Issues in Chronic Tinnitus, Treatment and Management
Folmer et al (2014) describe and critique multiple tinnitus treatments for tinnitus. They report that “effective treatments for tinnitus are generally outnumbered by ineffective strategies, medications, devices, and surgeries…” which continue to be developed and promoted to treat tinnitus. The authors peformed an extensive, selective review of publications (from MedLine and PubMed) on tinnitus, published between 1940 and 2012. They report that effective and non-invasive tinnitus treatments that include “acoustic therapy (which includes hearing aids and other types of environmental sound enrichment)” as well as cognitive-behavioral therapy (CBT), psychological counseling and hypnosis, biofeedback, and relaxation training. Folmer et al report that over-the-counter (OTC) medications and prescription medicines may be useful with regard to facilitating sleep and/or reducing anxiety/depression and/or obsessive-compulsiveness. Further, they report that “consumers should be wary of medications, devices or procedures” marketed or promoted to “cure” tinnitus. However, effective and non-invasive tinnitus management strategies are available.
The authors note that acoustic treatments share a common rationale, that is, an increase in the loudness of environmental sounds, helps the patient perceive a relative decrease in the loudness of their tinnitus. Indeed, “acoustic therapy has been shown to be an effective method to reduce tinnitus perception or severity.” Acoustic therapy strives to decrease the tinnitus signal-to-noise ratio; however, not all acoustic therapies are equally effective. Folmer and associates note that “The Inhibitor” (an ultrasonic tinnitus treatment device that delivers a high-frequency bone-conducted stimuli) produced a sound that could not be perceived by their target population (i.e., people with severe and profound hearing loss). Further, the majority of people who tried a similar, earlier device (called HiSonic) didn’t like the sensations it produced, and they received no relief from their tinnitus. With specific regard to The Inhibitor, Folmer reports that no “well-designed research studies have been conducted to establish or confirm the Inhibitor’s efficacy.”
Folmer et al report that when a variety of amplitude and frequency modulated tones were presented to patients (see Reavis et al 2012, report on the Serenade device by SoundCure by ) for three minutes at a time, 13 of the 20 subjects were referred to as “poor responders.” Folmer and associates report that, “Overstatements of a treatment’s efficacy, even in light of modest research findings, are common in this field….” They state that, “…well-designed, placebo-controlled clinical trials should be conducted and analyzed before claims of efficacy are made….”
With regard to psychological interventions, CBT and acceptance and commitment therapy (ACT) have been shown to reduce a patient’s distress, anxiety, depression, and insomnia associated with their tinnitus. Folmer et al also address hypnosis, biofeedback, LASER, wearable magnets, transcranial magnetic stimulation, transcranial direct current stimulation, medications, over-the-counter substances, prescription medicines, acupuncture, neurectomy, microvascular decompression implantable devices, deep-canal hearing aids, stapes prosthesis, cochlear implants, middle-ear implants, bone-anchored implants, auditory brainstem implants, as well as deep brain stimulation and brain surface implants and vagus nerve stimulation, and more.
Folmer and associates conclude that most people who perceive chronic tinnitus do not require any treatment interventions. However, for those who do, effective and non-invasive management strategies are available. They state that ”our goal should be to help patients obtain relief from the condition so their quality of life improves and is not affected by the symptom….” They report effective tinnitus management strategies can help reduce the patient’s negative reaction to their tinnitus and reduce the amount of time they are bothered by their tinnitus. Effective tinnitus management strategies can also help the patient gain more control over their tinnitus, while reducing anxiety, depression and insomnia.
For More Information, References, and Recommendations
Folmer RL, Theodoroff SM, Martin WH, Shi Y. (2014) Experimental, Controversial, and Futuristic Treatments for Chronic Tinnitus. Journal of the American Academy of Audiology 25:106-125.