There is substantial heterogeneity in both the etiology and best-treatment strategy for patients with tinnitus. For many, the onset of tinnitus is associated with an offending noise exposure or other types of acoustic trauma. For others, the onset of tinnitus may have no identifiable environmental acoustic injury.
Patients may or may not be able to identify an emotional stressor associated with the onset and worsening of the tinnitus bother. Physicians should be alert to particular symptoms, which indicate referral to a specialist, and additional diagnostic testing may be appropriate.
Treatment directed at the auditory percept or tinnitus sound may not be effective because, for most people, the functional and emotional problems associated with tinnitus are based on the patient’s reaction to the sound rather than the nature of the sound itself. With this perspective, it is easier to understand why behavioral therapies, such as CBT, may be successful for patients with tinnitus.
NICE |Tinnitus: assessment and management | NICE guideline [NG155] |
This guideline covers the assessment, investigation and management of tinnitus in primary, community and secondary care. It offers advice to healthcare professionals on supporting people presenting with tinnitus and on when to refer for specialist assessment and management.
They are recruiting 144 participants who will be divided into three groups; those with severe or bothersome tinnitus, those who experience tinnitus but are not affected by it and those who do not have tinnitus. To assess how having tinnitus can affect concentration volunteers will participate in computer-based puzzles that test concentration, clear thinking and ability to multi-task. As their is evidence to show that having this condition can affect concentration and people with tinnitus may perform differently on computer-based puzzles that measure different types of cognition. (Source: University of Nottingham)
The study, Investigation of executive functioning in adults with and without tinnitus,is funded by the Medical Research Council (MRC) and NIHR Nottingham Biomedical Research Centre.
Action on Hearing Loss | n.d | UK national charity sets up cross channel partnership to help develop treatments for hearing loss and tinnitus
Action on Hearing Loss has partnered up with a renowned French Organisation Fondation Pour l’Audition to jointly fund research towards the development of new drug, gene and cell-based treatments for hearing disorders, including tinnitus.
The two organisations will invest up to £300,000 (Action on Hearing Loss) and up to €300,000 (Fondation Pour l’Audition) over 3 years, to support crucial projects in both universities and biotech companies all over the world.
Fondation Pour l’Audition is a French organisation which aims to promote hearing health and improve the lives of people with hearing loss. Although the foundation is based and functions in France, partnering up with Action on Hearing Loss is a big step towards linking up with other organisations on a global scale to find new treatments for people with hearing loss (Source: Action on Hearing Loss).
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.
This Cochrane Review is available in full with abstract from the Cochrane Library
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.
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
Sereda M, Xia J, El Refaie A, Hall DA, Hoare DJ| 2018| Sound therapy (using amplification devices and/or sound generators) for tinnitus in adults. Cochrane Database of Systematic Reviews |Issue 8| Art. No.: CD013094| DOI: 10.1002/14651858.CD013094.
The Cochrane Library has published a new protocol for an update of two Cochrane Reviews on sound therapy (masking) and on amplification with hearing aids for tinnitus that were first published in the Cochrane Library in Issue 12, 2010 and updated in 2012 (Hobson 2012).
JAMA | April 2018 | Experimental Device Could Offer Hope for Millions With Tinnitus
A research team at the University of Michigan has developed a novel, noninvasive treatment to address tinnitus. While a trial was initially conducted on guinea pigs the scientists have now studied human subjects. They recruited 20 adults with mild to moderate somatic tinnitus—the type that patients can temporarily modulate by clenching their jaws or pushing pressure points on their face or forehead. Those maneuvers indicate that somatosensory stimuli play a role in their tinnitus because patients can increase or decrease their symptoms. About two-thirds of people with the condition have somatic tinnitus.
The trial uses both sound and electrical stimulation to alter the brain’s circuitry and slow the firing rates of hyperactive, synchronized neurons, which suppresses the phantom ringing or buzzing of tinnitus.
The team developed a device that participants could use at home to receive sound stimulation through earphones and mild electrical stimulation via electrodes positioned on their neck or face. They wore these for half an hour each day, six of the participants used a bimodal protocol and the other half used a unimodal protocol. After treatment for 4 weeks followed by a month-long washout period, the participants were moved to the other treatment for a further month.
The trial was double-blinded. Weekly monitoring assessed tinnitus volume and tinnitus-related quality of life.
The device uses both sound and electrical stimulation to alter the brain’s circuitry and slow the firing rates of hyperactive, synchronized neurons, which suppresses the phantom ringing or buzzing of tinnitus.
Susan Shore, a professor of otolaryngology in the university’s Kresge Hearing Research Institute, and lead researcher in the study said, “In both groups the sound alone didn’t work,” Shore said. “But the combined bimodal stimulation showed a significant improvement in their tinnitus or reduction of their tinnitus loudness and a reduction of the impact of their tinnitus in their lives.” (JAMA)
The clinical trial is anticipated to begin in August.
A survey by the British Tinnitus Association (BTA) found just under a third of UK parents (32%) think children under the age of 10 can have tinnitus; and just 37% think it can affect children aged 10 to 16
Research commissioned by the BTA has revealed the worrying statistic, which the charity says reinforces the misconception that the hearing condition only affects older people.
The research also revealed many parents are unaware of the common signs of the hearing condition in children, such as anxiety or difficulty concentrating.
To help tackle the problem, the charity has created guidance for both parents and teachers:
Tinnitus: A Parents Guide:
Includes the signs and symptoms to look out for, as well as advice on the best places to get help and support if parents suspect their child has tinnitus
The aim of this study was to examine the relationship between the healthy eating index (HEI), a measure of dietary quality based on United States Department of Agriculture recommendations and report of tinnitus | International Journal of Audiology
Results: Of the sample, 21.1% reported tinnitus within the past year and 11.7% reported persistent tinnitus, defined as tinnitus experienced at least monthly or greater. Controlling for age, sex, race/ethnicity, diabetes, noise exposure and smoking status, we found that with healthier diet (poorer vs. better HEI) there was decreased odds of reported persistent tinnitus [odds ratio (OR); 0.67; 95% confidence interval (CI) 0.45–0.98; p = 0.03].
Conclusions: The current findings support a possible relationship between healthier diet quality and reported persistent tinnitus.