You’ve been working with tinnitus for more than twenty years. Do you also know it from personal experience?
Luckily not — only for a couple of seconds at most, maybe up to two minutes.
Have you ever come across any artistic expressions of tinnitus that resonated with you?
Tinnitus, hearing loss, and hearing damage are common among musicians — not only among today’s rock, pop, or hip-hop stars, but also classical composers of the past. One notable example is Bedřich Smetana, who suffered from tinnitus. In one of his compositions, String Quartet From My Life (Z mého života), he incorporated the experience directly: a high-pitched sound played by the violin represents the persistent tone he heard.
bio
Prof. Dr. med. Berthold Langguth (1967) is a Professor at the Department of Psychiatry and Psychotherapy, Universität Regensburg. He earned his medical degree from Ludwig‑Maximilians‑Universität München (1988–1995) and completed his PhD in 1998 on learning and generalization in brain injury patients. He went on to specialize in neurology (2002) and psychiatry and psychotherapy (2006), subsequently rising through roles at Regensburg’s University Hospital fpr Psychiatry and Psychotherapy — serving as senior physician, habilitated in 2009 for his work on transcranial magnetic stimulation and neuroplasticity. In 2012 he became chief physician of the psychiatric outpatient and admissions services, and in 2023 vice director of the clinic. Since co-founding the inter-disciplinary Tinnitus Center at the University of Regensburg in 2007, he has also chaired the executive committee of the Tinnitus Research Initiative. Langguth supervises pioneering research in tinnitus, neuromodulation, affective disorders, and pain, and leads clinical services at the Tinnituszentrum Regensburg.
I was struck by how much people with tinnitus suffer, how few effective treatments exist.
What drew you to this field, then?
My interest in neuroplasticity led me to tinnitus research. We initially tried to replicate a Yale study using transcranial magnetic stimulation to treat auditory hallucinations in schizophrenia. But we couldn’t recruit enough patients. That’s when we realized tinnitus could also be seen as a form of auditory phantom perception. ENT colleagues had many patients eager to try experimental treatment, so we shifted focus. I was struck by how much people with tinnitus suffer, how few effective treatments exist, and thought our experience in psychiatry might be helpful.
We sought to better understand the heterogeneity in tinnitus, established large databases and study methodologies, and explored a wide range of treatments — including pharmacological, psychotherapeutic, cognitive-behavioural, and sound therapies.
That brings us to the scope of the field — how many disciplines does tinnitus research consist of?
One of the main challenges in tinnitus research is that it sits between disciplines. Traditionally, ENT specialists and audiologists handle tinnitus, but their focus is on the ear and hearing system. While most tinnitus patients have hearing loss, the ear alone doesn’t explain the condition.
Over time, we've learned that tinnitus can only be understood through the interaction among the ear, the brain, and other factors — requiring an interdisciplinary approach. ENT doctors and audiologists are central due to the link with hearing loss, but neurologists, psychiatrists, and sometimes neurosurgeons are also involved. Vascular issues may call for neuroradiologists, and pulsatile tinnitus can stem from abnormal blood flow. The somatosensory system plays a role too, so physiotherapists may be needed, and even dentists when the temporomandibular joint is involved.
Speaking of subjective tinnitus, I found very differing figures, from 17 percent up to 40 percent. Once I got tinnitus myself after a night of partying, I couldn’t hear well for three or four days. Would I be included in the statistics?
That's indeed a problem, and as you suggest, these variable prevalence numbers are related to different definitions of tinnitus. Is it already tinnitus if somebody has from time to time a short-lasting sound in the ear or after some loud concerts? Another issue is that, in most surveys, there's no clear-cut distinction between people who just experience the sound but are not impaired and those who are severely suffering from the sound. We need a clear definition.
We made a concerted effort to establish consensus and proposed distinctions that have since been adopted by the WHO in the International Classification of Diseases. According to our definition, tinnitus is considered present if it lasts longer than five minutes and occurs on most days. Another important distinction we advocate is between a benign perceptual phenomenon and a severely distressing condition — one that disrupts sleep, impairs concentration, and leads to exhaustion. If you had tinnitus for three days and it then disappeared, this would not be classified as chronic tinnitus.
In Switzerland, concert loudness is regulated, and a musician enforcing these rules told me he believes sound quality actually improved.
Is it dangerous even so? I couldn’t hear people from a distance until it — luckily — ended.
It’s recommended to attend your next concert with earplugs, as the sound exposure likely caused a form of temporary hearing loss — which also triggered the tinnitus.
Many times, I asked musicians, staff, and even club managers in music clubs why the music was so loud — until I finally got an explanation: the sound engineer was half-deaf and simply played it too loud.
Indeed, many music engineers assume that louder means better, but audiences often disagree. I’m involved in the WHO’s Make Listening Safe initiative, which addresses this issue. In Switzerland, concert loudness is regulated, and a musician enforcing these rules told me he believes sound quality actually improved. However, it’s not just concerts — cinemas and video games also contribute to cumulative noise exposure, especially through headphones. This can lead to irreversible hearing damage before it’s even detected, making awareness and safe listening practices all the more important.
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Speaking of neuroplasticity, are some people more susceptible to developing tinnitus than others?
Yes. There are risk factors both for developing tinnitus and for how severely it affects a person’s quality of life.
Elderly people are at higher risk not only for hearing loss but also for developing tinnitus. Moreover, we could already identify certain genetic variants associated with an increased risk.
Personality traits play a role in how individuals experience tinnitus. Some people adapt relatively easily — after six months, they might say, “I still have it, but it's not a problem.” Others, however, suffer significantly, often because they focus their attention on the tinnitus.
How far has genetic research on tinnitus progressed?
Compared to other disorders, we are still at the very beginning. We know that sometimes tinnitus aggregates in families — if a family member has tinnitus, the risk increases. It becomes more complex considering there are different forms of tinnitus, such as unilateral and bilateral. Tinnitus on both sides is more strongly associated with increased susceptibility, genetic predisposition, and familial aggregation. Recent research has also shown that there are specific genetic risk factors for severe tinnitus or tinnitus disorder, but much more research is needed.
Recent research has also shown that there are specific genetic risk factors for severe tinnitus or tinnitus disorder.
What are your own recent advances in neuromodulation?
Unfortunately, neuromodulation alone has shown only limited efficacy, and we haven’t been as successful as we had hoped. That’s why we now combine it with auditory stimulation — for example, using so-called bimodal stimulation, which involves pairing auditory input with some form of electrical or magnetic brain stimulation.
Another approach we're exploring is individualized stimulation. We've found that certain stimulation programmes work well for some patients but not for others. To address this, we now test individual patients to tailor the stimulation accordingly.
Both approaches remain experimental. The data are not yet conclusive or replicable, but they point to promising directions.
You speak some Czech. How did your proximity to Czechia come about?
My wife is from Ostrava, and my mother also lived in the Šumava Mountains before moving to Germany.
We’ve had a long-standing collaboration with colleagues from University Hospital Brno, which has had a rather peculiar history in the media. My wife has always enjoyed the Czech popular science radio programme Meteor, and about twenty years ago, one episode mentioned that psychiatry had begun using magnetic stimulation as a treatment method. That sparked my interest, and I reached out to colleagues in Brno to learn more. Our collaboration has continued ever since. During a special broadcast for the anniversary of Meteor, they mentioned — likely thanks to my wife's email — that their story had led to the formation of a scientific collaboration between Regensburg and Brno.
