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Review
, 121 (7), 1555-64

Systematic Review and Meta-Analyses of Randomized Controlled Trials Examining Tinnitus Management

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Review

Systematic Review and Meta-Analyses of Randomized Controlled Trials Examining Tinnitus Management

Derek J Hoare et al. Laryngoscope.

Abstract

Objectives/hypothesis: To evaluate the existing level of evidence for tinnitus management strategies identified in the UK Department of Health's Good Practice Guideline.

Study design: Systematic review of peer-reviewed literature and meta-analyses.

Methods: Searches were conducted in PubMed, Cambridge Scientific Abstracts, Web of Science, and EMBASE (earliest to August 2010), supplemented by hand searches in October 2010. Only randomized controlled trials that used validated questionnaire measures of symptoms (i.e., measures of tinnitus distress, anxiety, depression) were included.

Results: Twenty-eight randomized controlled trials met our inclusion criteria, most of which provide moderate levels of evidence for the effects they reported. Levels of evidence were generally limited by the lack of blinding, lack of power calculations, and incomplete data reporting in these studies. Only studies examining cognitive behavioral therapy were numerous and similar enough to perform meta-analysis, from which the efficacy of cognitive behavioral therapy (moderate effect size) appears to be reasonably established. Antidepressants were the only drug class to show any evidence of potential benefit.

Conclusions: The efficacy of most interventions for tinnitus benefit remains to be demonstrated conclusively. In particular, high-level assessment of the benefit derived from those interventions most commonly used in practice, namely hearing aids, maskers, and tinnitus retraining therapy needs to be performed.

Figures

Fig 1
Fig 1
Summary of the systematic literature search.
Fig 2
Fig 2
Meta-analyses of cognitive behavioral therapy (CBT) interventions. Pooled effect sizes and 95% confidence intervals (CI) are given in bold and as diamond shapes in the forest plot (right). (A) Comparison of internet-CBT versus control using Tinnitus Reaction Questionnaire (TRQ) total scores preintervention and postintervention. (B) Comparison of therapist-delivered CBT versus control TRQ total scores preintervention and postintervention. (C) Comparison of therapist-delivered CBT versus control Tinnitus Questionnaire (TQ) total scores preintervention and postintervention. (D) Funnel plot shows estimated effect against standard error (SE) for the therapist delivered CBT study using TRQ (filled circles). There is considerable asymmetry around mean effect size (evidence of publication bias). Open circles show calculated position of results from studies that would be required to bring the plot back to symmetry. (E) Funnel plot shows estimated effect against SE for the therapist delivered CBT studies using TQ. There is good symmetry and therefore no evidence of publication bias. *Sample sizes were assumed. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]

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References

    1. Davis A, El Rafaie A. Tinnitus Handbook. San Diego: Singular Publishing Group; 2000. Epidemiology of tinnitus; pp. 1–23.
    1. Steinmetz LG, Zeigelboim BS, Lacerda AB, Morata TC, Marques JM. The characteristics of tinnitus in workers exposed to noise. Braz J Otorhinolaryngol. 2009;75:7–14. - PubMed
    1. Ferreira LMBD, Ramos J, Mendes EP. Characterization of tinnitus in the elderly and its possible related disorders. Braz J Otorhinolaryngol. 2009;75:249–255. - PubMed
    1. Kröner-Herwig B, Zachriat C, Weigand D. Do patient characteristics predict outcome in the outpatient treatment of chronic tinnitus? Psychosoc Med. 2006;3 Doc 7. - PMC - PubMed
    1. Department of Health. Provision of Services for Adults With Tinnitus. A Good Practice Guide. London: United Kingdom; 2009. Central Office of Information.
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