Mourning for Silence: Bereavement and Tinnitus-A Perspective

Abstract

Tinnitus is defined as the conscious awareness of a tonal or composite noise for which there is no identifiable corresponding external acoustic source, which becomes tinnitus disorder when the phantom sound is associated with suffering and/or disability. There is only limited knowledge about the time course of tinnitus disorder. Bereavement science has identified four different trajectories: resilience, recovery, chronic, and delayed. The question arises whether these four trajectories exist in tinnitus as well if one considers tinnitus as the loss of silence (at will). To verify whether these four trajectories exist, short-term tinnitus progression was analyzed retrospectively using an Ecological Momentary Assessment (EMA) approach, extracting the data from patients who started using the TrackYourTinnitus (TYT) app (version 1, Ulm University, 2013) from the start of their tinnitus perception. Four patients were identified retrospectively via the TYT app with acute tinnitus, and the bereavement trajectories were reconstructed based on EMA. In conclusion, this perspective suggests that the four known bereavement trajectories may exist in tinnitus, and prospective evaluations of larger samples are warranted to confirm or disprove this analogy between bereavement and tinnitus, in which tinnitus is conceived as the loss of (controllable) silence.

Keywords: bereavement; tinnitus; trajectory.

Figure 1

Trajectories of patients with tinnitus. Red line = tinnitus loudness; black line = tinnitus distress.

Figure 2

Schematized trajectories of tinnitus evolution based on bereavement science.

Figure 3

Similar pathophysiological mechanisms underpin chronic pain, chronic tinnitus, PTSD and PGD, in which genetic vulnerability and environment-induced epigenetic changes introduce proinflammatory state that turns the acute symptom into a chronic persistent state.