Cognitive behavioural therapy for tinnitus

BACKGROUND: Tinnitus is an auditory perception that can be described as the experience of sound, in the ear or in the head, in the absence of external acoustic stimulation (not usually audible to anyone else). At present no specific therapy for tinnitus is acknowledged to be satisfactory in all patients. Cognitive behavioural therapy (CBT) uses relaxation, cognitive restructuring of the thoughts and exposure to exacerbating situations in order to promote habituation and may benefit tinnitus patients, as may the treatment of associated psychological conditions. OBJECTIVES: To assess whether cognitive behavioural therapy is effective in the management of patients suffering from tinnitus. SEARCH STRATEGY: Our search included the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006), MEDLINE and EMBASE. The last search date was June 2006. SELECTION CRITERIA: Randomised controlled trials in which patients with unilateral or bilateral tinnitus as main symptom received cognitive behavioural treatment. DATA COLLECTION AND ANALYSIS: One review author (PMD) assessed every report identified by the search strategy. The four review authors assessed the methodological quality, applied inclusion/exclusion criteria and extracted data. MAIN RESULTS: Six trials comprising 285 participants were included. 1. PRIMARY OUTCOME: subjective tinnitus loudness. CBT compared to a waiting list control group: we found no significant difference (Standardised Mean Difference (SMD) 0.06 (95% CI -0.25 to 0.37)). CBT compared to another intervention (Yoga, Education, Minimal Contact - Education and Education): we found no significant difference (SMD 0.1 (95% CI -0.22 to 0.42)).2. SECONDARY OUTCOMES: a) Depression. CBT compared to a waiting list control group: we found no significant difference in either group (SMD 0.29 (95%CI -0.04 to 0.63)). CBT compared to another intervention (Yoga, Education and Minimal Contact - Education): we found no significant difference (SMD 0.01 (95% CI -0.43 to 0.45)). b) Quality of life: CBT compared to a waiting list control group: we found a significant difference in favour of CBT versus the waiting list group (SMD 0.7 (95% CI 0.33 to 1.08)). CBT compared to another intervention (Education, Minimal Contact - Education and Education): we also found a significant difference between CBT and the other intervention control group (SMD 0.64 (95% CI 0.29 to 1.00)). There were no adverse/side effects reported in any trial. AUTHORS' CONCLUSIONS: We did not find a significant difference in the subjective loudness of tinnitus, or in the associated depression. However we found a significant improvement in the quality of life (decrease of global tinnitus severity) of the participants, thus suggesting that cognitive behavioural therapy has an effect on the qualitative aspects of tinnitus and contributes positively to the management of tinnitus.