Three of Australasia’s leading tinnitus practitioners – MYRIAM WESTCOTT, GRANT SEARCHFIELD AND MINI GUPTA – have spent decades between them helping patients, including the most complex cases. For Tinnitus Awareness Week (3-9 February), they shared their stories of persistence and hope.
I’m living in hell. Can you save me?” These words from a distraught patient changed the trajectory of Ms Mini Gupta’s audiology career.
“I was sitting in my clinic and a distressed man who a doctor had referred walked in,” she recalls. “Those were the first words he said, and this is where it changed. I felt helpless because he’d come for help, yet I knew little about tinnitus.
“He said, ‘Don’t tell me I have to learn to live with it.’ Those words struck me deeply. I chose to listen, acknowledging his struggle, and it changed my path. That day, I committed to upskilling myself to better serve those facing auditory dysfunctions causing tinnitus.”
Gupta started reading journal articles about tinnitus and later completed a Fellowship in Tinnitus and Hyperacusis studies from Salus University. She learnt Tinnitus Retraining Therapy (TRT) from its founders, Americans Dr Pawel Jastreboff and Dr Margaret Jastreboff. Ironically, she brought the couple to Melbourne in February 2025 to lead their last training for 32 audiologists before retirement.
Eight years after her first tinnitus patient, Gupta has transformed countless lives, including Melbourne man Mr Damian Duke, who developed debilitating tinnitus after back surgery. Despite trying every available treatment, he found no relief. Desperate and emotionally drained, he discovered her Google reviews and sought help.
“He was in tears during his first appointment,” Gupta recalls. “He said, You’re my last hope Mini. If you can’t help me, my children will lose their father.
“Damian is now living a normal life and has done extremely well with tinnitus retraining therapy and continued cognitive behavioural therapy (CBT) with us at the clinic. His commitment to the treatment and follow up has been exceptional.”
Duke says: “It took over my life and I was at breaking point as no-one was able to help. Mini worked out the issue causing my tinnitus and a plan to treat it. Only tinnitus sufferers know what we are going through but I can honestly say this works and you will get your life back.”
Gupta emphasises the importance of providing hope with a plan for every patient. “About 60% who I see are suicidal and they’ve all been successfully treated,” she says. “By the time they come to me they’re often desperate and have tried many things.”
Gupta receives referrals from audiologists nationwide for opinion and management plans. An initial telehealth appointment involves assessment, counselling and advice for the referring audiologist on further investigations and a treatment plan.
If a situation is catastrophic, she requests patients come to see her. “Patients often travel from interstate when telehealth is insufficient,” she says. “My clinical approach combines audiological practices with principles of neuroscience and psychotherapy to provide holistic care.”
Gupta did a Bachelor’s in Speech Therapy and Audiology, and a Master’s of Audiology in India before arriving in Australia in 2006. After passing her Audiology Australia exam here, she worked for Amplifon, Audika and The Royal Victorian Eye and Ear Hospital’s Cochlear Implant Clinic before starting her own practice in Mount Waverley, Melbourne in 2017.
She initially rented a room in a medical clinic and educated doctors that audiologists did more than prescribe hearing aids. The encounter with the first tinnitus patient was followed by ENT surgeon Dr Ryan De Freitas suggesting she focus on tinnitus.
Gupta believes more audiologists should specialise in the condition but lack of Medicare and government funding for assessment and treatment is a barrier for patients.
Use sound therapy, not masking
She emphasises that traditional coping strategies for tinnitus often involve masking the sound, which can worsen the condition. According to Tinnitus Retraining Therapy, tinnitus should never be masked but rather integrated with therapeutic sounds at a balanced level, she says.
The therapy sound should never exceed the volume of the tinnitus, allowing the brain to perceive it as neutral. Gupta insists that being aware of tinnitus alongside therapeutic sound is essential for achieving long-term relief.
Her tinnitus treatment focuses on counselling and educating patients about ear anatomy, tinnitus generation, and how the brain processes sound and emotions like fear. “TRT teaches the brain that tinnitus is a neutral signal that doesn’t deserve attention,” she explains.
“I use hearing devices to program sound therapy using TRT protocols which provide relief from tinnitus annoyance. It’s like taking paracetamol to reduce pain perception.” The therapy, based on neurophysiology, adjusts sound levels according to tinnitus severity and hearing loss.
Temporomandibular joint (TMJ) dysfunction can contribute to tinnitus due to its anatomical proximity to the ear and Eustachian tube, she adds. “The TMJ joint, located anterior to the ear canal, is functionally linked to the muscles controlling the Eustachian tube and surrounding structures,”she says.
“Even minor alterations in TMJ function can disrupt the balance of these systems, leading to conditions such as Eustachian tube dysfunction and middle ear issues, which may trigger or exacerbate tinnitus.”
During the Covid-19 pandemic, Gutpa’s workload increased significantly. “Many patients had nasal congestion and blocked Eustachian tubes,” she says. “At its peak my team was seeing 23 to 25 tinnitus patients per week, compared to seven to eight pre-Covid.”
Melbourne audiologist with 30 years’ experience in tinnitus and hyperacusis, Ms Myriam Westcott, emphasises a holistic, personalised psychological approach and says self-management and collaboration with other healthcare professionals are important to manage tinnitus effectively.
Westcott developed an interest in hyperacusis at her first workplace, Victoria’s Deaf Society, where she noticed underdiagnosis of hyperacusis in tinnitus patients and lack of consensus and collaboration in hyperacusis understanding.
“With tinnitus, not only are we looking at the central auditory pathway, we’re looking at how that intersects with psychological and somatic pathways because tinnitus is not just caused by hearing loss but can be triggered by stress,” she says.
“Tinnitus neuroscience has shown that stress held in the head, neck and jaw musculature can cause or aggravate tinnitus at both a somatic and neurological level.”
Tinnitus can become enhanced by psychological aspects of its perception.
“Most people absorb tinnitus into their sense of normal and get on with their lives. However, tinnitus onset/aggravation can be highly stressful or even traumatic – they’re the patients I most commonly see, who need strong support.
“It’s important for them to learn not to view it as an alien imposition or worry something’s wrong with their brain but see it as a naturally occurring phenomenon that can be managed,” Westcott says.
A minority with adjustment disorder however don’t have resources to adjust psychologically to tinnitus.
Westcott had a holistic view of tinnitus and hyperacusis decades before patient-centred care was standard. Her colleagues Mr Ross Dineen and Ms Kate Moore at her practice DWM Audiology, known for treating challenging tinnitus and other complex cases, agreed on this approach.
“Looking at the patient holistically from a bio/psycho/social perspective has been an intuitive way in which I’ve worked. It’s viewed as patient-centred care today and means working in a multidisciplinary team with colleagues to get the best outcome for the patient,” she adds.
Westcott attends international conferences to keep up with the neuroscience and has developed close relationships with other clinicians, has lectured and led workshops, including at The University of Melbourne, and helped establish Tinnitus Australia.
Psychological approach, habituation and self-management
In Australia, few professions other than audiology specialise in tinnitus, she adds, whereas overseas, more ENTs, neurologists, psychologists and psychiatrists dive in.
“I trained in TRT and believe in its neurophysiological model, the role of the limbic system and use of low-level noise. But my approach is broader, personalised and interactive, focusing on evaluating the psychological aspects of the patient’s subconscious appraisal of the tinnitus sound.
“I believe psychological approaches are more effective because they’re personalised and more interactive. That doesn’t negate that everything can work together – in my view, it’s not an either-or approach.”
Westcott’s treatment involves history taking, interviewing patients and exploring auditory, psychological and somatic pathways that contribute to their reaction. “Most auditory processing is subconscious. Unless people have that personalised understanding, they don’t really know what they’re dealing with,” she adds.
She says TRT categorises patients via intensity of their response and whether they have hyperacusis or a hearing loss. “It’s not really explored what those psychological connections might be for the individual patient, and I think it needs to be.
“Most have seen an audiologist for hearing tests. An explanation is important because apart from being distressed, many are bewildered.
“Once patients understand their pathways, it’s deeply reassuring and they know what they’re dealing with. My approach is to spend time discussing how they might self-manage changing those pathways to help their brain view the tinnitus as a boring sound, and to strip back enhancement of the tinnitus experience because of stress and distress.”
For tinnitus enhanced by muscular stress, Westcott refers to a physiotherapist who understands those somatic pathways, and a psychologist to support tinnitus related distress.
“People need psychological support of an intense reaction to achieve a satisfactory level of tinnitus habituation,” she adds.
Audiological strategies she uses to support habituation include using sound therapeutically, personalised to cater for any associated hyperacusis. “Psychological strategies include reducing tinnitus vigilance or monitoring.
“I curate information at a personal level so patients can take on the self-management responsibility of driving their recovery or habituation pathway, with ongoing support available as needed,” Westcott says.
She works online seeing tinnitus and hyperacusis patients from around Australia and the world. This includes people with acoustic shock and tensor tympani syndrome, which she is a world expert in, and whose symptoms have an application in tinnitus and hyperacusis.
Some are referred for an online, extended program to Tasmanian audiologist and meditation teacher Ms Dani Fox, who runs a tinnitus clinic. “I have no problem working collaboratively with colleagues who have something to offer that I might not,” Westcott adds.
She also recommends Tune Out self-guided program, a cognitive behavioural approach and practical tools for under $77. Developed by an Australian psychologist experienced in tinnitus, it’s for patients who’ve had audiological and medical assessment or intervention and require further support.
If patients are suicidal, Westcott advises alerting their GP ASAP. Clinicians’ mental health can also be at stake so they should ensure self-care.
“Audiologists often under-rate their counselling abilities and their ability to support an anxious patient,” she says.
“Restoring hearing through hearing aids can have a profound benefit on reducing tinnitus awareness but not necessarily make it go away. By boosting external sounds to where they should be heard, it can rather nicely drown out the internal sound. That auditory stimulation can be beneficial at a neurological level and may influence tinnitus emergence.”
She criticises limited training opportunities for audiologists, and advises audiologists to go as far as they feel comfortable, referring to experts if they cannot provide a service.
Westcott says while the effect of placebo needs to be considered in any treatment (tinnitus has roughly a 40% placebo response rate), there are potential benefits of bimodal neuromodulation combining sound and electrical stimulation.
Also dedicating his career to tinnitus is Professor Grant Searchfield, University of Auckland Academic Head Audiology, and an audiologist with 30 years’ experience.
“I was working at a public ENT hospital and did a lot of hearing tests but many patients said they wanted assistance with ‘the sound in their ears,” he recalls. “Like most graduates I had a bit of an idea about tinnitus but not a great deal of ability to put it into effective practice.”
A presentation on tinnitus at university sparked interest in research and in 1995 he attended a tinnitus conference in the US and started making connections. He started a tinnitus clinic with the support of an experienced ENT specialist.
“Many audiologists are reluctant to practise in this area because they fear managing some of the emotional characteristics that people with tinnitus may have but for me that has been a relatively small proportion of the people I’ve seen so I think it’s a largely unfounded fear,” he says.
“While some aspects remain consistent, such as audiologists’ reluctance to treat tinnitus, there has been significant growth in available tools and approaches. This evolution includes the emergence of different approaches from nearly all hearing aids now having tinnitus management options to apps, online courses, clinicians being able to provide greater, more in-depth counselling, and increased advocacy,” Prof Searchfield says.
“With the growth of awareness comes a rise of misinformation on the internet though which increases the importance of education and appropriate counselling.”
Biggest breakthrough
Prof Searchfield says the biggest breakthrough, whether it is yet seen as a breakthrough, is the acknowledgement that “we need to personalise therapies for the people that we see as no two tinnitus patients are the same”.
“What might work for one person, may not for another,” he adds. “It’s not a breakthrough like the internet or mobile phones but a much softer concept, and from that, I believe a lot of good is going to happen down the track.
“The need for personalised therapies involves tailoring treatments to individual needs. The clinicians’ role is to identify the right treatment.”
Prof Searchfield says he tells his students to be pragmatic, not dogmatic in the way they approach treatment. “They must keep their eyes and ears open to what the person is saying and how they’re reacting. We may get to the point where we can do testing and that will help us but until then we rely on clinicians’ soft skills.”
A multidisciplinary approach, referrals, and building a network of specialists are crucial for effective tinnitus management, he adds. He agrees about potential benefits of physiotherapy and massage for managing neck and jaw pain, which can impact tinnitus, stating there’s a strong neurophysiological link between input from the neck and jaw to the auditory system.
“It’s not unusual to see people who’ve had a neck injury develop tinnitus and if the injury is resolved, the tinnitus remains,” he adds.
Ask about hearing, feelings, neck and jaw pain
Prof Searchfield emphasises the importance of asking about hearing, feelings, and neck or jaw pain during consultations. Audiologists can use the Tinnitus Sample Case History Questionnaire and the Tinnitus Functional Index for evaluation plus the Tinnitus Version of the COSI (Client Oriented Scale of Improvement) for counselling and goal setting, he adds.
“The secret ingredient is the clinician helping the person identify the right treatment or knowing alternatives if something is not working,” he says.
“My colleagues and I are developing machine learning (ML) tools to help clinicians personalise tinnitus treatments. They aim to predict treatment success based on demographic information, questionnaires and EEG (electroencephalogram to measure electrical activity in the brain) results. Early feedback on treatment effectiveness can mean adapting therapies as needed.”
A spinout company from the university, TrueSilence Therapeutics, formed and is launching its first version of an ML tinnitus tool in New Zealand in 2025. It aims to guide clinicians in prescribing the best solution for each individual, making it sustainable and viable so it returns a profit.
“Early on, you might have a set of results, goals or impacts that tinnitus has on the individual, and demographic information such as age and gender which may be predictive of different treatment benefits,” he says.
“We’ve shown that we can predict responders and non-responders to some treatments via questionnaires and objective EEG.”
The tool aims for clinicians to tell patients they have a likelihood of success of 75% for this treatment, for example, versus another therapy. “When patients plateau on a treatment, or are not satisfied, the tool can direct them to another treatment that may act on a different aspect of the tinnitus, so they don’t provide a therapy that’s not going to work,” he explains.
Down the track he predicts therapy may adapt as it receives information that results are plateauing and treatment is losing effectiveness.
“The audiologist will still be the primary care manager but is expanding their ability to provide services. Most people they see will eventually have a hearing loss as well,” Prof Searchfield adds.
Another goal is to improve access to clinicians. “We need more clinicians doing tinnitus work, and to enable that, we must have frameworks that build on skills audiologists have that don’t place too much burden on them and enable them to manage clients through technology. This can reduce the workload of the clinician in a way that helps both parties.”
He predicts blood tests using blood-borne indicators may in future inform best treatment, and medications may be activated by personalised sound stimulation.
Westcott adds: “It’s enormously rewarding to feel that you’ve made a difference to somebody’s life. It’s been a huge process to commit to improving the understanding for patients, particularly the areas I consider poorly understood – the sound intolerance space – so having people breathe a sigh of relief and say, ‘Thank you, that was so helpful. I understand what’s happening and I know what to do now’ is huge.”
*If this story has brought up issues for you, you can call Lifeline’s 24/7 Crisis Support on 13 11 14 or text 24/7 to 0477 13 11 14. Beyond Blue Support Service is free and available 24/7 365 days a year: Deaf community assistance, connect to the National Relay Service and ask to be put through to Beyond Blue on 1300 22 4636. Call TTY 1800 555 677 and ask for 1300 22 4636. Chat to a counsellor online at beyondblue.org.au/get-support.
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