Current understanding of subjective tinnitus in adults

PURPOSE

An up-to-date overview of epidemiology, etiology and pathophysiological mechanisms, diagnostic and evaluation methods, current treatment status and future directions of subjective tinnitus in adults.

METHODS

Review of current evidence-based literature on subjective tinnitus in adults.

RESULTS

The prevalence of subjective tinnitus in the adult population is estimated to be around 14%, and it tends to increase with age. Subjective tinnitus is a complex condition with multiple factors contributing to its origin. However, the exact causes and underlying mechanisms remain unknown. Potential causes may include hearing loss, dysfunction in the somatosensory system, and auditory cortical dysfunction, although severe underlying pathology is rare. Currently, diagnosis primarily relies on patient self-reported medical history and physician-based clinical assessment due to the lack of objective testing. Various treatment and management options have been proposed, but their effectiveness varies, and there is no universally agreed-upon treatment option.

CONCLUSIONS

Tinnitus is a complex and heterogeneous disease with a high incidence rate and a tendency to increase with age. A holistic perspective is needed to understand the generation, perception, and emotional responses to tinnitus. Diagnosis requires a comprehensive assessment based on medical history and relevant examinations, identification of concurrent psychosomatic comorbidities, and active pursuit of objective diagnostic methods. At the same time, on the basis of existing treatment plans and combining emerging technologies, we will develop new personalized, precise, and combined treatment plans.

Health-Related Quality of Life in Subjective, Chronic Tinnitus Patients: A Scoping Review

PURPOSE

This scoping review aims to assess whether the severity or distress of subjective tinnitus is negatively associated or correlated with the level of health-related quality of life (HRQoL). A second objective is to examine whether tinnitus patients score differently on HRQoL questionnaires in comparison to subjects without tinnitus and whether HRQoL differs between specific subgroups of tinnitus.

METHODS

This scoping review adheres to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA guidelines): the statement and extension for scoping reviews (PRISMA-ScR). The following databases were consulted (on the 20th of October 2023): PubMed, Cochrane Library, Web of Science, and Scopus. The search string was composed of the terms tinnitus, HRQoL, and synonyms. A double-blinded screening for eligibility was performed, first on the title and abstract and subsequently on the full-text articles. Studies were considered eligible if they looked at HRQoL questionnaire results for adult patients (> 18 years) reporting chronic (> 3 months), subjective tinnitus as a primary complaint.

RESULTS

In total, 37 studies with a total sample size of 33,900 participants were included in this scoping review, with some studies answering multiple study objectives. Seventeen studies demonstrated the presence of a significant negative correlation between tinnitus-related distress and HRQoL. Two studies indicated that HRQoL is mediated by tinnitus-related distress. Eighteen studies found that, in general, patients with tinnitus scored significantly lower on HRQoL questionnaires in comparison to subjects without tinnitus. Nineteen studies demonstrated that subgroups of patients with more severe tinnitus complaints or specific additional complaints scored worse on HRQoL questionnaires.

CONCLUSION

Based on the current literature, chronic subjective tinnitus-related distress has a significant impact on health-related quality of life. In addition, subjects without tinnitus generally score significantly higher on HRQoL questionnaires than patients with tinnitus. The heterogeneity in outcome measures between studies precludes meta-analysis. Increased homogeneity in the choice of HRQoL questionnaires would make a comparison between studies possible, which would give valuable information on both a clinical and an economic level, guiding future tinnitus treatment.

REGISTRATION

The protocol for the scoping review is registered at Open Science Framework: https://doi.org/10.17605/OSF.IO/F5S9C .

Advances in acupuncture treatment for tinnitus

Tinnitus is the abnormal perception of sound in the absence of a corresponding external acoustic stimulus, which seriously affects the patients' quality of life, physical and mental health, and the safety of life. There is almost no effective cure for tinnitus, primarily due to its complicated etiopathogenesis and unclear mechanisms. As a major and ancient physical therapy in Traditional Chinese Medicine, acupuncture has been widely used in tinnitus because of its simple operation, rapid effect, and low cost. This paper reviews the relevant literature on the treatment of different kinds of tinnitus by acupuncture, and summarizes the therapeutic efficacy and mechanism of acupuncture on tinnitus, which is expected to provide new ideas and research directions for the study of tinnitus treatment by acupuncture. Tinnitus is the abnormal perception of sound in the absence of a corresponding external acoustic stimulus, which seriously affects the patients' quality of life, physical and mental health, and the safety of life. There is almost no effective cure for tinnitus, primarily due to its complicated etiopathogenesis and unclear mechanisms. As a major and ancient physical therapy in Traditional Chinese Medicine, acupuncture has been widely used in tinnitus because of its simple operation, rapid effect, and low cost. This paper reviews the relevant literature on the treatment of different kinds of tinnitus by acupuncture, and summarizes the therapeutic efficacy and mechanism of acupuncture on tinnitus, which is expected to provide new ideas and research directions for the study of tinnitus treatment by acupuncture.

Diagnostic Value of Different Types of Tinnitus

INTRODUCTION

Tinnitus is the perception of sound when no external objective noise is present. It is not defined as an illness, but rather a symptom of an underlying process. Although it is a widely prevalent and distressing otologic issue, its pathological mechanism is not entirely known.

AIM

The present paper aims to discover if tinnitus characteristics can guide us in the diagnosis of the pathology that produces it.

METHODS

This paper uses literature review approach from various publications, including PubMed and The International Tinnitus Journal which include discussed elements related to classification of tinnitus, characteristics of tinnitus, aetiology of different types of tinnitus, and patient's description of tinnitus. The study was conducted between December 2021 and June 2022 and included publications dated from 1992 until 2022. The focus was on the characteristics of tinnitus and their capability to guide the diagnosis process.

RESULTS

30 publications were found suitable for this research and described the proper characteristics of tinnitus and their significance in the diagnosis process.

CONCLUSION

The characteristics of tinnitus do not have the ability to firmly diagnose the pathology which determines tinnitus, yet it may guide the diagnosis.

Efficacy of hearing aid treatment on sound perception and residual hearing preservation in patients with tinnitus and coexisting hearing loss: study protocol for a randomized controlled trial

BACKGROUND

Chronic subjective tinnitus poses significant challenges in clinical practice, and it is usually associated with hearing impairment, particularly with high-frequency sensorineural hearing loss (SNHL). Patients suffering from tinnitus with SNHL experience one of the most severe sensory disabilities, and this has devastating effects on their quality of life. Nowadays, mild to moderate SNHL can be managed with a properly fitted hearing aid (HA) that provides sound amplification, and several studies suggest that HAs may also benefit those with tinnitus. However, inadequate attention has been paid by medical personnel to the impact of HA use in residual hearing protection for patients with tinnitus and coexisting SNHL, and existing evidence is still at a preliminary stage. This study aims to identify and evaluate the efficacy of the use of HAs in both sound perception and residual hearing preservation among patients with tinnitus and coexisting SNHL.

METHODS AND DESIGN

The present study is a prospective, single-center, outcome assessor and data analyst-blinded, randomized, controlled trial. Eligible participants will be recruited and randomly allocated into the HA intervention group and the waiting list control group at a ratio of 1:1. The primary outcome is to evaluate the severity of tinnitus using the Tinnitus Handicap Inventory as a continuous variable at 6 months from randomization. Secondary outcome measures include changes in hearing status and mental states. The trial will last 6 months, with follow-up visits at 3 months and 6 months.

DISCUSSION

This will be the first randomized, controlled trial to identify and evaluate HAs' efficacy on residual hearing preservation among tinnitus patients with coexisting high-frequency SNHL in China. We are aiming for novelty and generalizability, and strengths of this study are that it will examine the effectiveness of HA in patients with tinnitus and hearing impairment and will further explore the residual hearing protection provided by HA treatment in the tinnitus group.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05343026. Registered on April 25, 2022.

Transcutaneous Electric Nerve Stimulation in Chronic Subjective Tinnitus

OBJECTIVE

It is aimed to determine the therapeutic role of transcutaneous electrical nerve stimulation (TENS) on chronic subjective tinnitus with a randomized and comparative analysis.

METHOD

46 individuals with normal hearing, chronic subjective tinnitus, aged 20-65; randomly divided into the study (TENS therapy) and tje control groups. The control group (n = 23) was informed only about tinnitus, while the study group (n = 23) received TENS therapy (20 sessions in 4 weeks). Before TENS therapy, tinnitus-related evaluations of all participants [tinnitus frequency, loudness, minimum masking level (MMS), residual inhibition (RI)] were made and Tinnitus Handicap Inventory (THI), Visual Analogue Scale (VAS), Short Form 36 (SF-36), and The Quality of Life Scale were applied to the participants. These evaluations and questionnaires were repeated after 4 weeks of the therapy.

RESULTS

There was a significant decrease in the tinnitus severity after TENS therapy in the study group (p = 0.003). Moreover, it was found that VAS (loudness and annoyance), THI (functional, emotional and total score), SF-36 (physical function, physical role, pain, general health, vitality, emotional role and social function) values improved compared to before TENS therapy and the difference was significant (p < 0.05). There was no significant difference between the first and last evaluations of the control group (p > 0.05).

CONCLUSION

TENS is an effective, practical and reliable therapy method in reducing severity, loudness, and annoyance of tinnitus, and increasing the quality of life in individuals with chronic subjective tinnitus.

Effect of Frequency Discrimination Training on Tinnitus in Individuals with Flat Sensorineural Hearing loss

Tinnitus is associated with sensorineural hearing loss irrespective of its severity and configuration. Frequency discrimination training is a contemporary method used for the treatment of tinnitus. However, its efficacy in treating tinnitus associated with flat sensorineural hearing loss is not studied yet. The objectives were to assess (a) treatment effect across sessions on tinnitus percept using subjective questionnaires (b) association in the severity and handicap of tinnitus before and after FDT treatment. A total of 16 participants with mean age of 56 years, who had subjective tinnitus and flat sensorineural hearing loss ranging from mild to moderate were included in the study. However, only 11 participants completed the treatment regime. Each participant was provided FDT in a game format for 15 days. The Quantitative (tinnitus pitch and loudness in each session) and qualitative measurements (THI and TFI) were assessed in each participant. Friedman test revealed a significant reduction in handicap from tinnitus as reflected in THI and reduced functionality impairment from tinnitus as reflected in TFI across sessions. Besides, a significant association was observed in the Chi-square test in severity and handicap of tinnitus before and after therapy. A change in pitch and reduced loudness was noted in eight of 11 participants. Three of them had no tinnitus perception at the end of the treatment regime. The current study findings demonstrate the efficacy of FDT using a game module in treating tinnitus associated with flat sensorineural hearing loss. The perceived severity and handicap of tinnitus reduces as a function of treatment.

Resting-state Networks in Tinnitus : A Scoping Review

Chronic subjective tinnitus is the constant perception of a sound that has no physical source. Brain imaging studies show alterations in tinnitus patients' resting-state networks (RSNs). This scoping review aims to provide an overview of resting-state fMRI studies in tinnitus, and to evaluate the evidence for changes in different RSNs. A total of 29 studies were included, 26 of which found alterations in networks such as the auditory network, default mode network, attention networks, and visual network; however, there is a lack of reproducibility in the field which can be attributed to the use of different regions of interest and analytical methods per study, and tinnitus heterogeneity. Future studies should focus on replication by using the same regions of interest in their analysis of resting-state data, and by controlling adequately for potential confounds. These efforts could potentially lead to the identification of a biomarker for tinnitus in the future.

Evaluation of Eye Movement Desensitization and Reprocessing in the management of tinnitus. An observational study

OBJECTIVES

Tinnitus can induce disabling psychological suffering, requiring an integrative multimodal approach, combining neuromodulation and psychotherapeutic methods. We sought to evaluate the therapeutic efficacy and acceptability of Eye Movement Desensitization and Reprocessing (EMDR) in tinnitus.

MATERIALS AND METHODS

This was a single-center prospective non-comparative study. Inclusion criteria comprised: adult patient, with chronic tinnitus, Tinnitus Handicap Inventory (THI) score>17, causing psychological distress motivating active treatment after ineffective "classic" treatment (combining advice, sound therapy and first-line drug treatment), and agreement to EMDR therapy. Therapeutic efficacy was defined by a decrease in THI or Visual Analog Scale (VAS) scores. Treatment acceptability was defined by the rate of included patients who completed therapy.

RESULTS

Thirty-eight patients were included. There was a significant reduction of 53.5% in THI score in 78.9% of patients (P<0.0001; 64.8±20.8 before versus 31.8±24.7 after treatment), and of 51% in VAS score in 76.3% of patients (P<0.0001; 7.24±2.12 before versus 3.58±2.03 after treatment). The treatment acceptability was 86.8%.

CONCLUSION

EMDR appeared to be an effective alternative that was acceptable to the majority of patients, after failure of "classic" first-line treatment, improving quality of life in tinnitus patients and thus relieving disability.

On the relationship between tinnitus distress, cognitive performance and aging

In this study we analyzed psychometric data of 107 individuals who suffer from chronic subjective tinnitus. In particular, we elucidated the relationship between tinnitus-related distress, psychological comorbidities, age, and hearing, and the performance in cognitive concentration and interference tests. Previous research has provided first evidence that individuals with tinnitus may have deficits in cognitive tasks. The present study aimed at extending former research by investigating the relationship between tinnitus distress and cognition. Statistical analyses comprised correlation and regression approaches. We observed a significant relationship between tinnitus distress (tinnitus score, TQ), age and hearing loss and the performance in tests on selective and sustained attention (d2 test) and cognitive interference (Stroop test). Tinnitus distress was identified as the most important predictor of cognitive performance (additionally age for cognitive interference). For other psychometric variables (perceived stress, PSQ; self-efficacy, optimism and pessimism, SWOP) and hearing loss we could not find any meaningful relationship with cognitive performance. The results clearly point to a (currently non-causal) relationship between cognitive skills and distress of tinnitus-related symptoms. Furthermore, the influence of age is noteworthy as this finding implies that with increasing age an appropriate coping with aversive tinnitus symptoms based on proper cognitive functions and age-related hearing dysfunctions, namely inhibition, may become more difficult. Hence, it is suggested to consider cognitive tests as a supplementary measurement in clinical assessment of tinnitus and to raise awareness for the impairing influence of tinnitus on cognition in daily life.

Is There Any Effect of Subjective Tinnitus on Vestibular Evoked Myogenic Potentials

Idiopathic subjective tinnitus has a complex pathophysiology in which not only cochlear and central classical auditory pathways but also nonclassical auditory pathways of different parts of the brain are involved. Vestibuloocular and vestibulocollic pathways are the central projections of utricle and saccule used in the vestibular evoked myogenic potential (VEMP) test. Aim of this study was to investigate the effects of idiopathic subjective tinnitus on vestibuloocular and vestibulocollic pathways via VEMP. We prospectively analyzed 30 unilateral idiopathic subjective tinnitus patient's cervical, ocular VEMP tests, tinnitus handicap index scores, symptom duration and compared with contralateral ear and 35 healthy volunteers. The latencies and amplitudes of P1 and N1 waves were recorded and pathologic wave criteria was calculated according to healthy volunteer's data. In cervical VEMP there were significant longer latencies of P1 and N1 waves with respect to contralateral ear and control group. In ocular VEMP test, N1 and P1 latencies and amplitudes were not significantly different. The percentages of pathologic wave of the tinnitus side were not significantly higher in both cervical VEMP and ocular VEMP tests with respect to contralateral side. Tinnitus handicap index scores and symptom duration had no relationship with latency and amplitude of VEMP tests. Although cervical VEMP P1 and N1 latencies were significantly longer, subjective tinnitus did not result in pathological alterations in the VEMP test. Presence of subjective tinnitus is not an influencing factor in the VEMP interpretation.

Pharmacotherapy of Tinnitus

Tinnitus is a common symptom for which there is in most cases no causal therapy. The search for an improvement of tinnitus through pharmacological interventions has a long tradition. The observation that tinnitus can be transiently suppressed by the use of lidocaine has shown that the symptom is susceptible to pharmacotherapy. So far, however, no medication has been found for either acute or chronic subjective tinnitus that reliably leads to a long-term reduction or even complete disappearance of the symptom for the majority of tinnitus sufferers. Nevertheless, in everyday clinical life, drugs are frequently used, usually off-label, to relieve tinnitus or tinnitus-associated symptoms (e.g. sleep disturbance, depression, anxiety disorder or hearing loss). This chapter shows the different approaches to acute and chronic subjective tinnitus by means of pharmacotherapeutic interventions. Furthermore, this review reports on the scientific studies carried out in this area in recent years and explains the difficulties in finding a suitable medication for most forms of tinnitus. In addition, it reports on the pharmacotherapeutic options for objective tinnitus and describes the development of tinnitus as a side effect of certain drugs. Finally, possible target structures are mentioned, which should possibly be addressed in pharmacological studies in the near future.

Tinnitus

Objective and subjective tinnitus can often be differentiated based on comprehensive history, physical examination, and audiogram. Examples of objective tinnitus include vascular abnormalities, palatal myoclonus, patulous eustachian tube, and stapedial/tensor tympani muscle spasm. Subjective tinnitus is usually associated with hearing loss. Rarely, tinnitus is the result of an underlying condition. In these cases, imaging and additional testing may be indicated. Classification of the type, quality, and intensity of tinnitus is helpful in the work-up and treatment of tinnitus. Treatment modalities include cognitive behavioral therapy, tinnitus retraining therapy, sound therapy, hearing aids, cochlear implants, pharmacotherapy, and brain stimulation.

Exploring pathogenesis in subjects with subjective Tinnitus having kidney deficiency pattern in terms of Traditional Chinese Medicine based on serum metabolic profiles

OBJECTIVE

To investigate the metabolic pathogenesis in subjects with subjective tinnitus (ST) having kidney deficiency pattern (KDP) (ST/KDP) in terms of Traditional Chinese Medicine.

METHODS

Three groups of subjects, including healthy individuals, subjects with ST/KDP, and subjects who were healthy initially and then developed ST/KDP one year later (healthy ¡ú ST/KDP), were recruited for this study. Serum metabolic profiles of all subjects were analyzed using ultra-performance liquid chromatography coupled with quadruple-time-of-flight mass spectrometry. The metabolic characteristics of the ST/KDP subjects were determined, and the corresponding biomarkers were predicted. The metabolomics data from the healthy ¡ú ST/KDP subjects were collected for further verification.

RESULTS

Twelve metabolites in the ST/KDP subjects were different from those of the healthy control subjects. Of these metabolites, according to the prediction, except for octanoic acid, other metabolites might characterize ST/KDP. Ten metabolites at the outcome ST/KDP stage were different from those at the initial (control) stage. Through the comparison of these metabolites with the predicted metabolites, five common metabolites, including upregulated glutamate, serotonin, orotic acid and 8-oxoguanine, as well as downregulated taurine, were found. These common metabolites were significantly associated with canonical pathways including calcium signaling, ¦Ã-aminobutyric acid (GABA) receptor signaling, purine and pyrimidine biosynthesis, taurine biosynthesis, and serotonin receptor signaling.

CONCLUSION

The metabolic pathogenesis in ST/KDP subjects was characterized by upregulated glutamate, serotonin, orotic acid and 8-oxoguanine, as well as downregulated taurine, additionally, perturbations of calcium signaling, GABA receptor signaling, purine and pyrimidine biosynthesis, taurine biosynthesis, and serotonin receptor signaling.

Short-Term Effect of Gabapentin on Subjective Tinnitus in Acoustic Trauma Patients

INTRODUCTION

Although several treatment approaches have been proposed for tinnitus, there are currently no Food and Drug Administration (FDA)-approved agents available to treat this condition. In this study, we evaluated the effect of gabapentin on the sensation of subjective tinnitus in patients with acoustic trauma referring to the ear, nose and throat (ENT) clinic of Taleghani Hospital during 2014.

MATERIALS AND METHODS

In this double-blind, randomized clinical trial, 103 patients with tinnitus due to acoustic trauma who were referred to the ENT clinic of Taleghani Hospital during 2014 were randomized to the gabapentin (300 mg bid, n=55) or control (n=48) groups. The two groups were then compared before and after 6 weeks of treatment using a visual analog scale (VAS). At least a 30% reduction in VAS was considered a response to treatment.

RESULTS

Differences between the two groups regarding sex, age, duration of disease, and audiometry results was not significant (P>0.05). After 6 weeks' treatment, the VAS significantly decreased in both groups (P<0.001), but the reduction was significantly greater in the gabapentin group compared with control (P<0.001). Forty-nine patients (89%) in the gabapentin group and 28 control patients (58.3%) responded to treatment (≥30% reduction in VAS), with the difference between the two groups being statistically significant (P<0.001).

CONCLUSION

We conclude that gabapentin 300 mg bid for 6 weeks is an effective treatment for acoustic tinnitus. In addition, the placebo effect in relieving tinnitus is remarkable.

Relationship between increased carotid artery stiffness and idiopathic subjective tinnitus

Tinnitus is defined as perception of sound with no external stimulus, and can separate into pulsatile and non-pulsatile types. Arterial stiffness is a parameter that can predict the cardiovascular event and associated with incidence of stroke. It has been shown that increased arterial stiffness may lead to microvascular damage in brain. Our aim was to assess the arterial stiffness of the carotid system in the development and severity of idiopathic subjective tinnitus. Forty subjective tinnitus patients and 40 age- and sex-matched controls were enrolled in the study. The parameters obtained from the participants included pure tone hearing (dB), serum lipid profile (mg/dl), fasting glucose (mg/dl), blood pressure (mmHg), and body mass index (BMI, kg/m²). The common carotid artery (CCA) stiffness index, Young's elastic modulus (YEM), common carotid intima-media thickness (CIMT), peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), pulsatility index (PI), vessel diameter, mean velocity (MV), and volume flow (VF) were measured in both the right and left common carotid arteries in both groups. The CCA stiffness index, YEM measurements, right CIMT, and left PI were found to be significantly higher in the patients than those in the control group (p < 0.05). With regard to the severity of the tinnitus and the patient characteristics, there was a significant positive correlation with the CCA stiffness index, YEM measurements, left CIMT, and neutrophil-to-lymphocyte ratio (NLR). However, only the right and left CCA stiffness parameters were found to be statistically significant in the multivariate analysis as independent predictors of a moderate to high degree of tinnitus. The increased stiffness index of the common carotid arteries was significantly associated with the formation and severity of tinnitus. Therefore, an assessment of the carotideal system may be helpful in these patients.

Increased mean platelet volume in patients with idiopathic subjective tinnitus

Tinnitus is the perception of sound with no external stimulus and idiopathic subjective tinnitus is the most common type in adults. Mean platelet volume (MPV) alterations were shown in some inflammatory diseases and were evaluated as a clinically useful marker. Our aim was to investigate MPV alterations in idiopathic subjective tinnitus patients. A total of 101 patients and 54 age- and sex-matched healthy control subjects were enrolled in the study. Patients included in the study had complaints of tinnitus for at least 3 months. All patients underwent detailed otolaryngologic examination, blood sampling, pure tone audiometry, magnetic resonance imaging of ear, and vertebrobasilar artery Doppler ultrasonography to make the differential diagnosis of tinnitus. Blood sampling consisted of renal-liver-thyroid function tests, lipid profile, and complete blood count. All tests and examinations except the imaging modalities were also performed for the control group. There were no differences in age and sex distribution of groups. Mean platelet volume values were significantly increased in tinnitus patients when compared with controls (p = 0.001). We think that MPV can be qualified as a useful marker in tinnitus patients.

Auditory and visual 3D virtual reality therapy as a new treatment for chronic subjective tinnitus: Results of a randomized controlled trial

BACKGROUND

Subjective tinnitus (ST) is a frequent audiologic condition that still requires effective treatment. This study aimed at evaluating two therapeutic approaches: Virtual Reality (VR) immersion in auditory and visual 3D environments and Cognitive Behaviour Therapy (CBT).

METHODS

This open, randomized and therapeutic equivalence trial used bilateral testing of VR versus CBT. Adult patients displaying unilateral or predominantly unilateral ST, and fulfilling inclusion criteria were included after giving their written informed consent. We measured the different therapeutic effect by comparing the mean scores of validated questionnaires and visual analog scales, pre and post protocol. Equivalence was established if both strategies did not differ for more than a predetermined limit. We used univariate and multivariate analysis adjusted on baseline values to assess treatment efficacy. In addition of this trial, purely exploratory comparison to a waiting list group (WL) was provided.

RESULTS

Between August, 2009 and November, 2011, 148 of 162 screened patients were enrolled (VR n = 61, CBT n = 58, WL n = 29). These groups did not differ at baseline for demographic data. Three month after the end of the treatment, we didn't find any difference between VR and CBT groups either for tinnitus severity (p = 0.99) or tinnitus handicap (p = 0.36).

CONCLUSION

VR appears to be at least as effective as CBT in unilateral ST patients.

The efficacy of individual treatment of subjective tinnitus with cognitive behavioural therapy

INTRODUCTION

It has been a long time since subjective tinnitus cases were described for the first time but they still lack a treatment with proven effectiveness. The main goal of this study was to evaluate the effectiveness of cognitive behavioural therapy in these patients.

PATIENTS AND METHOD

Between 2012 and 2013, 310 patients that suffered from subjective tinnitus were studied. Of these, 267 were included in treatment based on cognitive behavioural therapy. The monitoring period lasted 18 months for most cases, while it lasted 21 months for 11 patients.

RESULTS

Considering patients that interrupted their treatment as failures, the percentage of recovery was 95.7%.

CONCLUSION

Cognitive behavioural therapy should always be included in the treatment of people suffering from tinnitus.