The Effect of 4-7-8 Breathing Exercise Technique on Tinnitus Handicap, Psychological Factors, and Sleep Quality in Tinnitus Patients: A Randomized Controlled Study.
Kirazli G, Baran S, et al. • Brain and behavior • 2026
4-7-8 breathing exercises performed for 6 weeks resulted in significant decreases in tinnitus handicap, anxiety, perceived stress, and sleep quality scores compared to a control group that received only an informative session.
Key Findings
Results
The experimental group showed significant decreases in all outcome measures after 6 weeks of 4-7-8 breathing exercises, while the control group showed no significant changes from baseline.
Experimental group: 23 patients with subjective tinnitus; control group: 25 patients with subjective tinnitus
Both groups received a 1-hour informative session on tinnitus at the start of the study
The experimental group additionally performed 4-7-8 breathing exercises for 6 weeks
Outcome measures included VAS, THI, ISI, TAI, and PSS-10, assessed at baseline and at 6 weeks
Control group questionnaire and VAS scores after 6 weeks did not differ significantly from their baseline scores
Results
The 4-7-8 breathing exercise technique produced significant reductions in tinnitus handicap as measured by the Tinnitus Handicap Inventory (THI) in the experimental group.
THI scores in the experimental group showed a significant decrease compared to pre-application scores
No significant change in THI was observed in the control group over the same period
The THI is a validated questionnaire used to assess the impact of tinnitus on daily functioning
Both groups had subjective tinnitus as the inclusion criterion
Results
Sleep quality, as measured by the Insomnia Severity Index (ISI), significantly improved in the experimental group following 6 weeks of 4-7-8 breathing exercises.
ISI scores showed a significant decrease in the experimental group after the 6-week program
ISI scores in the control group did not show a significant change from baseline
The comparison between experimental and control groups after the intervention showed a significant difference in ISI scores
Results
Trait anxiety, as measured by the Trait Anxiety Inventory (TAI), was significantly reduced in the experimental group after the 6-week 4-7-8 breathing exercise program.
TAI scores in the experimental group showed significant decreases compared to pre-application scores
The control group did not show significant changes in TAI scores over the 6-week period
Between-group comparison after the intervention favored the experimental group
Results
Perceived stress, as measured by the Perceived Stress Scale-10 (PSS-10), was significantly reduced in the experimental group following the 4-7-8 breathing exercise intervention.
PSS-10 scores in the experimental group showed significant decreases from baseline to post-intervention
Control group PSS-10 scores did not differ significantly from baseline after 6 weeks
When experimental and control groups were compared after the intervention, a significant decrease was found in PSS-10 scores of the experimental group
Results
Tinnitus loudness as rated by the Visual Analog Scale (VAS) decreased significantly in the experimental group but not in the control group.
VAS scores in the experimental group showed significant decreases after the 6-week program compared to pre-application scores
VAS scores of the control group after the session did not differ significantly from baseline scores
The between-group comparison after the intervention showed a significant difference in VAS scores
Methods
The study was a parallel-group randomized controlled trial registered on ClinicalTrials.gov (NCT06360731) with a total of 48 subjective tinnitus patients.
23 patients were allocated to the experimental group and 25 to the control group
The study design was a parallel-group randomized controlled trial
Assessments were conducted before and at the end of the 6-week program
The 4-7-8 breathing technique involves inhaling for 4 counts, holding for 7 counts, and exhaling for 8 counts
Conclusions
The authors concluded that the 4-7-8 breathing exercise technique can be used as a simple, effective, and supportive therapy method in the clinical management of tinnitus patients.
The technique is described as 'simple, effective, and supportive'
It is positioned as a complementary or adjunctive approach to existing tinnitus management
Effects were observed across multiple domains: handicap, anxiety, stress, sleep, and perceived loudness
The 6-week duration was sufficient to demonstrate statistically significant changes in the experimental group
What This Means
This research suggests that a simple breathing exercise called the 4-7-8 technique — where you inhale for 4 counts, hold your breath for 7 counts, and exhale for 8 counts — may help people who suffer from tinnitus (ringing or buzzing in the ears). In this small randomized controlled trial, 48 tinnitus patients were divided into two groups: one group received an hour-long educational session about tinnitus, while the other received the same session and also practiced the 4-7-8 breathing exercise for six weeks. At the end of the study, the breathing exercise group showed meaningful improvements in how much their tinnitus bothered them, how loud it seemed, how anxious they felt, how stressed they were, and how well they slept — while the education-only group showed no significant improvements in any of these areas.
This research suggests that a structured breathing exercise requiring no special equipment or cost could serve as a practical add-on to standard tinnitus care. Tinnitus is a condition with no widely accepted cure, and it is often associated with significant psychological distress and sleep problems, making multi-symptom interventions particularly valuable. The improvements seen across anxiety, stress, sleep, and tinnitus-related handicap suggest that the breathing technique may work in part by calming the nervous system.
This research suggests these findings should be interpreted with caution given the relatively small sample size (48 total participants) and the short 6-week follow-up period. Larger studies with longer follow-up periods would be needed to confirm whether these benefits are sustained over time and to better understand which patients are most likely to benefit from this approach.
Kirazli G, Baran S, Uysal G, Ozdogan A, Durankaya S, Ogut M. (2026). The Effect of 4-7-8 Breathing Exercise Technique on Tinnitus Handicap, Psychological Factors, and Sleep Quality in Tinnitus Patients: A Randomized Controlled Study.. Brain and behavior. https://doi.org/10.1002/brb3.70854