Sound Therapy for Tinnitus Management: Practicable Options

Structured Abstract Objectives: A review was undertaken to evaluate the peer-reviewed literature on three areas of tinnitus management for the following Key Questions (KQs): (1) measures used to assess patients for management needs (KQ1); (2) effectiveness of treatments (KQ2); and (3) identification of prognostic factors (KQ3). Data sources: MEDLINE®, Embase®, CINAHL®, PsycINFO®, AMED©, and Cochrane CENTRAL were searched from January 1970 to June 2012. An extensive grey literature search, which included documents from regulatory and tinnitus-related organizations, was also undertaken. Review methods: Standardized systematic review methodology was employed. Eligibility criteria included English-language studies of adults with subjective idiopathic (nonpulsatile) tinnitus; excluded studies involved tinnitus as the result of middle ear pathologies or focused on methods to determine psychosomatic tinnitus. For KQ2, all pharmacological/food supplement, medical/surgical, sound/technologic...

Seminars in Hearing, 2014

Tinnitus continues to challenge patients from all walks of life and clinicians from a variety of disciplines. The lack of an evidence base to support a specific treatment confounds efforts to provide consistent benefit to patients and in many instances creates in the patient the impression that nothing can be done to improve their situation. Part of the problem is that although patients rarely experience complete elimination of a tinnitus signal, they often experience relief when receiving effective counseling, specific coping strategies, and sound therapy. Although in most clinical activities the tinnitus remains (i.e., it is not cured), its influence may wane as the patient learns to manage their environment, activities, and ultimately their response to tinnitus. At the same time, several medical interventions target reduction of the tinnitus sound, an approach more consistent with what patients expect as a cure. Therefore, the majority of clinical activity directed at care for patients with tinnitus typically targets either elimination of the tinnitus sound (tinnitus treatment) or modification of the patient's response to the sound (tinnitus management). This review distinguishes and offers examples of both treatment and management programs employed clinically for patients with tinnitus.

Journal of The American Academy of Audiology, 2019

Background: It is well accepted among clinicians that maskers and hearing aids combined with counseling are generally helpful to tinnitus patients, but there are few controlled studies exploring the efficacy of maskers alone to decrease the prominence of tinnitus. Purpose: We investigated the benefit of maskers for patients with chronic, bothersome tinnitus. Research Design: Crossover single-participant design, where each participant served as their own control. Study Sample: 18 adults with subjective, nonpulsatile, sensorineural tinnitus. Intervention: Participants participated in two six-week trials: one with sound therapy and one without. No counseling was provided in either group. Masking devices were fit with sounds intended to reduce the tinnitus prominence. Data Collection and Analysis: Participants rated tinnitus loudness, tinnitus annoyance, and acceptability of the background sounds using a numeric 0-100 interval scale and completed the Tinnitus Primary Functions Questionnaire (TPFQ). Results: Three participants dropped out. On the total score of the TPFQ, 5 of 15 remaining participants (33%) showed a benefit. Using a derived score based on functions showing a handicap before the study, maskers benefit was observed in the areas of sleep (five of nine), hearing (three of eight), thoughts and emotions (three of four), and concentration (four of eight). The TPFQ and annoyance data complemented each other well. Conclusions: This study demonstrates the benefit of partial masking, encouraging patients to seek help from audiologists interested in providing support for tinnitus patients.

The Journal of Rehabilitation Research and Development, 2005

Chronic tinnitus is experienced by 10%-15% of the population, of which only about 20% require clinical intervention. People requiring intervention have different levels of need, ranging from the provision of basic information to long-term, individualized treatment. We address this clinical need by outlining a five-level "progressive intervention" approach to the management of tinnitus that would provide a systematic framework for treatment by audiologists. At each level, patients must be appropriately referred-usually to otolaryngology, psychology, and/or psychiatry. Level 1 is an interview method of screening for determining if the person requires clinical intervention (and addressing basic questions). Level 2 is the provision of structured group educational counseling. If the screening determines that care is urgently required or if further help is needed following the group session(s), a tinnitus intake assessment (Level 3) should be performed. The intake assessment, wh...

2011

FDA-Food and drug administration MHRA-UK Medicines and Healthcare products Regulatory Agency NIHL-Noise-induced hearing loss RCT-Randomised controlled trials TCA-Tricyclic antidepressant THI-Tinnitus Handicap Inventory SSRIs-Selective serotonin re-uptake inhibitors

Hearing Research, 2010

Acoustic stimulation with hearing aids or noise devices is frequently used in tinnitus therapy. However, such behind-the-ear devices are limited in their high-frequency output with an upper cut-off frequency of approximately 5e6 kHz. Theoretical modeling suggests that acoustic stimulation treatments with these devices might be most effective when the tinnitus pitch is within the stimulated frequency range. To test this hypothesis, we conducted a pilot study with 15 subjects with chronic tinnitus. Eleven subjects received hearing aids and four subjects noise devices. Perceived tinnitus loudness was measured using a visual analog scale, and tinnitus-related distress was assessed using the Tinnitus Questionnaire. After six months of device usage, reductions of perceived tinnitus loudness were seen only in subjects with a tinnitus pitch of less than 6 kHz. When subjects were grouped by tinnitus pitch, the group of patients with a tinnitus pitch of less than 6 kHz (n ¼ 10 subjects) showed a significant reduction in perceived tinnitus loudness (from 73.4 AE 6.1 before to 56.4 AE 7.4 after treatment, p ¼ 0.012), whereas in subjects with a tinnitus pitch of 6 kHz or more (n ¼ 5 subjects) tinnitus loudness was slightly increased after six months of treatment (65.0 AE 4.7 before and 70.6 AE 5.9 after treatment), but the increase was not significant (p ¼ 0.063). Likewise, tinnitus-related distress was significantly decreased in the low-pitch group (from 31.6 AE 4.3 to 20.9 AE 4.8, p ¼ 0.0059), but not in the group with high-pitched tinnitus (30.2 AE 3.3 before and 30.0 AE 5.1 after treatment, p ¼ 1). Overall, reductions in tinnitus-related distress in our study were less pronounced than those reported for more comprehensive treatments. However, the differences we observed between the low-and the high-pitch group show that tinnitus pitch might influence the outcome of acoustic stimulation treatments when devices with a limited frequency range are used.

Cochrane Database of Systematic Reviews, 2018

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European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2017

The majority of tinnitus patients are affected by chronic idiopathic tinnitus, and almost 60 different treatment modalities have been reported. The present study is a multidisciplinary systematic analysis of the evidence for the different forms of treatment for chronic tinnitus. The results are used to form the basis of an S3 guideline. A systematic search was carried out in PubMed and the Cochrane Library. The basis for presenting the level of evidence was the evidence classification of the Oxford Centre of Evidence-based Medicine. Whenever available, randomised controlled trials were given preference for discussing therapeutic issues. All systematic reviews and meta-analyses were assessed for their methodological quality, and effect size was taken into account. As the need for patient counselling is self-evident, specific tinnitus counselling should be performed. Due to the high level of evidence, validated tinnitus-specific, cognitive behavioural therapy is strongly recommended. ...

Journal of the American Academy of Audiology, 2013

Background: Tinnitus can have a devastating impact on the quality of life of the sufferer. Although the mechanisms underpinning tinnitus remain uncertain, hearing loss is often associated with its onset, and hearing aids are among the most commonly used tools for its management.