Specialized Treatment Based on Cognitive Behavioral Therapy (CBT) vs. Usual Care for Tinnitus: A Randomized Controlled Trial2
Objective: To determine if CBT with a sound therapy is more effective at treating a tinnitus patient versus sound therapy alone.
Methods: Researchers enrolled and treated 492 previ- ously untreated patients whose primary complaint was tinnitus. An independent research assistant randomly assigned four patient groups to receive either specialized CBT with sound therapy or other traditional care. Patients and assessors were masked to treatment assignment. Health-related quality of life, tinnitus severity, and tinnitus impairment were assessed before treatment and at three, eight, and 12 months after randomization.
Results: Compared with 247 patients assigned to usual care, 245 patients assigned to the specialized care group improved in health-related quality of life and decreased tinnitus severity and impairment.
Why it’s important: Tinnitus patients benefit most from a multi-disciplinary treatment program. This study provides data on a large scale to prove what has been known from smaller studies of patients and hopefully in turn will help make this type of treat- ment approach a standard of care for all tinnitus patients.
Tinnitus Retraining Therapy: Mixing Point and Total Masking are Equally Effective3
Objective: To determine the effectiveness of Tinnitus Retraining Therapy and conclude if the theory that habituation cannot occur without total masking is accurate.
Methods: Forty-eight tinnitus patients were randomly assigned to one of three groups: counseling, counsel- ing plus bilateral noise generators set to completely mask the tinnitus, or counseling plus bilateral noise generators with a focus on the mixing point (partial masking just below total masking). A picture-based counseling protocol was used to assist in providing similar counseling among all three groups. The Tinnitus Handicap Questionnaire was administered before and after 12 months of treatment.
Results: After 12 months, in the counseling group, three of 18 patients benefited significantly; in the mixing point group, six of 19 patients benefited; and in the total masking group, four of 11 patients showed improvement from the treatment. The aver- age decrease in the questionnaire was 16.7% for
the counseling group, 31.6% for the retraining group, and 36.4% for the total masking group. No significant average differences among groups were observed, concluding that a focus on mixing point masking is not required for tinnitus habituation.
Why it’s important: The study successfully challenges an accepted principle in tinnitus literature, and proves that traditional forms of clinical sound therapy can be equally effective at treating tinnitus. This information is useful for researchers, clinicians and patients alike.
Tinnitus and Drugs
Clonazepam Quiets Tinnitus: A Randomized Crossover Study with Ginkgo Biloba4
Objective: This study assessed the effect of Ginkgo biloba and clonazepam on tinnitus.
Methods: Twenty-seven men and 11 women (aged 16-80) with tinnitus for more than two months were enrolled. Participants were randomized to either clonazepam or Ginkgo biloba for the first three weeks. For the next two weeks of washout no medication was taken. For the final three weeks, subjects were given the other drug. Tinnitus was assessed with pitch and loudness matching, tinnitus handicap inventory, and visual analog scales of loudness, duration and annoyance.
Results: Clonazepam significantly improved tinnitus loudness (74% of subjects), duration (63%), annoyance (79%), and tinnitus handicap inventory score (61%), whereas the Ginkgo biloba showed no significant differences on any of these measures.
Why it’s important: To date there are no approved drugs for tinnitus. Clinical studies on drug therapy have been limited in patient group size, therefore it is hard to draw concrete conclusions about a drug’s efficacy or its potential side effects on a huge dynamic population. However, in recent years, more and more clinical studies on drugs and tinnitus have been conducted and are becoming more refined. Studies like this may one day help point to a pharmacological approach to treating tinnitus.
Does Tinnitus Distress Depend on Age of Onset?5 Objectives: It is currently not completely understood why some people feel distressed by their tinnitus while others don’t. Several studies indicate that the amount of tinnitus distress is associated with many factors including anxiety, depression, personality, the psycho- social situation, the amount of related hearing loss and Summer 2012 | Tinnitus Today
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