Dr Lucy Handscomb on training the brain to live with tinnitus

Tinnitus, often described as a ringing or buzzing in the ears, is a complex neurological condition affecting one in seven adults. It occurs when the brain generates phantom sounds in the absence of external stimuli. The cause of tinnitus is not always clear, but it’s frequently associated with hearing loss, causing the brain to become hyperactive and create these sounds. There is no cure for tinnitus, but teaching the brain not to pay much attention to the sounds is a key part of psychologically-based therapies for tinnitus. In this Q&A, we speak to Dr Lucy Handscomb about the MindEar app and how it can help those with tinnitus to change their relationship with tinnitus.  

What types of treatments are effective for tinnitus? 

At the moment there is no cure for tinnitus. However, there is much that can be done to help people manage it. The treatment with the most evidence behind it is cognitive behaviour therapy (CBT), which has been shown in multiple studies to bring about substantial reductions in tinnitus-related distress. Most people with tinnitus also benefit from being better informed about it and learning self-management techniques such as stress reduction. Those who also have hearing loss often find that hearing aids make tinnitus less audible. 

You are currently involved in a trial investigating whether a new app could help patients ‘live well’ with tinnitus, could you tell us what this app does? 

MindEar was developed by two specialists in audiological science who were familiar with the fairly substantial amount of evidence demonstrating the effectiveness of cognitive behavioural therapy (CBT) in reducing tinnitus-related distress. Given that CBT is not widely available for tinnitus in many countries, they were inspired to put some tried and tested CBT strategies into an app, so this approach could be easily accessible to more people affected by tinnitus. The app provides CBT through a chatbot with other approaches such as sound therapy.  

Why were you inspired to investigate MindEar as a tool for patients living with tinnitus? 

I learned about the MindEar app at a tinnitus conference and had a few conversations with one of its founders, Fabrice Bardy. At the time I was just starting in a new NHS post and seeing tinnitus patients who had been on a very long waiting list for therapy, made much longer by covid lockdowns. I could see at first-hand how many of these people had got into negative spirals with their tinnitus and often picked up quite misleading and unhelpful information.  I thought if they could at least be getting some reliable, regular help while waiting, this could give them some immediate relief and put them in a better mindset for starting therapy. That’s why I developed my project; giving some patients on out waiting list free access to the MindEar app and comparing their questionnaire results to others on the waiting list without access to it. 

How does the app work?  

The main aim of psychologically-based therapies for tinnitus is habituation. I describe this to patients as getting to the point when you don’t really notice the tinnitus much of the time, even though it’s still there and you can hear it if you listen. It’s not really a case of tuning out tinnitus directly. A combination of learning more about tinnitus, reframing negative thoughts, changing behavious and practising mindfulness helps people to change their relationship with their noises. If the brain learns to accept tinnitus as a meaningless sound, it can habituate to it and pay it much less attention, in much the same way as we habituate to many of the environmental sounds around us (traffic, central heating etc). There are many different features in the app; relaxing sounds to listen to (seashore, forest etc), information, instructions for breathing exercises; but what makes it different from many others is the chatbot. You can type in your thoughts and feelings about tinnitus and it will respond to you in a style informed by CBT. 

Can you share any insights from the trials conducted with the MindEar app? 

There have only been a couple of fairly small-scale trials done so far, involving volunteers from the community with tinnitus (not clinic patients). These have shown that MindEar reduces tinnitus-related distress, compared to no treatment and compared to a more general mental health chatbot, so initial results are promising. Nevertheless, some research shows that maintaining engagement with the app can be difficult; usage tends to tail off quite quickly. This seems to be an issue with many healthcare-related apps. 

What future plans do you have for the MindEar app and its development? 

I’m still recruiting participants for my NHS study, so won’t have any results for a few months yet. One area I am interested in exploring is whether the app can be a useful adjunct to in-person treatment, given that we don’t have capacity to see patients in my clinic as frequently as we would like to. It may be that MindEar is a useful follow-up to therapy as well as an introduction. 

Biography

Dr Lucy Handscomb joined the teaching team at UCL Ear Institute in 2010 and is mostly involved in the education of audiologists, specialising in adult aural rehabilitation, counselling skills, tinnitus and hyperacusis. Since 2010 she has been co-organiser of the Ear Institute’s popular masterclass – Advanced Management of Tinnitus and Hyperacusis – which is attended by audiologists from around the world as well as UCL MSc students.

She comes from a clinical background and also works part-time as a hearing therapist at the Royal National Ear, Nose and Throat Hospital (part of UCLH) where she specialises in tinnitus therapy.

She has published a number of research papers in the field of tinnitus and completed her PhD – an evaluation of a cognitive behavioural model of tinnitus distress – in 2018.