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