Outcomes for tinnitus are better when cognitive-behavioral therapy is added to audiological therapies. Tinnitus is common and potentially debilitating; treatment is not standardized and often is fragmented and poorly coordinated.
Audiological therapies, such as habituation to an external sound generator, often are employed, and cognitive-behavioral therapy (CBT) has been proposed as a treatment. Neither approach has been evaluated rigorously.
Netherlands researchers surveyed audiological referral centers to define a “usual care” protocol that consisted primarily of audiological interventions, with an added social work component when indicated. They then randomized 492 patients with tinnitus to this usual care protocol or to a multidisciplinary approach.
In the latter approach, audiological interventions were enhanced with CBT-based educational sessions and, when indicated, supplemented by treatment that involved clinical psychologists, social workers, and movement, physical, and speech therapists –– usually in a group setting.
Outcomes were measured using standard scales at 3 months (after usual or enhanced audiological treatment), 8 months (after adding social work intervention or interdisciplinary treatment as needed), and 12 months (after 4 months of no contact).
Compared with patients in the usual-care group, those assigned to multidisciplinary treatment had significantly less tinnitus severity and impairment at all three time points and significantly better health-related quality of life at 8 and 12 months.
Comment: This complex intervention could help standardize care for a stubborn and frustrating condition. Cost-effectiveness data will be reported separately.
— Bruce Soloway, MD
Published in Journal Watch General Medicine June 21, 2012
CITATION: Cima RFF et al. Specialised treatment based on cognitive behaviour therapy versus usual care for tinnitus: A randomised controlled trial. Lancet 2012 May 26; 379:1951. [Medline® Abstract]