Tinnitus Retraining Therapy (TRT) for tinnitus

Phillips JS, McFerran D

Published Online:

March 17, 2010

Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation. Tinnitus may be perceived in one or both ears, within the head or outside the body. Although various theories have been suggested, the cause is not fully understood. A wide range of treatments have been used, but none has been found effective in all patients.

A form of treatment called Tinnitus Retraining Therapy (TRT) is used in many countries to treat this symptom. This treatment comprises a form of educational counselling and sound therapy given according to a specific protocol. Only one study, involving 123 participants, matched the inclusion criteria for this review. Although this study suggested considerable benefit for TRT in the treatment of tinnitus the study quality was not good enough to draw firm conclusions. No side effects of treatment were described. Further research is required.

Abstract (click to read)

Background:

Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation. Although an outright cure for tinnitus remains elusive, various management strategies have been developed to help to lessen the impact of the symptom. Following the publication of a neurophysiological model of tinnitus, Tinnitus Retraining Therapy (TRT) was developed. Using a combination of directive counselling and sound therapy in a strict framework, this is one of the most commonly used treatment modalities for tinnitus. Many studies refer to the use of TRT where in fact a modified version of this therapy is actually being implemented. It is therefore important to confirm the use of authentic TRT when reviewing any study that reports its use.

Objectives:

To assess the efficacy of TRT in the treatment of tinnitus.

Search strategy:

The search included the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE and reference lists of identified publications. The date of the most recent search was 26 August 2009.

Selection criteria:

Randomised controlled trials of TRT versus no treatment, or other forms of treatment, in adult patients with tinnitus.

Data collection and analysis:

Both authors critically appraised the retrieved studies for risk of bias and extracted data independently. Where necessary, we contacted the original study authors for further information.

Main results:

Only one trial (123 participants) was included in the review. Several excluded trials did not follow the strict protocol for TRT, evaluating instead a modified form of TRT. The included trial showed TRT to be more effective than a tinnitus masking (TM) approach. In this study outcome data for tinnitus severity were presented using three instruments (Tinnitus Handicap Inventory (THI), Tinnitus Handicap Questionnaire (THQ), Tinnitus Severity Index (TSI)) for patients in three groups (participants' tinnitus being a 'moderate problem', big problem' or 'very big problem').

At 18 months, improvements for the three groups in the three scores (TRT versus TM) were respectively: 'moderate problem' - THI: 18.2 versus 4.6, THQ: 489 versus 178, TSI 7.5 versus 1.6; 'big problem' - THI: 29.2 versus 16.7, THQ: 799 versus 256, TSI: 12.1 versus 6.7; and 'very big problem' - THI: 50.4 versus 10.3, THQ; 1118 versus 300, TSI: 19.7 versus 4.8.

Authors' conclusions:

A single, low-quality randomised controlled trial suggests that TRT is much more effective as a treatment for patients with tinnitus than tinnitus masking.

This record should be cited as:

Phillips JS, McFerran D. Tinnitus Retraining Therapy (TRT) for tinnitus. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD007330. DOI: 10.1002/14651858.CD007330.pub2

Assessed as up to date:

August 26, 2009

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Primary Review Group:

Ear, Nose and Throat Disorders Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective is tinnitus retraining therapy (TRT) in the treatment of tinnitus?

Bottom line:

A single, low-quality randomised controlled trial suggested TRT is more effective as a treatment for patients with tinnitus than tinnitus masking (use of “white noise” generators). In this study, outcome data for tinnitus severity were presented using three instruments, the Tinnitus Handicap Inventory, Tinnitus Handicap Questionnaire, and Tinnitus Severity Index, for patients in three groups (participants’ tinnitus being a “moderate problem”, a “big problem” or a “very big problem”). Patients with a “very big problem” showed much greater benefit from TRT at 18 months compared with those whose initial tinnitus problem was “moderate” or “big”. No side effects of treatment were reported.

Caveat:

Although this study suggested considerable benefit for TRT in the treatment of tinnitus, the study quality was insufficient to draw firm conclusions. The study was not blinded but issues regarding incomplete data were addressed appropriately and all data were presented in full. The authors of the study used a non-specified form of random allocation for the first patient, followed by alternation between assignment to treatment and control groups. The study population was drawn from a veterans’ hospital and may not have been representative of the general tinnitus population in terms of age distribution, the preponderance of men and the frequency of a history of acoustic trauma.

Context:

A wide range of therapies have been proposed for the treatment of tinnitus symptoms, including cortisone, vasodilators, benzodiazepines, lidocaine, spasmolytic drugs, anticonvulsants, antidepressants, ginkgo biloba, hyperbaric oxygen, cognitive behavioural therapy, transcranial magnetic stimulation, tinnitus masking, music therapy, reflexology, hypnotherapy, and traditional Chinese medicine, including acupuncture. TRT involves a combination of directive counselling and sound therapy in a strict framework, and is one of the most commonly used treatment modalities for tinnitus.

Cochrane Systematic Review:

Phillips JS and McFerran D. Tinnitus Retraining Therapy (TRT) for tinnitus. Cochrane Reviews, 2010, Issue 3. Article No. CD007330. DOI: 10.1002/14651858.CD007330.pub2. This review contains one study involving 123 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Ear, nose, & throat > Ear > Tinnitus

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Tinnitus Retraining Therapy (TRT) for tinnitus

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