We’ve all probably experienced tinnitus, a phantom ringing, whooshing, or buzzing sound in your ears that can be momentary or constant and chronic. It can be soft like a whisper or loud like an explosion. John Moring knows all about it.
“I've had tinnitus basically all my life. I can't remember experiencing silence,” Moring said. He doesn’t know why he has it. It could be linked to head or neck injuries he experienced as a young gymnast. But living with tinnitus has made him sensitive to others for whom phantom sounds are a regular companion. Disproportionately, that includes current or former members of the military.
“Tinnitus is the number one service-connected disability within the VA, so it's a huge problem,” Moring said, “And we don't have very many effective strategies to reduce the distress.”
John Moring, PhD, is a clinical psychologist and an assistant research professor in the Department of Psychiatry at UT Health San Antonio, and his experience of living with tinnitus informs his research into the connection between tinnitus and post-traumatic stress disorder (PTSD). Early in his career, Moring noticed that veterans with PTSD suffered more from tinnitus than those with depression or anxiety, but mental health practitioners don’t yet know why. For some, it could be that the event that caused PTSD — something loud like gunfire, or something that can cause sudden pressure changes, like a bomb — could also have caused tinnitus. “If that's the case, then the tinnitus might serve as a constant reminder that you cannot escape, a reminder of that psychological trauma,” Moring explained.
The phantom sound itself could then be a trigger for flashbacks or other symptoms of PTSD.
Moring has completed a small study on the interaction between PTSD and tinnitus, in which he recorded subjects’ responses to cognitive processing therapy (CPT) for PTSD and cognitive behavioral therapy (CBT) for tinnitus. “What we noticed is that the PTSD did resolve significantly, and the tinnitus-related distress actually decreased as well.”
The results of this study did not reach statistical significance, Moring said, but he suspects that may be because it didn’t include enough subjects. He’s been approved to do a larger study, and wants to see if he can replicate those earlier results. He’d also like to get a clearer understanding of why people with PTSD suffer more from tinnitus than do those with other mental health diagnoses.
“Is it that it's a unidirectional kind of relationship in which PTSD exacerbates tinnitus, or is it the other way around, where tinnitus is exacerbating the PTSD symptoms?” Moring asked. Does PTSD treatment also ease the anguish caused by tinnitus? Does tinnitus treatment lessen PTSD? Moring hopes his next study will clarify that
Moring will also examine whether there are changes to the brain throughout treatment. “So for a subset of participants, they'll be undergoing functional MRI, a brain scan, to determine how the brain is changing from baseline up to a six-month post-treatment follow-up,” Moring said.
For many suffering from chronic tinnitus, like Moring, there is no cure. For him, the sounds have faded into the background, but that’s not true for 20% of those with chronic tinnitus. He hopes his research will give audiologists and mental health practitioners better tools to help ease their patients' distress. “Instead of having a large pebble in your shoe, and you're walking around with that, maybe it's to the point where it's like a fine grain of sand,” Moring said, “And you can just barely tell that it's there.”
“We're going to be walking around with this tinnitus for the rest of our lives, probably, so let's get to the point where we can live a fulfilled and value-driven life,” Moring added.
Moring is now enrolling active-duty military service members and veterans in his study, which will get underway this summer and run through 2028.
Science & Medicine is a collaboration between TPR and The University of Texas Health Science Center at San Antonio, about how scientific discovery in San Antonio advances the way medicine is practiced everywhere.
