Small-group counseling in a modified tinnitus retraining therapy for chronic tinnitus

Abstract

Objectives: The authors have treated chronic tinnitus patients using a combination of a simplified tinnitus retraining therapy (TRT) and medications, which we called modified TRT. In this clinical setting, we have attempted small-group counseling to find a time-effective equivalent of individual counseling. The aim of the present study was to evaluate the effectiveness of small-group counseling by comparing the treatment outcomes between individual and small-group counseling.

Methods: The patients who had distressing chronic tinnitus with normal hearing or mild hearing loss were included. The subjects were placed into the small-group (group 1:4) or the individual (group 1:1) counseling group, and underwent a modified TRT composed of a single session of directive counseling and ambient sound stimulation. In addition, alprazolam (0.25 mg) and ginkgo biloba extract (80 mg) were administered orally to the subjects for 3 months. The 3- and 6- month outcomes were assessed using the follow-up rates and tinnitus severity scores: awareness, tinnitus handicap inventory (THI), loudness, annoyance, and effect on life. The treatment responses were classified as improvement, no changes, and worsening.

Results: Of the total 149 patients (77 in group 1:1; 72 in group 1:4), 104 patients completed the protocol at 3 months, and 55 patients at 6 months. The follow-up rates were similar in both groups. Over the period of 6 months, all scores declined significantly except the loudness score at 3 months in both groups. Treatment responses showed no between-group differences. The success rate based on THI was 70% in group 1:1, and 64% in group 1:4 at 6 months.

Conclusion: The small-group counseling of our modified TRT was comparable to the individual counseling for tinnitus relief. We suggest that this protocol can be implemented effectively in any crowded otolaryngology clinics.

Keywords: Benzodiazepines; Directive counseling; Tinnitus; Tinnitus retraining therapy.

Fig. 1

Changes in tinnitus severity scores at 3 months after modified tinnitus retraining therapy. All scores except LD improved significantly in both groups (^*P<0.05 vs. pretreatment scores, paired t-test). AW, awareness; LD, loudness; AN, annoyance; EOL, effect on daily life; THI, tinnitus handicap inventory. Error bars indicate SE.

Fig. 2

Changes in tinnitus severity scores at 3- and 6-months after modified tinnitus retraining therapy. The pretreatment scores are not different between the groups (t test). All scores declined significantly throughout 6 months without between-group difference (^*P<0.01 vs. pre-Tx scores, repeated-measures ANOVA). The slow declines from the 3- to 6-month values are not statistically significant. Data presented in the table are mean±SD. Error bars indicate SE. AW, awareness; LD, loudness; AN, annoyance; EOL, effect on daily life; THI, tinnitus handicap inventor.

Fig. 3

Therapeutic outcomes based on each tinnitus severity score at the 3-month assessment. Data presented are number of patients. Improvement/worsening=a decrease/an increase of ≥ 20 points in the AW score; ≥ 2 points in each of the LD, AN, and EOL score; ≥ 20% with respect to the initial value in the THI score. 1:1=group 1:1 (n=52); 1:4=group 1:4 (n=52), chi-square test. AW, awareness; LD, loudness; AN, annoyance; EOL, effect on daily life; THI, tinnitus handicap inventor.

Fig. 4

Therapeutic outcomes based on each tinnitus severity score at the 6-month assessment. 1:1=group 1:1 (n=27); 1:4=group 1:4 (n=28), chi-square test. AW, awareness; LD, loudness; AN, annoyance; EOL, effect on daily life; THI, tinnitus handicap inventor.