In a recent press relase, Inner Ear Solutions announced the release of iTinnitus Solutions 1.1, an app directed at sufferers of tinnitus. First, a bit of background – tinnitus basically refers an a false perception of sound caused by an abnormality in your ear (as opposed to, say, auditory hallucinations which are associated with various types of brain dysfunction). In short, its that annoying ringing that most of us get occasionally.

Some people are chronic sufferers, with their tinnitus resulting from causes including drug side effects, inner ear damage from repeat exposure to loud sounds, or even tumors on the auditory nerve. Having spent some time in an otology (ear) clinic, I saw how debilitating a problem this can be for some, however transient it may be for the rest of us. So can this $0.99 app really bring some relief to patients who are suffering?

So to understand this app, a basic understanding of tinnitus is probably worth establishing (skip this paragraph if you’re familiar with the topic). The basic idea here is that dysfunction peripherally – either the auditory nerve, inner ear, or middle ear – causes a false sense of sound, the “ringing” which can really take any number of forms (ringing, pulsing, clicking, etc). As noted above, the causes vary widely but the end result is really the same, namely damage to some part of the peripheral (outside the brain) hearing structures. The tinnitus generally worsens with a number of different environmental triggers – stress, caffeine, high salt intake, and even being in a quiet environment. Therapy is generally centered around mitigating these triggers and trying to figure out what the underlying cause is. So if a tumor is compressing the auditory nerve, it needs to come out. Or if a new antibiotic was recently started, it needs to be stopped.

However, there are some cases that just can’t be fixed, such as the most common cause – noise-induced inner ear injury. So what then? There are some medical therapies (antidepressants) but, if those fail, sound therapy comes into play. The premise is that ambient noises can drown out the tinnitus and, in some patients, produce a residual suppression of the tinnitus even after the ambient noise is withdrawn. Pillows with speakers embedded in them are, for example, useful in helping patients suppress their tinnitus enough to sleep. Direct delivery of sound into the ear – hearing aids, headphones, etc – have been shown to be even more effective. These sound generators are generate a broad range of frequencies (100-8000 Hz) which can be pretty finely tuned, such as the sound generator from United Hearing Systems. Response rates are variable, with one study showing that the best effect in patients with the worst symptoms.

iTinnitus Solutions, according to the website, claims to help characterize tinnitus by frequency and timing. This feature, if in fact accurate, is of unclear benefit. I rarely saw a specific characterization of frequency used in the otology clinic and nothing I read in the literature suggested that this data is useful in management. What could be useful, however, is the ability to record triggers that are associated with a worsening of symptoms. Much like migraine therapy, identifying key triggers could really help patients manage their tinnitus. So what about the app’s claims to “treat” tinnitus? Some of the key claims like “listening to the tone matching your tinnitus for 10-20 minutes will leave you with a sense quiet” are suspect – according to an otolaryngology reference text, standard sound generators typically aim for a wide frequency spectrum rather than a targeted range (although there is some trial and error fine tuning). It does not appear however that any sort of frequency matching is part of management. In addition, the implication that all patients will experience benefit is absolutely false as both current and reference literature suggest variable and partial responses at best. I also could not find any support for the six week “habituation” protocol that the app claims to support, which basically involves starting at a high level of masking (the ambient noise) and tapering it down for six weeks.

So all in all, I suspect the only useful feature of this app will be the ability to correlate symptoms with triggers. The masking therapy is basically equivalent to listening to anything, even music, on the iPhone. And neither this iPhone based masking or habituation therapy have any support in the literature that I could identify, nor is any listed on the website. Let’s be clear – I’m all for innovative solutions to medical problems. But I think this will prove to be a gimmick which at best will cause unsuspecting patients to waste a dollar or, at worst, convince patients to attempt to self-treat rather than visiting a physician to receive real care for their condition. I’d love to be wrong about this and see even a small trial suggesting this iPhone based therapy works. But I’m not holding my breath.

Note: Much of the background information for this article came from Cummings Otolaryngology: Head and Neck Surgery, 4th ed, Chapter 124 “Tinnitus Management Program”