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Meta-Analysis
, 12 (12), CD013094

Sound Therapy (Using Amplification Devices and/or Sound Generators) for Tinnitus

Affiliations
Meta-Analysis

Sound Therapy (Using Amplification Devices and/or Sound Generators) for Tinnitus

Magdalena Sereda et al. Cochrane Database Syst Rev.

Abstract

Background: Tinnitus affects 10% to 15% of the adult population, with about 20% of these experiencing symptoms that negatively affect quality of life. In England alone there are an estimated ¾ million general practice consultations every year where the primary complaint is tinnitus, equating to a major burden on healthcare services. Clinical management strategies include education and advice, relaxation therapy, tinnitus retraining therapy (TRT), cognitive behavioural therapy (CBT), sound enrichment using ear-level sound generators or hearing aids, and drug therapies to manage co-morbid symptoms such as insomnia, anxiety or depression. Hearing aids, sound generators and combination devices (amplification and sound generation within one device) are a component of many tinnitus management programmes and together with information and advice are a first line of management in audiology departments for someone who has tinnitus.

Objectives: To assess the effects of sound therapy (using amplification devices and/or sound generators) for tinnitus in adults.

Search methods: The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL, via the Cochrane Register of Studies); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 23 July 2018.

Selection criteria: Randomised controlled trials (RCTs) recruiting adults with acute or chronic subjective idiopathic tinnitus. We included studies where the intervention involved hearing aids, sound generators or combination hearing aids and compared them to waiting list control, placebo or education/information only with no device. We also included studies comparing hearing aids to sound generators, combination hearing aids to hearing aids, and combination hearing aids to sound generators.

Data collection and analysis: We used the standard methodological procedures expected by Cochrane. Our primary outcomes were tinnitus symptom severity as measured as a global score on multi-item tinnitus questionnaire and significant adverse effects as indicated by an increase in self-reported tinnitus loudness. Our secondary outcomes were depressive symptoms, symptoms of generalised anxiety, health-related quality of life and adverse effects associated with wearing the device such as pain, discomfort, tenderness or skin irritation, or ear infections. We used GRADE to assess the quality of evidence for each outcome; this is indicated in italics.

Main results: This review included eight studies (with a total of 590 participants). Seven studies investigated the effects of hearing aids, four combination hearing aids and three sound generators. Seven studies were parallel-group RCTs and one had a cross-over design. In general, risk of bias was unclear due to lack of detail about sequence generation and allocation concealment. There was also little or no use of blinding.No data for our outcomes were available for any of our three main comparisons (comparing hearing aids, sound generators and combination devices with a waiting list control group, placebo or education/information only). Data for our additional comparisons (comparing these devices with each other) were also few, with limited potential for data pooling.Hearing aid only versus sound generator device onlyOne study compared patients fitted with sound generators versus those fitted with hearing aids and found no difference between them in their effects on our primary outcome, tinnitus symptom severity measured with the Tinnitus Handicap Inventory (THI) at 3, 6 or 12 months (low-quality evidence). The use of both types of device was associated with a clinically significant reduction in tinnitus symptom severity.Combination hearing aid versus hearing aid onlyThree studies compared combination hearing aids with hearing aids and measured tinnitus symptom severity using the THI or Tinnitus Functional Index. When we pooled the data we found no difference between them (standardised mean difference -0.15, 95% confidence interval -0.52 to 0.22; three studies; 114 participants) (low-quality evidence). The use of both types of device was again associated with a clinically significant reduction in tinnitus symptom severity.Adverse effects were not assessed in any of the included studies.None of the studies measured the secondary outcomes of depressive symptoms or depression, anxiety symptoms or generalised anxiety, or health-related quality of life as measured by a validated instrument, nor the newly developed core outcomes tinnitus intrusiveness, ability to ignore, concentration, quality of sleep and sense of control.

Authors' conclusions: There is no evidence to support the superiority of sound therapy for tinnitus over waiting list control, placebo or education/information with no device. There is insufficient evidence to support the superiority or inferiority of any of the sound therapy options (hearing aid, sound generator or combination hearing aid) over each other. The quality of evidence for the reported outcomes, assessed using GRADE, was low. Using a combination device, hearing aid or sound generator might result in little or no difference in tinnitus symptom severity.Future research into the effectiveness of sound therapy in patients with tinnitus should use rigorous methodology. Randomisation and blinding should be of the highest quality, given the subjective nature of tinnitus and the strong likelihood of a placebo response. The CONSORT statement should be used in the design and reporting of future studies. We also recommend the use of validated, patient-centred outcome measures for research in the field of tinnitus.

Conflict of interest statement

Magdalena Sereda: MS is funded through the British Tinnitus Association Senior Research Fellow/Head of Research Fellowship. MS is Chief Investigator on NIHR Research for Patient Benefit grant 'Feasibility of conducting a multi‐centre RCT to assess effectiveness and cost‐effectiveness of digital hearing aids in patients with tinnitus and hearing loss'. MS is a member of the Steering Committee for British Society of Audiology Tinnitus and Hyperacusis Special Interest Group and leading on the development of the BSA recommended procedure for candidacy and fitting of combination hearing aids. MS is a Principal Investigator on the British Society of Audiology Applied Research Grant supporting the development of the recommended procedure.

Jun Xia: none known.

Amr El Refaie: none known.

Deborah A Hall: DAH is an NIHR Senior Investigator and Section Editor for the journal Hearing Research, Elsevier. She leads the Core Outcome Measures in Tinnitus (COMiT) initiative whose work is currently supported by the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska‐Curie grant agreement No 764604 and the NIHR Nottingham Biomedical Research Centre.

Derek J Hoare: DJH is Associate Editor for the International Journal of Audiology and BMC Health Services Research, and Chair of the British Society of Audiology tinnitus and hyperacusis special interest group. He is funded by the NIHR and research lead for tinnitus and hyperacusis at the NIHR Nottingham Biomedical Research Centre. He has received tinnitus research funding from the British Society of Audiology, the British Tinnitus Association and the NIHR.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figure 3
Figure 3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figure 4
Figure 4
Forest plot of comparison: 2 Combination hearing aid versus hearing aid, outcome: 2.1 Tinnitus symptom severity.
Analysis 1.1
Analysis 1.1
Comparison 1 Hearing aid only compared to sound generator only for tinnitus, Outcome 1 Tinnitus symptom severity at 3 months.
Analysis 1.2
Analysis 1.2
Comparison 1 Hearing aid only compared to sound generator only for tinnitus, Outcome 2 Tinnitus symptom severity at 6 months.
Analysis 1.3
Analysis 1.3
Comparison 1 Hearing aid only compared to sound generator only for tinnitus, Outcome 3 Tinnitus symptom severity at 12 months.
Analysis 2.1
Analysis 2.1
Comparison 2 Combination hearing aids compared to hearing aids for tinnitus, Outcome 1 Tinnitus symptom severity at 3 to 5 months.

Update of

  • Cochrane Database Syst Rev. doi: 10.1002/14651858.CD013094

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