Results of an Interdisciplinary Day Care Approach for Chronic Tinnitus Treatment: A Prospective Study Introducing the Jena Interdisciplinary Treatment for Tinnitus

Abstract

Objective: Considering the heterogeneity of the symptoms shown by patients suffering from chronic tinnitus, there are surprisingly few interdisciplinary treatments available, and mostly available only for inpatients. In order to provide an interdisciplinary treatment, we developed a day care concept in which each patient was treated by an ENT doctor, a cognitive behavioral therapist, a specialist for medical rehabilitation and an audiologist (Jena Interdisciplinary Treatment for Tinnitus, JITT). The aim of this study was to observe the changes of tinnitus related distress due to interdisciplinary day care treatment and to determine which factors mediate this change.Subjects and Methods: Tinnitus annoyance was measured using the Tinnitus Questionnaire on 308 patients with chronic tinnitus. They were treated in the day care unit over five consecutive days between July 2013 and December 2014. Data were collected before treatment when screened (T0), at the beginning (T1) and at the end of the 5 day treatment (T2), as well as 20 days (T3) and 6 months after treatment (T4).Results: Overall, tinnitus annoyance improved significantly from the screening day to the beginning of treatment, and to a much larger degree from the beginning to the end of treatment. The treatment outcome remained stable 6 months after treatment. Patients with the following symptoms displayed higher tinnitus annoyance at T0: dizziness at tinnitus onset, tinnitus sound could not be masked with background noise, tinnitus worsening during physical stress, comorbid psychiatric diagnosis, higher age and higher hearing loss. Loudness of tinnitus perceived in the right ear correlated with tinnitus annoyance significantly. Demographic, tinnitus and strain variables could only explain 12.8% of the variance of the change in tinnitus annoyance from T0 to T4. Out of 39 predictors, the only significant ones were “sick leave 6 months before treatment” and “tinnitus annoyance at T0.”Conclusion: The newly developed JITT represents a valuable treatment for chronic tinnitus patients with improvement remaining stable for at least 6 months after treatment. Using a large number of variables did not allow predicting treatment outcome which underlines the heterogeneity of tinnitus.

Hearing Therapy Improves Tinnitus-Related Distress in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss: A Randomized-Controlled Cross-Over Design

“…The study joins previous research on self-reported symptom-relief following hearing aid fittings in patients with hearing loss [ 19 , 20 , 47 ] with possible mechanisms involving enhancements of individuals’ tonal environments [ 21 , 48 , 49 ], tinnitus masking [ 19 ], reduced tinnitus awareness and improved communication opportunities [ 22 ] or possible psychological effects such as, for some patients, enhanced senses of self-efficacy, control, or social inclusion. In the present study, the majority of participants (68%) wore the hearing aids between 5.25 and 13.41 h/day, which is broadly consistent with the previously reported times in the literature (e.g., 3.67–11.93 h/day [ 50 ], 5.49–11.77 h/day [ 51 ], or 1.20–11.00 h/day [ 52 ]).…”

Chronic tinnitus and the limbic system: Reappraising brain structural effects of distress and affective symptoms

“…Indeed, several previous studies have not included tinnitus patients with psychiatric co-morbidity. While this might allow for more homogeneous samples, it is not congruent with the clinical realities of tinnitus not only being associated with subjective distress but also manifest psychopathologies (Durai and Searchfield, 2016; Ivansic et al, 2017; Jacques et al, 2013; Pattyn et al, 2016; Trevis et al, 2016; Ziai et al, 2017). Even though our study aimed at addressing this factor, we need to consider the limitation that our choice of psychiatric controls mostly included depression/anxiety disorder patients (to match this particular tinnitus sample), so expansion to other psychopathology dimensions is warranted.…”

“…The two tinnitus groups (total of n = 59 patients) included patients with chronic, bilateral tinnitus with a duration of more than three months. Patients were recruited from the specialised interdisciplinary tinnitus entre (Ivansic et al, 2017) of the Department for Otorhinolaryngology in Jena, were they had undergone extensive medical investigation before taking part in the study. Most of the tinnitus patients suffered from hearing loss (4-pure tone average (4-PTA) > 25 dB in pure tone audiogram).…”

Surgical Neuromodulation of Tinnitus: A Review of Current Therapies and Future Applications

“…There is significant evidence to suggest that tinnitus is not just an abnormality in the auditory pathway. The distress and functional declines associated with tinnitus are not only a function of the perceived loudness of the percept (39). Tinnitus-related distress is associated with depression, anxiety, and somatic symptom severity (40).…”