A multidisciplinary systematic review of the treatment for chronic idiopathic tinnitus

Abstract

The majority of tinnitus patients are affected by chronic idiopathic tinnitus, and almost 60 different treatment modalities have been reported. The present study is a multidisciplinary systematic analysis of the evidence for the different forms of treatment for chronic tinnitus. The results are used to form the basis of an S3 guideline. A systematic search was carried out in PubMed and the Cochrane Library. The basis for presenting the level of evidence was the evidence classification of the Oxford Centre of Evidence-based Medicine. Whenever available, randomised controlled trials were given preference for discussing therapeutic issues. All systematic reviews and meta-analyses were assessed for their methodological quality, and effect size was taken into account. As the need for patient counselling is self-evident, specific tinnitus counselling should be performed. Due to the high level of evidence, validated tinnitus-specific, cognitive behavioural therapy is strongly recommended. In addition, auditory therapeutic measures can be recommended for the treatment of concomitant hearing loss and comorbidities; those should also be treated with drugs whenever appropriate. In particular, depression should be treated, with pharmacological support if necessary. If needed, psychiatric treatment should also be given on a case-by-case basis. With simultaneous deafness or hearing loss bordering on deafness, a CI can also be indicated. For auditory therapeutic measures, transcranial magnetic or direct current stimulation and specific forms of acoustic stimulation (noiser/masker, retraining therapy, music, and coordinated reset) for the treatment of chronic tinnitus the currently available evidence is not yet sufficient for supporting their recommendation.

One-Year Results for Patients with Unilateral Hearing Loss and Accompanying Severe Tinnitus and Hyperacusis Treated with a Cochlear Implant

“…This is an important finding as when the cost-effectiveness of a treatment is evaluated non-use can have a large negative impact on the final calculation. The impact of cochlear implantation on tinnitus reduction is well established [Amoodi et al, 2011;Bruggeman et al, 2017;Knopke et al, 2017;Pan et al, 2009;Pierzycki et al, 2016;Ramakers et al, 2015;Zenner et al, 2017]. The results reported here also show both a statistically and clinically significant reduction in tinnitus loudness and handicap.…”

“…Studies report that around 40-50%, or even in excess of 80%, of CI candidates have tinnitus pre-implantation [Quaranta, 2004;Baguley and Atlas, 2007;Kompis et al, 2012;Pierzycki et al, 2016;Mikkelsen, 2017]. After receiving a CI, many patients report that as well as restoring hearing their tinnitus is also reduced, and many studies show significant reductions in tinnitus severity with implant use [Pan et al, 2009;Amoodi et al, 2011;Ramakers et al, 2015;Pierzycki et al, 2016;Bruggeman et al, 2017;Knopke et al, 2017;Zenner et al, 2017]. Initially, it was assumed that this reduction was a consequence of the attention shifting away from the tinnitus towards the environment sounds picked up and transmitted by the CI system, but recent research has indicated that the tinnitus may be supressed by the intracochlear stimulation, independent of the acoustic input picked up by the sound processor [Arts et al, 2016].…”

“…Techniques such as cognitive behavioural therapy help to alter the noxious response to tinnitus [Cima et al, 2014]. Where patients have a hearing loss, hearing aid fitting is recommended, or if the hearing loss is severe to profound, a cochlear implant (CI) is indicated [Fuller et al, 2017;Zenner et al, 2017]. The prevalence of tinnitus in patients with severe to profound bilateral hearing loss being considered for cochlear implantation is high.…”

Unilateral Cochlear Implantation Reduces Tinnitus Loudness in Bimodal Hearing: A Prospective Study

“…The effect size for loudness reduction indicates a strong effect comparable to or higher than effect sizes that were reported for generally accepted tinnitus therapies that, however, serve to reduce tinnitus-related distress as opposed to tinnitus loudness (40, 41). Two prospective studies on tinnitus following cochlear implantation addressed tinnitus loudness in a similar way, namely, by a visual analog scale (35, 38).…”

Cervical Medial Branch Blocks For The Diagnosis Of Somatosensory Tinnitus. A Pilot Study.

“…The diagnosis of SST is challenging and is mainly based on medical history [1]. A variety of treatments have been proposed, including physiotherapy [15,[17][18][19], osteopathy [15,17,18], chirotherpay [3] neural therapy [15,17,18], electro stimulation [19], acupuncture [20], transcranial magnetic stimulation [20,21], and brain stimulation [20,22,23].…”