Combining Parts of Sound Retraining and Talk Therapy Can Give Relief
By Kathleen Doheny
WebMD Health News
Reviewed by Louise Chang, MD
May 24, 2012 -- Combining parts of two established treatments for tinnitus in a new way can work, according to new research.
Tinnitus is a persistent ringing or buzzing in the ears that can be debilitating.
Researcher Rilana Cima of Maastricht University in the Netherlands and colleagues used parts of sound-based retraining therapy and talk therapy in what they say is a unique way.
This approach worked better than usual care, they found.
"This was very effective in decreasing tinnitus severity, distress, and impact on daily life and general health," Cima tells WebMD.
The study is published in The Lancet.
Two U.S. experts had mixed reaction to the study. One said the new research adds scientific credibility to the two approaches. Another said there is not much new in the study.
Tinnitus: Back Story
About 50 million people in the U.S. experience tinnitus, according to the American Tinnitus Association. About 2% of the population has tinnitus so severe their quality of life is impaired.
Those with tinnitus perceive a sound when no external source of sound exists. They may describe the condition as a ringing, buzzing, hissing, or whooshing in the ears. It can affect one or both ears.
Most often, noise exposure leads to tinnitus, according to the American Tinnitus Association. It can be a single extreme noise or the accumulated result of noise over time.
Another known cause of tinnitus is a head or neck injury.
Typically, many different treatments are offered, but with little evidence of effectiveness.
Often, says Cima, a doctor will tell a patient with tinnitus: "Nothing more can be done; you have to learn to live with it."
In severe cases, patients can become depressed and unable to work or socialize.
Tinnitus: Combining Treatments
Cima assigned 247 patients with tinnitus to usual care and 245 to the specialized care.
Those in the usual care were seen by an audiologist to start. If the audiologist thought they also needed a social worker, the audiologist would refer them.
Those in specialized care got a combination of audiology and psychology treatments. The team included many health care providers, such as psychologists and other therapists.
In typical tinnitus retraining therapy, counseling sessions and exposure to a neutral external sound are used, Cima says.
"A sound generator is prescribed to patients," Cima says. "It generates a sound. The theory is that by listening to this masking sound the patients will [get used] to it, as well as to their tinnitus."
However, what is new, Cima tells WebMD, is that they combined the audiological and psychological treatments within a behavioral framework. In her approach, the behavioral intervention and the sound intervention are carried out at the same time.
"We believe that not the sound itself but the reactions (fear and misinterpretations) to this sound determine whether or not people will develop complaints," she says.
She focuses on modifying the reactions to the sounds. Patients often want to avoid the tinnitus, she says. They do this by not wanting to stay in silent environments, for instance.
"I say often to patients: 'In order to [get used] to your tinnitus, you have to be willing to perceive your tinnitus.'"
After that first step, those with more severe tinnitus went on to a second step, which included group treatment with a variety of therapists.
Combining Treatments: Results
After 12 months, those in the specialized care group reported better quality of life, less severity of the tinnitus, and decreased impairment compared to the usual-care group.
Many had dropped out of each group. In all, 161 finished all 12 months of the usual care; 171 completed the combined approach.
Ideally, Cima says, the patients can keep using the skills learned in the program. If they have remission, they can return for more treatment, she says.
Information on costs is not yet available, she says.
Tinnitus Treatments: Expert Opinions
While the treatments used in the new study have been around for decades, the new research documents that it works in a scientific way, says William Martin, PhD, director of the Tinnitus Clinic and Tinnitus Research at the Oregon Health and Science University in Portland.
"It's not groundbreaking," he says of the combination approach, "but it is an important step in terms of documenting how we should be approaching these poor people."
"The important message here in this study is, there are no shortcuts in managing tinnitus," he tells WebMD. "You have to treat the whole person. It's not just an ear issue."
"In our clinic, we find several things that impede the recovery process," Martin says. "Insomnia, anxiety, and depression. When you bring in a cognitive therapist, you provide an opportunity to address those issues in the context of the tinnitus."
"We have a whole crew we work with," he says. In addition to audiology professionals, they get help from other health professionals, including psychiatrists, as needed.
Martin says only a few U.S. centers offer such a comprehensive approach.
Another expert says the study is well-designed, but he takes a dimmer view of the findings. "There's nothing new in what's happening here," says Richard Tyler, PhD, professor of audiology at the University of Iowa and an expert in the field.
Cima's approach, with input from psychologists, he says, "would be hard to do in the States because there are not that many psychologists who are familiar with tinnitus."
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SOURCES: Cima R. The Lancet, May 26, 2012. Langguth, B. The Lancet, May 26, 2012. Richard Tyler, PhD, professor of audiology, University of Iowa, Iowa City. Rilana F.F. Cima, researcher, Maastricht University, Maastricht, Netherlands. William Martin, PhD, director, Tinnitus Clinic and Tinnitus Research, Oregon Health and Science University, Portland.
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