Authors' objectives:

The aim of this paper is to investigate the effectiveness of tinnitus retraining therapy (TRT) in treating chronic subjective tinnitus.

Authors' recommendations: Summary and Recommendations. Tinnitus is a phantom auditory perception which can be potentially debilitating. It is a common otologic symptom and yet still poorly understood. At present the underlining pathophysiology of tinnitus remains unclear. Tinnitus presents an enormous challenge for clinicians to treat. Various ways of treating tinnitus have been tried, none of them providing a cure. Some of these treatments, such as cognitive-behavioral therapy and tinnitus masking, may provide relief of the symptoms. However, the results of these treatments are still inconclusive due to the quality of published research on the subjects (Evidence level 1). Tinnitus Retraining Therapy was developed by Jastreboff and Hazell in early 1990s based on the neurophysiological model of tinnitus developed by Jastreboff in late 1980s. Currently, there are many centres in the world claiming to treat tinnitus patients according to the TRT method developed by Jastreboff and Hazell. However, based on the published literature, it seems that there are significant variations in how the Jastreboff and Hazell model is applied across these centres. Most of published literature on the effectiveness of TRT would be classified as case series/case reports (Evidence level 4). The authors of these case series claimed a success rate of between 50%-80%. From a critical appraisal standpoint the evidence provided from this research is inconclusive due to the unavailability of controls, unclear patient selection criteria, the variability of TRT methods being implemented and the variability in the criteria of treatment outcomes being employed. The only available randomized controlled trial (Evidence level 1) on the effectiveness of TRT has been conducted and presented by researchers at the National Center for Rehabilitative Auditory Research, the Departments of Veterans Affairs, Portland, OR (the full article is in preparation for submission). At 18 months, 87% of patients in TRT programs had significant improvement compared to 58% among those using tinnitus masking therapy. However, caution has been noted by the researchers in interpreting the outcomes of this research due to the fact that this is the first and only RCT study and has not been replicated by others. It should be noted that the US Department of Veterans Affairs serves a distinctive population, therefore, the generalizability of this research and its implications to the WCB of BC injured workers population needs to be examined further. It is suggested that: 1. The Hearing Loss Department together with the EBPG conduct a formal study on the effectiveness of TRT and other treatment modalities being offered to treat subjective chronic tinnitus. 2. In the case that a formal evaluation can not be undertaken, it is recommended that the WCB: - undertake a more in-depth and inclusive cost analysis on TRT from the WCB of BC perspective - investigate the cause of variation in the services being provided by the four different providers - should ensure that validated outcome measurement tools, such as the Tinnitus Handicap Inventory, should be chosen and applied toward every TRT patients in order to provide analyzable data from all providers - investigate why, to date, the WCB of BC successful outcome rates are lower than that reported in the literature.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.worksafebc.com/health_care_providers/related_information/evid ence_based_medicine/default.asp

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: WorkSafeBC

Contact Address: 6591 Westminster Highway, Richmond, BC, V7C 1C6 Canada. Tel: 604-231-8417; Fax: 604-279-7698

Contact Name: ebpg@worksafebc.com

Contact Email: ebpg@worksafebc.com

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