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Review
. 2024 Jul 31;14(8):813.
doi: 10.3390/jpm14080813.

Efficacy of Internet-Based Therapies for Tinnitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Egidio Sia  1 , Giancarlo Tirelli  1 , Annalisa Gatto  1 , Chiara Angela Mineo  1 , Kaveri Curlin  2 , Mehdi Abouzari  2
Affiliations
Review

Efficacy of Internet-Based Therapies for Tinnitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Egidio Sia et al. J Pers Med. .

Abstract

Background: Tinnitus presents a major public health challenge, impacting quality of life. With conventional therapies being often time-consuming and costly, interest in Internet-based treatments, such as auditory treatments and Internet-based cognitive behavioral therapy, has grown due to their improved patient adherence. This meta-analysis aims to review existing scientific literature to assess the effectiveness of Internet-based therapies (IBTs) in treating tinnitus.

Methods: Studies up to February 2024 using the Tinnitus Functional Index (TFI), Tinnitus Handicap Inventory (THI), or Tinnitus Reactions Questionnaire (TRQ) to monitor tinnitus before and after IBTs were searched in PubMed, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials. Variation of the score with time was analyzed and a comparison was made with non-IBT studies. Treatment effects were analyzed using Cohen's d model.

Results: A total of 14 articles were considered, with a total of 1574 patients. Significant improvements in questionnaire scores were noted post-treatment. In the IBT group, THI and TFI decreased by 17.97 and 24.56 points, respectively (Cohen's d THI: 0.85; TFI: 0.80). In the control group, THI and TFI decreased by 13.7 and 4.25 points, respectively (Cohen's d THI: 0.55; TFI: 0.10).

Conclusions: Internet-based therapies showed reliable effectiveness, possibly due to improved patient compliance, accessibility, cost-effectiveness, and customization.

Keywords: Tinnitus Functional Index (TFI); Tinnitus Handicap Inventory (THI); Tinnitus Reactions Questionnaire (TRQ); internet-based treatment; tinnitus.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure A1
Figure A1
THI at 12-month follow-up in Internet-based treatment group [26,31,32].
Figure A2
Figure A2
TFI at 12-month follow-up in in Internet-based treatment group [22,23].
Figure 1
Figure 1
Selection of articles according to the PRISMA statement flow diagram.
Figure 2
Figure 2
THI scores in patients who underwent internet-based therapies. (a) Pre-treatment scores; (b) post-treatment scores. This figure shows a THI decrease of 17.97 points (from 48.64 pre-treatment to 30.67 post-treatment). 1: iCBT studies; 2: a sound therapy study; 3: an iCBT + therapist study; 4: an iCBT + sound therapy study; 5: a virtual reality study [21,23,26,27,29,30,31,32,34].
Figure 3
Figure 3
TFI scores in patients who underwent internet-based therapies. (a) Pre-treatment scores; (b) post-treatment scores. This figure shows a TFI decrease of 24.59 points (from 57.02 pre-treatment to 32.43 post-treatment). 1: iCBT studies; 2: an iCBT + therapist study [22,23,24,25,33].
Figure 4
Figure 4
TRQ scores in patients who underwent internet-based therapies. (a) Pre-treatment scores; (b) post-treatment scores. This figure shows a TRQ decrease of 8.96 points (from 29.62 pre-treatment to 20.66 post-treatment). 1: iCBT studies [28,29].
Figure 5
Figure 5
THI and TFI scores of the control group treatment (CGT, patients who did not undergo internet-based therapies). This figure shows a THI decrease of 13.72 points and a TFI decrease of 4.25 in the CGT group. (a) Pre-treatment THI scores; (b) post-treatment THI scores; (c) pre-treatment TFI scores; (d) post-treatment TFI scores. 1: studies with DF as control group treatment; 2: a study with iCBT as control group treatment; 3: studies with CBT as control group treatment; 4: a study with F2F as control group treatment [21,23,24,26,27,29,31,32,34].
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