Tinnitus Retraining Therapy (TRT) for tinnitus: Cochrane systematic review

Abstract

Assessed as up to date: 2009/08/25

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.

Author(s)

Phillips John S, McFerran Don

Summary

Tinnitus Retraining Therapy (TRT) for tinnitus

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.

Reviewer's Conclusions

Implications for practice

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

Implications for research

Further research should consider:

  • treatment protocols that strictly adhere to the format of TRT administration as proposed by its creator;
  • the use of more robust methodology that would avoid criticism of the method of randomisation; this would avoid any suggestions of bias and result in higher quality studies for systematic review.

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