause tinnitus - or the ringing in the ears.

This chronic condition can be connected to a sudden explosion of sound or long-term hearing loss. Those with tinnitus have reported experiencing sinusitis, blows to the head, neck injuries, damage to the jaw, the hardening of bones in the ears, damage to nerves involved in hearing sound, brain circulation and ear wax blockage.

Types of Tinnitus

Tinnitus is a relatively common condition, and there are several varieties:

Acute Tinnitus: This is the type of ringing or buzzing that comes on suddenly and is short-term, usually lasting less than three months. It’s often triggered by something temporary, like being at a loud concert, getting an ear infection, or having earwax build-up. In many cases, this kind of tinnitus fades on its own once the underlying issue is resolved.
Chronic Tinnitus: This is the long-lasting kind. If you’ve been hearing that persistent noise for more than three months, it’s considered chronic. This type of tinnitus can stick around and, in some cases, become a permanent part of your life.
Subjective Tinnitus: Most people who experience tinnitus have what’s called subjective tinnitus. This means that only you can hear the ringing or buzzing-it’s not detectable by anyone else, including a doctor. It’s a sensation generated by your auditory system, often due to damage in the ear or changes in how the brain processes sound.
Objective Tinnitus: Objective tinnitus is a bit different from the more common forms of tinnitus because it’s not just in your head-other people can hear it too, like a doctor using special instruments.

These types of tinnitus all result from different causes.

Understanding Tinnitus: Causes, Symptoms, and Treatment Options

Common Medical Treatments in Singapore

In Singapore, medical treatments are designed to address both the symptoms of tinnitus and any underlying causes.

Medications: Common treatments include medications such as antidepressants or anti-anxiety drugs, which may help to reduce the severity of symptoms.
Hearing Aids: Hearing aids are another common intervention, particularly for those who may have hearing loss associated with their condition. By amplifying external sounds, hearing aids can help mask tinnitus symptoms and improve overall auditory perception.
Innovative Devices: In addition to these options, innovative devices such as tinnitus maskers and wearable sound generators are available. These specialized devices can provide therapeutic sounds designed to distract from the noise caused by tinnitus, often allowing for improved concentration and relaxation.

Effectiveness of Tinnitus Treatments

The effectiveness of tinnitus treatments can vary significantly from person to person. Clinical studies have shown that while some individuals experience substantial relief from symptoms with the use of medications, others may find limited success. Research indicates that combining pharmacological treatments with behavioral therapies can enhance efficacy, leading to a more comprehensive management plan.

Sound therapy has also garnered support for its effectiveness in managing tinnitus. Studies indicate that patients using sound therapy techniques report decreased awareness of tinnitus and improved quality of life. Furthermore, the role of hearing aids in tinnitus management shows promising results. Patients who incorporate hearing aids into their treatment plan often report a decrease in tinnitus symptoms due to the amplification of external sounds. By making everyday environmental sounds more noticeable, these devices can help diminish the contrast between silence and the internal noise of tinnitus.

Specialized Clinics in Singapore

Singapore is home to several clinics specializing in tinnitus treatment, staffed with experienced audiologists and ENT (ear, nose, and throat) specialists.

National University Hospital: One notable institution is the National University Hospital, which offers comprehensive evaluation and management for tinnitus sufferers.
Tan Tock Seng Hospital’s ENT Department: Another prominent facility is Tan Tock Seng Hospital’s ENT department, which provides personalized assessment and a range of treatment options for tinnitus. Their multidisciplinary team focuses on innovative solutions tailored to each patient’s needs, ensuring a holistic approach to managing tinnitus.
Private Clinics: In addition to these hospitals, private clinics such as The Ear Nose Throat Centre and Hearing Partners are gaining recognition for their dedicated tinnitus services. These clinics offer state-of-the-art diagnostic tools and customized treatment programs.

Lifestyle Adjustments

Lifestyle factors play a crucial role in managing tinnitus symptoms and can significantly influence the effectiveness of medical treatments. Diet modifications, such as reducing sodium intake, avoiding caffeine, and eliminating alcohol, may help reduce the severity of symptoms for some individuals. Regular physical exercise is also an important aspect of lifestyle modification that aids in tinnitus management. Exercise can enhance circulation and improve overall well-being, which may lead to decreased symptoms of tinnitus.

Tinnitus Counselling Clinic (TCC) at Changi General Hospital (CGH)

To help patients with tinnitus better cope with their condition, a Tinnitus Counselling Clinic (TCC) was established at Changi General Hospital (CGH), Singapore, in 2008. The initial CGH tinnitus counselling protocol delivered information to the patient about the ear, the process of hearing, and the causes and mechanisms of tinnitus.

The counselling session lasted 90-120 minutes and consisted of six components:

Administration of the THI and tinnitus history taking.
Introduction about the ear and hearing, causes of tinnitus and related theories.
Interpretation of patient’s audiogram.
Creating a better understanding of healthy and damaged cochlear hair cells by showing pictures using a toothbrush analogy.
Explaining sound and non-sound self-help strategies.
Providing written recommendations tailored to the individual patient.

The sound strategies used were:

Sound enrichment environment (i.e. opening windows, switching on the fan or air-conditioning).
Listening to radio programmes to improve hearing skills.

Nonsound strategies included:

Detecting trigger factors.
Distraction and relaxation (e.g. physical exercises, watching television and cycling).
Changes in thinking, as tinnitus is not harmful and will not cause deafness.

Most patients found the counselling helpful at follow-up. Tinnitus is a troubling symptom, often without a definite aetiology or known pathophysiology.

Trial on Chronic Tinnitus Treatment

An international multicentre, parallel-arm, superiority, randomised controlled trial investigated whether combination therapies are superior to single interventions in the treatment of chronic subjective tinnitus. Tinnitus patients were recruited from five clinical sites across the EU and randomly assigned using a web-based system, stratified by their hearing and distress level, to single or combination treatment of 12 weeks. Cognitive-behavioural therapy, hearing aids, app-based structured counselling, or app-based sound therapy were administered either alone or as a combination of two treatments resulting in ten treatment arms. App-based treatments were delivered without direct contact or guidance from clinicians.

The primary outcome was the difference in the change from baseline to week 12 in the total score of the Tinnitus Handicap Inventory (THI) between single and combination treatments in the intention-to-treat population. All statistical analysis were performed blinded to treatment allocation.

674 patients of both sexes aged between 18 and 80 years were screened for eligibility. 461 participants (190 females) with chronic subjective tinnitus and at least mild tinnitus handicap were enroled, 230 of which were randomly assigned to single and 231 to combination treatment. Least-squares mean changes from baseline to week 12 were −11.7 for single treatment (95% confidence interval [CI], −14.4 to −9.0) and −14.9 for combination treatments (95% CI, −17.7 to −12.1), with a statistically significant group difference (p = 0.034). Cognitive-behavioural therapy and hearing aids alone had large effect sizes, which could not be further increased by combination treatment. No serious adverse events occurred.

In this trial involving patients with chronic tinnitus, all treatment arms showed improvement in THI scores from baseline to week 12. Combination treatments showed a stronger clinical effect than single treatment, however, no clear synergistic effect was observed when combining treatments. Instead, we observed a compensatory effect, where a more effective treatment offsets the clinical effects of a less effective treatment.

Table 1: Demographic and clinical characteristics of the participants at baseline (stratified by treatment arm)

Characteristic	Single Treatment (N=230)	Combination Treatment (N=231)
Age (mean ± SD)	50.2 ± 13.1	48.5 ± 12.8
Female (n, %)	102 (44.3)	88 (38.1)
Hearing Aid Indication (n, %)	59 (25.7)	65 (28.1)
THI Total Score (mean ± SD)	48.5 ± 19.5	47.4 ± 19.9