The effect of tinnitus retraining therapy on chronic tinnitus: A controlled trial

Abstract

Objectives: The goal of this study was to compare treatment outcomes for chronic bothersome tinnitus after Tinnitus Retraining Therapy (TRT) versus standard of care treatment (SC) and to determine the longevity of the effect over an 18-month period.

Study design: A randomized controlled trial comparing TRT to SC for chronic tinnitus.

Methods: Adults with subjective, stable, bothersome chronic tinnitus associated with hearing loss amenable to aural rehabilitation with hearing aids were recruited. The Tinnitus Handicap Inventory (THI) was the primary outcome measure and the Tinnitus Functional Index (TFI) the secondary outcome measure of tinnitus severity and impact. Data were collected at screening, entry (0 months), and 6, 12, and 18 months after the beginning of treatment, using an integrated digitized suite of evaluation modules. TRT consisted of directive counseling and acoustic enrichment using combination hearing aids and sound generators; SC consisted of general aural rehabilitation counseling and hearing aids.

Results: Significant improvement in tinnitus impact occurred after both TRT and SC therapy, with a larger treatment effect obtained in the TRT group. Lasting therapeutic benefit was evident at 18 months in both groups. THI initial scores were unstable in 10% of enrolled participants, showing moderate bidirectional fluctuation between screening and baseline (0 month) assessment.

Conclusion: Adults with moderate to severe tinnitus and hearing loss amenable to amplification, benefit from either TRT or SC treatment when combined with hearing aid use. TRT benefit may exceed that of SC. The global improvement in tinnitus severity that accrued over an 18-month period appeared to be robust and clinically significant.

Level of evidence: I.

Keywords: chronic; hearing aids; randomized controlled trial; retraining therapy; tinnitus.

Figure 1

Flow diagram of participant screening, enrollment, intervention and analysis. LDL = loudness discomfort level; THI = tinnitus handicap inventory; TRT = tinnitus retraining therapy; SC = standard of care.

Figure 2

Average hearing thresholds for left and right ears, for TRT and SC participants. TRT = tinnitus retraining therapy; SC = standard of care.

Figure 3

Change in total THI score from baseline to 18‐month follow‐up for participants receiving TRT or SC treatment (ITT analysis shown). *p < .05; ^***p < .000. ITT = intention to treat; THI = tinnitus handicap inventory; TRT = tinnitus retraining therapy; SC = standard of care.

Figure 4

Change in total TFI score from baseline to 18‐month follow‐up for participants receiving TRT or SC treatment (ITT analysis shown). The TFI instrument was not available during screening for all participants when this study was initiated, partial data sets are reported for screening (TRT n = 13 and SC n = 14) and entry (TRT n = 6 and SC n = 4). Significance levels are ^*p < .05, ^**p < .01, and ^***p < .005. ITT = intention to treat; THI = tinnitus handicap inventory; TFI = Tinnitus Functional Index; TRT = tinnitus retraining therapy; SC = standard of care.

Figure 5

Proportion of participants meeting or exceeding the clinical improvement criterion of 50% decrease in entry THI total score. In the TRT group, 7, 13, and 14 participants met the criterion at 6‐, 12‐, and 18‐month assessment points. In the SC group, 5, 5, and 6 participants met the criterion at 6‐, 12‐, and 18‐month assessment points. THI = tinnitus handicap inventory; TRT = tinnitus retraining therapy.