Abstract
IntroductionTo date, guidelines recommend the use of a stepped care approach to treat tinnitus. The current clinical management of tinnitus frequently consists of audiologic interventions and tinnitus retraining therapy (TRT) or cognitive behavioral therapy (CBT). Due to the high heterogeneity of the tinnitus population and comorbidity of tinnitus with insomnia, anxiety, and depression, these interventions may not be sufficient for every patient. The current study aims to determine whether a bimodal therapy for chronic, subjective tinnitus consisting of the combination of TRT and eye movement desensitization reprocessing (EMDR) results in a clinically significant different efficacy in comparison with the prevailing bimodal TRT and CBT therapy.MethodsPatients were randomized in two treatment groups. The experimental group received the bimodal therapy TRT/EMDR and the active control group received the bimodal therapy TRT/CBT. Evaluations took place at baseline (T0), at the end of the treatment (T1), and 3 months after therapy (T2). The tinnitus functional index (TFI) was used as primary outcome measurement. Secondary outcome measurements were the visual analog scale of tinnitus loudness (VASLoudness), tinnitus questionnaire (TQ), hospital anxiety and depression scale (HADS), hyperacusis questionnaire (HQ), global perceived effect (GPE), and psychoacoustic measurements.FindingsThe TFI showed clinically significant improvement in both bimodal therapies (mean decrease 15.1 in TRT/CBT; p < 0.001 vs. 16.2 in TRT/EMDR; p < 0.001). The total score on the TQ, HADS, HQ, and VASLoudness all demonstrated significant decrease after treatment and follow-up (p < 0.001) in the experimental and the active control group. GPE-measurements revealed that more than 80% (i.e., 84% in TRT/CBT vs. 80% in TRT/EMDR) of the patients experienced substantial improvement of tinnitus at follow up. Treatment outcome remained stable after 3 month follow-up and no adverse events were observed.ConclusionBoth psychotherapeutic protocols result in a clinically significant improvement for patients with chronic subjective tinnitus. No significant different efficacy was found for the TRT/EMDR treatment compared to the combination of TRT and CBT.Clinical Trial registrationClinicalTrials.gov, ID: NCT03114878. April 14, 2017.
Highlights
To date, guidelines recommend the use of a stepped care approach to treat tinnitus
All participants were randomized in one of the two treatment groups: one group received a combination of tinnitus retraining therapy (TRT) and cognitive behavioral therapy (CBT) while the other group received a combination of TRT and eye movement desensitization reprocessing (EMDR)
The current study aimed to (1) assess whether a bimodal therapy for chronic subjective tinnitus consisting of the combination. This randomized controlled trial was conducted aiming to investigate the effect of bimodal treatment TRT/EMDR compared to the effect of bimodal treatment TRT/CBT on the tinnitus outcome measurements
Summary
The current clinical management of tinnitus frequently consists of audiologic interventions and tinnitus retraining therapy (TRT) or cognitive behavioral therapy (CBT). Due to the high heterogeneity of the tinnitus population and comorbidity of tinnitus with insomnia, anxiety, and depression, these interventions may not be sufficient for every patient. The current study aims to determine whether a bimodal therapy for chronic, subjective tinnitus consisting of the combination of TRT and eye movement desensitization reprocessing (EMDR) results in a clinically significant different efficacy in comparison with the prevailing bimodal TRT and CBT therapy. About 8–20% of the population report chronic tinnitus and for 1–3% of these patients the sound is so debilitating that professional help is necessitated (Heller, 2003). The tinnitus population is highly heterogeneous, often requiring a combination of therapeutic support to manage the complexity of the symptoms. A specialized and client-centered treatment plan executed by a multidisciplinary team of professionals is recommended (Van de Heyning et al, 2015)
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