The Science of Listening to the Invisible: How physiotherapist and researcher Carina Bezerra Rocha is expanding how the healthcare field understands tinnitus

Evely Oliveira
19 minutes ago
9 min read

There are careers that follow predictable paths within a profession. And there are those that begin with a quiet restlessness, almost impossible to ignore.

In the case of physiotherapist and researcher Carina Bezerra Rocha, everything seems to have started with an inner refusal to accept ready-made answers.

Even at the beginning of her training, there was a clear sense that simply repeating paths that had already been fully explored would not be enough. Intellectual curiosity seemed to push her in the opposite direction—toward questions that had not yet been fully formulated.

This impulse led her to the study of temporomandibular disorders, a field that connects musculature, pain, and mandibular function. It was within this clinical territory that an unexpected question began to emerge. If the muscles and joints of the face can influence so many functions of the body, why couldn’t they also influence something that seems more distant, such as tinnitus?

Today, this question seems natural within the scientific literature. But when she first began exploring it, the territory was still diffuse and only lightly investigated.

Over time, that initial curiosity stopped being just a clinical intuition and began to turn into research. One of her first studies on the relationship between musculoskeletal structures and tinnitus helped broaden the discussion around what is known as somatosensory tinnitus, a field that investigates how different body systems can influence the perception of tinnitus.

The impact of that study extended beyond the academic environment in an unexpected way. The work ended up being cited by The New York Times, allowing an investigation conducted by a Brazilian physiotherapist to circulate in one of the largest newspapers in the world.

For her, however, the deepest impact of the research is not measured only by visibility.

It appears in the clinic.

Over more than two decades of treating patients with tinnitus, a reality has repeatedly emerged in a troubling way. Many people arrive after a long journey in search of answers, carrying exams, diagnoses, and a sentence they have heard countless times along the way: that tinnitus has no treatment.

It was by listening to these stories that her investigation ceased to be purely scientific and began to take on a deeply human dimension.

The researcher herself likes to describe herself through a curious metaphor: that of the mountain goat—an animal known for the precision with which it chooses each step and its ability to move forward across terrain where few dare to venture.

Today, the trajectory of Carina Bezerra Rocha spans three fronts that continually feed one another. The clinic, where patients seek relief from a symptom that is often neglected. Science, which aims to better understand the mechanisms that sustain it. And education, through which she trains professionals and shares knowledge about a subject that still challenges many certainties within medicine.

If for a long time tinnitus was treated as a territory without answers, her trajectory points to another possibility.

That understanding certain symptoms requires something that science and medicine do not always practice with enough time.

Listening.

Listening to the body.

Listening to the patient.

Listening to what exists beyond the noise.

After building a solid career across clinical practice, scientific research, and professional training, Carina Bezerra Rocha has become one of the most consistent voices investigating tinnitus within the healthcare field. We spoke with the researcher about science, listening, and the paths that still need to be explored.

Your trajectory as a pioneering physiotherapist in the field of tinnitus spans more than two decades across scientific research, clinical practice, and professional training. At some point along this journey, did you realize that you were building a new way of understanding tinnitus within healthcare?

Very early in my training, I had a very clear concern: the risk of falling into what I like to call intellectual melancholy—the territory of “more of the same.” I did not want to become a one-book professional.

This restlessness emerged toward the end of my undergraduate studies, when I had to choose the topic for my final thesis. I looked for something that connected with my clinical interests but that also explored territory that few of my colleagues had ventured into. That is how I began studying the role of physiotherapists in temporomandibular disorders.

Shortly afterward, tinnitus entered my life unexpectedly. And I quickly became fascinated by the idea of researching this area. In my mind, a guiding thread had formed between the somatosensory pathway (muscular) and the auditory pathway (tinnitus), even though I had never read a single article about it in the scientific literature.

The real turning point came in 2008, when I published the first scientific article on tinnitus written by a physiotherapist. At that moment, I realized that we were opening a new field of discussion about how this symptom could be understood, evaluated, and treated.

The impact was much greater than I had imagined. The study ended up being cited by The New York Times, and at that moment it became clear to me that this line of investigation had the potential to expand how tinnitus was being approached within healthcare.

All of this was an important awakening. A true turning point.

Your work helped consolidate the concept of somatosensory tinnitus, connecting body systems that for a long time were studied in isolation. What did this discovery reveal to you about the limits of an overly fragmented medicine and about the importance of looking at the human body in a more integrated way?

When I began my research, I came across the work of neurologist Robert Levine, who had proposed the hypothesis of an interaction between the somatosensory pathway and tinnitus. That was revealing to me, because it showed that this connection between systems had never really been absent. It had always existed. What was missing was the clinical awareness to recognize it.

The real problem was not the absence of knowledge, but its dehydration within clinical practice. Because science that remains confined to paper undergoes a silent process of fossilization.

I often explain the emergence of tinnitus using the metaphor of a glass. The base of that glass is usually hearing loss or some alteration in the auditory pathway. But the level of the liquid rises as different factors accumulate. Muscular, emotional, and systemic influences can increase that level until the glass overflows and tinnitus becomes perceptible to the patient.

This perspective revealed something important to me: reducing a tinnitus patient to a single anatomical structure is a form of clinical myopia. The human body does not function in isolated compartments. It operates as a living network of physiological interdependencies.

Many people living with tinnitus describe a journey marked by frustration, uncertainty, and often a feeling of invisibility within the healthcare system itself. Throughout your career, have there been encounters or patient stories that deeply transformed the way you understand this suffering?

Over the years, I have learned that tinnitus can take many forms. From patients dominated by catastrophic thoughts to those who live with the symptom without any suffering at all. All of them teach something and leave their mark.

It has been more than two decades treating around fifty tinnitus patients per week. Children, adults, and older adults—very different stories crossing paths through the same symptom.

I have been deeply moved listening to complex personal accounts. I have celebrated with enthusiasm cases of complete remission. But there is something that still profoundly unsettles me: how often these patients arrive at the clinic carrying the same sentence they have heard repeatedly along their journey—that tinnitus has no treatment.

This kind of statement creates something silent within medicine: a form of clinical invisibility.

Tinnitus may be one of the symptoms that suffers most from clinical reductionism within medicine. One of the causes I defend most strongly is precisely to challenge this conceptual narrowing. Tinnitus cannot continue to be imprisoned in a monothematic way of thinking, much less in a fallacious assumption.

Beyond research and clinical practice, you have also become an educator by training professionals and sharing knowledge. When did you realize that your work also meant building a community of professionals with expertise in tinnitus, capable of approaching the symptom with greater depth, listening, and sensitivity?

This realization came from two very striking experiences. The first was hearing about the clinical results of my students and noticing that many of their patients were also achieving complete tinnitus remission. At that moment, it became clear to me that knowledge had ceased to be something concentrated and was beginning to become something alive, expanding.

The second transformation happened when we began discussing clinical cases in a true peer-to-peer dialogue. Gradually, I stopped seeing myself as the only physiotherapist navigating this territory and began to recognize a generation of professionals deeply committed to caring for these patients.

For a long time, I walked almost entirely alone in this field. Today, I see something that moves me: a growing ecosystem of clinicians investigating tinnitus with greater depth, listening, and human sensitivity. And it is this ecosystem that I want to preserve.

The backbone of my mission is simple: to increase, year after year, the number of patients who can achieve tinnitus remission. And this only happens when knowledge and achievements stop being individual property and begin to circulate among professionals prepared to see the patient beyond the symptom.

Building a scientific career rarely follows a linear path. When investigating a topic that for a long time received little attention within healthcare, were there moments of doubt, resistance, or even intellectual isolation? What sustained your decision to continue? After so many years dedicated to research, patient care, and training new professionals, how do you feel about your voice in this field today?

An analogy I often make with my personality, which has always resonated with me, is that of the mountain goat. Not just for its persistence, its precision in choosing each step, or its ability to survive in hostile environments, but especially for a very particular trait: it goes exactly where almost no one goes.

And I chose a territory that many professionals prefer to avoid. To navigate this territory, I knew that curiosity alone would not suffice. Resistance was necessary.

Tinnitus is somewhat like that—a complex and frequently neglected clinical territory. For a long time, the most common response offered to patients was simply that there was not much to be done. This creates a silent kind of abandonment within healthcare itself.

I felt that I needed to climb this mountain.

And it was encountering so many helpless patients that sustained my decision to continue—patients who suffered not only from a symptom but from the sense of not being understood. It was there that I realized that giving up on this field would have been the easier choice, but not necessarily the more responsible one.

Interestingly, I often say that I did not choose tinnitus. In a way, it chose me. The things that are truly ours end up finding us. My entire professional life has orbited around this topic: my clinical practice, research, training of professionals, and the education I share on social media.

There are also two curious facts in this story. I myself experienced a bout of tinnitus about ten years ago, which later went into complete remission. And my daughter is named Melissa, a Greek name meaning “bee.” I like to think of it as an involuntary symbol of something that builds, little by little.

Today, I feel that my voice in this field does not exist in just one place. It exists at the intersection of clinical practice, science, and education. To transform a patient’s life in the clinic, I need well-conducted study and research. To teach other professionals, I need both research and clinical experience. And on social media, I try to fulfill an equally important role: disseminating basic, clear, and responsible information. Because in tinnitus, treatment often begins before any intervention. It begins when the patient finally receives correct information.

If you could amplify a single message to the world about tinnitus and the way we deal with this suffering, what would you want to be truly heard and understood?

If I could amplify a single message about tinnitus to the world, it would be this: tinnitus can be treated.

Treating tinnitus does not only mean achieving complete remission of the symptom. In clinical practice, there are many shades of gray between intense suffering and absolute silence. Reducing the volume of tinnitus is treatment. Making it intermittent is treatment. Lessening the patient’s suffering is also treatment.

Tinnitus is a demanding symptom. It asks a lot from those who suffer, but it also demands much from us, as healthcare professionals. That is why patients need to seek professionals with real experience in this field.

And to healthcare professionals, I make this appeal:

Few sentences are as devastating for a patient as hearing that “tinnitus has no treatment.” When we do not know how to manage a case, referring the patient is an act of responsibility and respect.