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. 2010 Mar 17;2010(3):CD007330.
doi: 10.1002/14651858.CD007330.pub2.

Tinnitus Retraining Therapy (TRT) for tinnitus

John S Phillips  1 , Don McFerran
Affiliations

Tinnitus Retraining Therapy (TRT) for tinnitus

John S Phillips et al. Cochrane Database Syst Rev. .

Abstract

Background: Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation. Although an outright cure for tinnitus remains elusive, various management strategies have been developed to help to lessen the impact of the symptom. Following the publication of a neurophysiological model of tinnitus, Tinnitus Retraining Therapy (TRT) was developed. Using a combination of directive counselling and sound therapy in a strict framework, this is one of the most commonly used treatment modalities for tinnitus. Many studies refer to the use of TRT where in fact a modified version of this therapy is actually being implemented. It is therefore important to confirm the use of authentic TRT when reviewing any study that reports its use.

Objectives: To assess the efficacy of TRT in the treatment of tinnitus.

Search strategy: The search included the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE and reference lists of identified publications. The date of the most recent search was 26 August 2009.

Selection criteria: Randomised controlled trials of TRT versus no treatment, or other forms of treatment, in adult patients with tinnitus.

Data collection and analysis: Both authors critically appraised the retrieved studies for risk of bias and extracted data independently. Where necessary, we contacted the original study authors for further information.

Main results: Only one trial (123 participants) was included in the review. Several excluded trials did not follow the strict protocol for TRT, evaluating instead a modified form of TRT. The included trial showed TRT to be more effective than a tinnitus masking (TM) approach. In this study outcome data for tinnitus severity were presented using three instruments (Tinnitus Handicap Inventory (THI), Tinnitus Handicap Questionnaire (THQ), Tinnitus Severity Index (TSI)) for patients in three groups (participants' tinnitus being a 'moderate problem', big problem' or 'very big problem').At 18 months, improvements for the three groups in the three scores (TRT versus TM) were respectively: 'moderate problem' - THI: 18.2 versus 4.6, THQ: 489 versus 178, TSI 7.5 versus 1.6; 'big problem' - THI: 29.2 versus 16.7, THQ: 799 versus 256, TSI: 12.1 versus 6.7; and 'very big problem' - THI: 50.4 versus 10.3, THQ; 1118 versus 300, TSI: 19.7 versus 4.8.

Authors' conclusions: A single, low-quality randomised controlled trial suggests that TRT is much more effective as a treatment for patients with tinnitus than tinnitus masking.

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Conflict of interest statement

Don McFerran does occasional work at the Tinnitus and Hyperacusis Centre which was one of the departments that developed TRT. However, he was not involved in that development process and has not published specifically on the topic of TRT. He has also conducted research into a possible drug treatment for tinnitus with Glaxo SmithKline. The review authors have provided advice to researchers about the design of a potential TRT trial, after consultation with and on the advice of the Cochrane ENT Group.

Update of

  • doi: 10.1002/14651858.CD007330

References

References to studies included in this review

Henry 2006 {published data only}
    1. Henry JA, Schechter MA, Zaugg TL, Griest S, Jastreboff PJ, Vernon JA, et al. Clinical trial to compare tinnitus masking and tinnitus retraining therapy. Acta Oto‐Laryngologica. Supplement 2006;556:64‐9. - PubMed
    1. Henry JA, Schechter MA, Zaugg TL, Griest S, Jastreboff PJ, Vernon JA, et al. Outcomes of clinical trial: tinnitus masking versus tinnitus retraining therapy. Journal of the American Academy of Audiology 2006;17(2):104‐32. - PubMed

References to studies excluded from this review

Caffier 2006 {published data only}
    1. Caffier PP, Haupt H, Scherer H, Mazurek B. Outcomes of long‐term outpatient tinnitus‐coping therapy: psychometric changes and value of tinnitus‐control instruments. Ear and Hearing 2006;27(6):619‐27. - PubMed
Goebel 1999 {published data only}
    1. Goebel G, Rubler D, Hiller W, Heuser J, Fichter MM. Evaluation of tinnitus retraining therapy in comparison to cognitive therapy and broad‐band noise generator therapy. Laryngo‐Rhino‐Otologie. 4th European Congress of Oto‐Rhino‐Laryngology Head and Neck Surgery (EUFOS), May 13‐18 2000, Berlin, Germany. 2000.
    1. Goebel G, Rubler D, Stepputat F, Hiller W, Heuser J, Fichter MM. Controlled prospective study of tinnitus retraining therapy compared to tinnitus coping therapy and broad‐band noise generator therapy. Proceedings of the Sixth International Tinnitus Seminar. Cambridge, UK, 5‐9 September. 1999.
Schmitt 2002 {published data only}
    1. Schmitt C, Kroner‐Herwig B. Comparison of tinnitus coping training and TRT: are they superior to education?. Proceedings of the 7th International Tinnitus Seminar. University of Western Australia, Freemantle, Australia, 5‐7 March. 2002.

References to ongoing studies

NIDCD 2009 {published data only}
    1. National Institute on Deafness and Other Communication Disorders (NIDCD). Randomized trial of Tinnitus Retraining Therapy. http://www.ClinicalTrials.gov. [NCT00578058]
TRC 2009 {published data only}
    1. Tinnitus Research Consortium. The effect of Tinnitus Retraining Therapy on subjective and objective measures of chronic tinnitus. http://www.ClinicalTrials.gov. [NCT00124800]

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