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According to new research, a multidisciplinary approach to treating tinnitus that combines cognitive behaviour therapy with sound-based tinnitus retraining therapy* is significantly more effective than currently available treatments at reducing symptoms of this common debilitating disorder and improving quality of life. The findings published in this week’s Lancet show that the new specialised care programme is beneficial in both mild and severe tinnitus, suggesting it could be implemented widely.
“The results are highly relevant for clinical practice because best practice for tinnitus has not been defined, and current treatment strategies are fragmented and costly”, explain Rilana Cima and Johan Vlaeyen from Maastricht University in the Netherlands, who led the research.
Tinnitus, described as a sustained ringing in the ears, affects up to 21% of adults at some point in their lifetime. Many treatments are offered for tinnitus, but there is very little evidence about which ones work best and few studies have compared treatments against each other.
In this study, researchers recruited 492 adults with tinnitus; 245 were randomly assigned to stepped specialised care** and 247 to usual care stratified by tinnitus severity and hearing ability in blocks of four. Validated questionnaires were used to measure health-related quality of life, tinnitus severity, and tinnitus impairment.
After 12 months, patients in the specialised care group reported improved quality of life (effect size 0·24***) and decreased tinnitus severity (0·43) and impairment (0·45) compared with those receiving standard treatment.
The authors point out: “We showed the effectiveness of specialised care compared with usual care not only after the first 3 months of first-step treatment, but also after the more intensive second-step treatment approach ended and 4 months of no treatment”.
They conclude: “Our findings could lead to consensus in policy about best practice in treatment of tinnitus, standard choices in referral trajectories, and the implementation of standardised tinnitus assessment and thereby more easily comparable outcomes”.
In a linked Comment, Berthold Langguth from the University of Regensburg in Germany says: “The results of this trial are especially convincing and relevant for clinical practice… Although the stepped care approach involved only a short intervention for most patients, specialised care was significantly better than usual care for the whole sample”.
He adds: “For future research, it should not be forgotten that most patients with tinnitus want a cure, which should be the ultimate goal of research efforts”.
*Tinnitus retraining therapy aims to improve tinnitus-related distress through counselling sessions and exposure to neutral external sound.
**Stepped care allows for the organisation of health services (audiologists, psychologists, speech therapists, movement therapists, physical therapists, and social workers) based on the individual needs of patients.
*** Effect sizes are generally categorised as small (0·2), medium (0·5), and large (0·8).