This article advances a carefully argued ethical, philosophical, and clinical case for audiologist-delivered cognitive behavioral therapy (CBT) in tinnitus care. Rather than framing the issue as a professional turf dispute between audiology and psychology, the author situates the debate within a broader question of responsibility: how clinicians should respond when patient suffering clearly exceeds the limits of traditional role definitions, yet falls through gaps in existing healthcare structures.

At the heart of the argument is a practical reality. Tinnitus-related distress is common, debilitating, and consistently shown to respond to CBT. Yet many patients do not conceptualize tinnitus as a mental health problem and therefore do not seek help from psychologists or psychiatrists. Instead, they turn to audiologists, the professionals they already associate with ear-related symptoms. This creates a recurring clinical dilemma: audiologists encounter patients in significant distress but are often told that CBT lies outside their professional scope. The article argues that refusing to address this distress, when evidence-based and appropriately bounded interventions exist, raises ethical concerns of its own.

The author emphasizes that audiologist-delivered CBT is not generic psychotherapy transplanted into audiology. It is a targeted, symptom-focused intervention developed specifically for tinnitus and related sound intolerance conditions. Tinnitus distress is conceptualized not as a psychiatric disorder but as a response to the lived experience of sound without an external source. While psychological processes are central to this distress, they operate within a context shaped by auditory perception, attention, memory, and meaning. This framing draws on phenomenological philosophy, particularly the work of Maurice Merleau-Ponty, who emphasized that human experience is embodied, situated, and inseparable from perception.

From this perspective, tinnitus distress emerges not simply from the sound itself but from how that sound is interpreted and integrated into a person’s emotional, cognitive, and social world. Audiologists, by virtue of their training in auditory physiology and perception, are uniquely positioned to address this intersection between sound and meaning. With additional specialist CBT training, they can offer structured interventions that directly target tinnitus-related distress while remaining within clearly defined boundaries.

A key strength of the article is its insistence on limits. Audiologist-delivered CBT is explicitly not intended to treat complex psychiatric conditions such as psychosis, trauma-related disorders, or severe depression. Instead, it focuses on distress that is directly linked to tinnitus, hyperacusis, or misophonia. Audiologists trained in CBT learn to differentiate between sound-related distress and broader psychopathology, applying targeted CBT to the former and referring the latter to appropriate mental health professionals. In this way, audiologist-delivered CBT is positioned as complementary to psychology rather than competitive with it.

The ethical argument is deepened through engagement with existential philosophy, particularly Jean-Paul Sartre’s distinction between facticity and transcendence. Facticity refers to the given conditions of one’s situation: professional titles, scope-of-practice documents, and original training. Transcendence refers to the human capacity to project beyond these givens and take responsibility for shaping one’s actions in response to real-world demands. According to Sartre, ethical failure arises in “bad faith,” when individuals hide behind their roles or institutions to avoid responsibility.

Applied to tinnitus care, this framework exposes a subtle moral tension. An audiologist who says, “CBT is outside my role,” may be acting cautiously and in line with formal boundaries. Yet when this stance repeatedly leaves patients without effective help, it risks becoming a form of bad faith: a retreat into professional identity at the expense of patient welfare. By contrast, an audiologist who acknowledges these limits but chooses to pursue rigorous CBT training acts in a mode of transcendence. They accept responsibility for responding to suffering rather than deferring it indefinitely elsewhere.

The article also critiques two common but flawed positions in the debate. The first is an overly empiricist stance, which argues that because the evidence base for audiologist-delivered CBT is smaller than that for psychologist-delivered CBT, it should not be pursued. This view, the author suggests, reduces ethical decision-making to a numbers game and ignores the substantial positive outcomes already demonstrated in clinical studies. The second is an idealist position that assumes psychologists should simply become tinnitus experts and patients should be motivated to see them. While tidy in theory, this vision fails to reflect clinical reality, where access barriers, patient perceptions, and gaps in specialist knowledge persist.

In contrast, audiologist-delivered CBT represents a pragmatic response to the world as it is, not as it might ideally be. The article reviews a growing body of evidence showing that audiologist-delivered and audiologist-guided CBT can reduce tinnitus distress, insomnia, anxiety, and associated difficulties, with high levels of patient acceptability. Importantly, these outcomes have been achieved within routine audiology services, suggesting scalability and real-world relevance.

The clinical implications are illustrated through familiar scenarios. Patients with severe tinnitus distress often undergo thorough audiological assessment, hearing aid fitting, and sound therapy, yet continue to struggle emotionally. Referring such patients to psychology is frequently ineffective in practice, either because referrals are not taken up or because tinnitus-specific expertise is lacking. Audiologists trained in CBT can bridge this gap by integrating neurophysiological education with cognitive and behavioral strategies, addressing distress at the point of care while remaining alert to signs that specialist mental health input is required.

The article concludes by situating this argument within the evolving scope of audiology itself. Citing the American Academy of Audiology’s Scope of Practice, the author notes that audiology already encompasses education and counseling for tinnitus, and explicitly allows for individual specialization aligned with ethics and competence. From this perspective, audiologist-delivered CBT is not a radical departure but a legitimate extension of audiological care in response to patient need, emerging evidence, and professional responsibility.

Ultimately, the article frames audiologist-delivered CBT as an ethical choice grounded in courage rather than convenience. It challenges clinicians and institutions alike to resist hiding behind rigid boundaries when those boundaries fail to serve patients. In doing so, it calls for a model of care that is philosophically informed, clinically grounded, and ethically responsive to the lived reality of tinnitus-related suffering.

We are sharing the full PDF of this article with permission from the American Academy of Audiology.