A Dutch study
carried out recently aims to assess the effectiveness of stepped-care cognitive
behaviour therapy and, compare it with the usual management in patients with
varying tinnitus severity.
Tinnitus is one
of the most disturbing and debilitating hearing-related problems. Here the
patient perceives a distressing sound internally, even in the absence of an
It has been
estimated that up to 21% of adults are likely to develop the condition during
their lifetime. Although not easily identified, tinnitus is characterized by
cognitive impairment which can be very debilitating and even affect everyday
life. The condition can be very bothersome for the patients and for their
family members too. There are no cures or standardized treatments for tinnitus
and this makes its management even more lengthy and frustrating.
There are two
main methods of treatment for tinnitus. First, sound-based therapies, such as
tinnitus retraining therapy, are used to mask tinnitus. This is meant to reduce
the annoyance the patient experiences from tinnitus. This therapy is usually
carried out in combination with structured counseling sessions. The second main
approach is cognitive behaviour therapy (CBT), which is a form of psychotherapy
aimed at modifying the patient's way of thinking and dealing with a particular
It is well known
that CBT can reduce patient's distress and enhance the quality of life.
However, it has yet not been tested if the intensity of cognitive behaviour
therapy could vary depending on the severity of tinnitus.
study was based on the belief that treatment must be provided depending on the
needs of the patients with varying severity of tinnitus. A new
multidisciplinary protocol for tinnitus treatment was proposed involving a
stepped-care cognitive behaviour therapy combined with certain aspects of
tinnitus retraining therapy.
A clinical trial
was undertaken at the Adelante Department of Audiology and Communication
(aged >18 years) who had tinnitus and who were previously untreated were
selected for the study. It was essential that these subjects had no other
health issues before participating in the study.
randomly allocated in a 1:1 ratio by the use of a computer-generated allocation
sequence. Depending on their tinnitis severity, they were stratified into four
layers and each of these strata were grouped in block sizes of four to be
treated either with a specialized care (comprising of cognitive behaviour
therapy with sound-focused tinnitus retraining therapy) or the usual care.
those investigating the outcome were masked to treatment assignment. Primary
outcomes that were evaluated include health-related quality of life, tinnitus
severity, and tinnitus impairment. These parameters were assessed before
treatment began and at 3 months, 8 months, and 12 months after treatment was
The method of
using a combination of theoretical models and treatment approaches, as was done
in this study, was a new one for treating tinnitis patients. Treating tinnitus
with retraining therapy-based approaches is only moderately effective.
Cognitive behaviour therapy seems the most promising approach in treating
tinnitis and in reducing tinnitis- related patient distress.
Stepped up management, combining the components of retraining therapy
within the framework of cognitive behavior therapy while taking into account
the severity of the complaint, appears to be the most effective in managing tinnitus.
Specialised treatment based on cognitive behaviour
therapy versus usual care for tinnitus: a randomised controlled trial; Rilana
et al; The Lancet Volume 379, Issue 9830, Pages 1951 - 1959