Sound therapy (using amplification devices and/or sound generators) for tinnitus

Cochrane Library | December 2018 |Sound therapy (using amplification devices and/or sound generators) for tinnitus

A recent  Cochrane systematic review into the impact of sound therapy for tinnitus finds:

“there is no evidence to support the superiority of sound therapy for tinnitus over waiting list control, placebo or education/information with no device. There is insufficient evidence to support the superiority or inferiority of any of the sound therapy options (hearing aid, sound generator or combination hearing aid) over each other. The quality of evidence for the reported outcomes, assessed using GRADE, was low. Using a combination device, hearing aid or sound generator might result in little or no difference in tinnitus symptom severity.

Future research into the effectiveness of sound therapy in patients with tinnitus should use rigorous methodology. Randomisation and blinding should be of the highest quality, given the subjective nature of tinnitus and the strong likelihood of a placebo response. The CONSORT statement should be used in the design and reporting of future studies. We also recommend the use of validated, patient‐centred outcome measures for research in the field of tinnitus.”

Plain language summary

Sound therapy (using amplification devices or sound generators) for tinnitus

Review question

Is sound therapy (using amplification devices, sound generators or both) effective for tinnitus in adults?

Background

Tinnitus is the awareness of a sound in the ear or head without any outside source. It affects 10% to 15% of the adult population. About 20% of people with tinnitus experience symptoms that negatively affect their quality of life including sleep disturbances, difficulties with hearing and concentration, social isolation, anxiety, depression, irritation or stress. Tinnitus can be managed through education and advice, relaxation therapy, psychological therapy, or devices that improve hearing or generate sound such as sound generators or hearing aids. Sometimes drugs are prescribed to manage problems associated with tinnitus such as sleep problems, anxiety or depression. The purpose of this review is to evaluate the evidence from high‐quality clinical trials to work out the effects of sound therapy (hearing aids, sound generators and combination hearing aids) on adults with tinnitus. We particularly wanted to look at the effects of sound therapy on tinnitus severity and any side effects.

Study characteristics

Our review identified eight randomised controlled trials with 590 participants in total. Seven studies looked at the effects of hearing aids, four combination hearing aids and three sound generators. Seven studies allocated participants into parallel groups and in one study participants tried each intervention in a random order. The outcomes that we looked for were severity of tinnitus symptoms, depression, anxiety, quality of life and side effects. In general, the risk of bias in the studies was unclear. There was also little or no use of blinding.

Key results

We did not find any data for our outcomes for any of our three main comparisons (comparing hearing aids, sound generators and combination devices with a waiting list control group, placebo or education/information only). There were also few data for our additional comparisons (comparing these devices with each other) and it was difficult to pool (combine) the data.

Hearing aid only versus sound generator device only

One study compared patients fitted with sound generators with those fitted with hearing aids and found no difference between them in their effects on our primary outcome, tinnitus symptom severity, at 3, 6 or 12 months. The use of both types of device was associated with a clinically significant reduction in tinnitus symptom severity.

Combination hearing aid versus hearing aid only

Three studies compared combination hearing aids/sound generators with hearing aids alone and measured tinnitus symptom severity. When we combined the data for tinnitus symptom severity we found no difference between them. The use of both types of device was again associated with a clinically significant reduction in tinnitus symptom severity.

Adverse effects were not assessed in any of the included studies.

None of the studies measured depressive symptoms or depression, anxiety symptoms or generalised anxiety, or other important outcomes of interest in this review.

Quality of evidence

Where outcomes that we were interested in for this review were reported, we assessed the quality of the evidence available as low. Using a hearing aid, sound generator or combination device might result in little or no difference in tinnitus symptom severity.

 

This Cochrane Review is available in full with abstract from the Cochrane Library

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Betahistine for tinnitus

Cochrane | December 2018| Betahistine for tinnitus

A recent Cochrane Review that looks at the efficacy of betahistine for tinnitus concludes that:

“There is an absence of evidence to suggest that betahistine has an effect on subjective idiopathic tinnitus when compared to placebo. The evidence suggests that betahistine is generally well tolerated with a similar risk of adverse effects to placebo treatments. The quality of evidence for the reported outcomes, using GRADE, ranged from moderate to very low.

If future research into the effectiveness of betahistine in patients with tinnitus is felt to be warranted, it should use rigorous methodology. Randomisation and blinding should be of the highest quality, given the subjective nature of tinnitus and the strong likelihood of a placeboresponse. The CONSORT statement should be used in the design and reporting of future studies. We also recommend the development of validated, patient-centred outcome measures for research in the field of tinnitus.”

 

There is an absence of evidence to suggest that betahistine has an effect on subjective idiopathic tinnitus when compared to placebo. The evidence suggests that betahistine is generally well tolerated with a similar risk of adverse effects to placebo treatments. The quality of evidence for the reported outcomes, using GRADE, ranged from moderate to very low.

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If future research into the effectiveness of betahistine in patients with tinnitus is felt to be warranted, it should use rigorous methodology. Randomisation and blinding should be of the highest quality, given the subjective nature of tinnitus and the strong likelihood of a placeboresponse. The CONSORT statement should be used in the design and reporting of future studies. We also recommend the development of validated, patient-centred outcome measures for research in the field of tinnitus. (Source: Cochrane Review)

The full review and abstract are available at Cochrane 

Tinnitus Week

Tinnitus Week takes place from 5-11 February 2018 and is an international awareness initiative led by a group of organisations, including the British Tinnitus Association, American Tinnitus Association, Tinnitus Hub and the Tinnitus Research Initiative.

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The aim of the week is to raise awareness of the condition, which affects approximately 1 in 10 of the population. The British Tinnitus Association campaign for the week will focus on children and young people.

The ‘Kids Talk Tinnitus’ campaign will engage with children, parents and schools to raise awareness of tinnitus amongst young people and drive the use of relevant support and resources. These can be found at www.tinnitus.org.uk/Pages/Category/tinnitus-in-children.

A new website has been set up, as a central resource collecting all the initiatives which will be taking place in 2018. This website can be found at www.tinnitusweek.com.

Find out more about Tinnitus Week  here.

Tinnitus Service Provision across the UK: a research briefing

Only two-fifths (41 per cent) of NHS audiology departments give tinnitus sufferers access to four key services needed to help manage their condition, according to a new report from charity Action on Hearing Loss launched to mark Tinnitus Awareness Week.

Freedom of Information requests, issued by the charity to every NHS adult audiology provider across the UK, reveals a postcode lottery of care for tinnitus patients with six audiology units not providing any tinnitus services at all and a further nine units having had to reduce services over the past two years.

View the research briefing here

Funding from charity for new treatments to silence tinnitus

To mark Tinnitus Awareness Week (2 – 8 February), UK charity Action on Hearing Loss
announced a major investment to fund a new study at Newcastle University, which aims to
accelerate the development of future tinnitus treatments.
Six million people in the UK are affected by tinnitus every day – ranging from a light buzzing to a
constant roar in the ears and head – with 600,000 seriously affected by the condition, which can
have a detrimental effect on quality of life including bouts of anxiety, difficulties socialising and
problems sleeping or being able to concentrate at work.
The three year, £300,000 project will be led by Dr Mark Cunningham at Newcastle University and
will involve researchers at Leicester University and the biotechnology company Autifony
Therapeutics Ltd, who are currently conducting a clinical trial of a drug for tinnitus.
The pioneering research aims to bridge the gap between promising laboratory research
discoveries and testing new medicines in tinnitus patients.
View the full press release here