Although considered a prevalent condition, tinnitus remains a challenging condition for hearing care professionals to treat and manage. More than 50 million people in the United States have reported experiencing tinnitus, resulting in an estimated prevalence of 10% to 15% in adults. Experts believe that about one in five individuals who experience tinnitus are bothered enough by the condition to seek clinical intervention. In October 2014, after an exhaustive review of the literature, the medical journal, Otolaryngology Head & Neck Surgery, published clinical practice guidelines to help clinicians better triage and manage bothersome tinnitus.
Among the recommendations supported by clinical evidence for those with persistent, bothersome tinnitus and documented hearing loss, published in the report, was the provision of a hearing aid evaluation and consideration of sound therapy devices such as hearing aids and table top maskers. Additionally, the expert panel recommended cognitive behavioral therapy to patients with persistent, bothersome tinnitus.
Four years following the report, although professionals organizations such as the International Hearing Society and the Tinnitus Practitioners Associations have incorporated some of the 2014 clinical guidelines into their tinnitus management approaches, the “strong recommendation” of cognitive behavioral therapy the 2014 clinical practice guidelines – perhaps because very few hearing care professionals have any formal training in it – could be under-utilized as a form of treatment for bothersome tinnitus.
The goal of cognitive behavioral therapy (CBT) is to reduce anxiety by helping patients identify and modify unhelpful thoughts and behaviors associated with tinnitus. A CBT approach teaches individuals coping with bothersome tinnitus skills to identify negative thoughts that result in distress, and to restructure those thoughts, so they are more accurate and helpful to the individual.
One recent study, however, indicates that hearing care professionals, without in-depth, formal training in psychological intervention such as CBT, can, nevertheless, provide CBT support following some nominal training. In a retrospective study published on-line in September in the American Journal of Audiology, British researchers gathered pre and post CBT data from 68 individuals. Results shows significant improvements in tinnitus annoyance, loudness and impact on quality of life following six weeks of face-to-face CBT sessions with an audiologist for one hour each week. The audiologists who delivered the CBT attended a Tinnitus and Hyperacusis Masterclass involving approximately 100 hours of directed self-learning, 30 hours of classroom learning, 20 hours of online discussion forums and 6 months of supervised practice as well as on-going direct supervision and coaching.
Cognitive Behavioral Therapy (CBT) and Tinnitus Relief
Although the audiologists in the study cited above received substantial CBT training and support, it does require considerable time and expense to complete more than 100 hours of specialized training in CBT.
In another recently published study, CBT was delivered to individuals with bothersome tinnitus using the internet. In a randomized study, 374 adults with bothersome tinnitus in the United Kingdom were randomly assigned to one of two groups: One group received the internet-based CBT over an 8-week period and the other group received two to three face-to-face CBT sessions in a tinnitus clinic.
Results showed that individuals participating in the internet-based CBT approach received outcomes that were equally effective relative to those in the face-to-face CBT approach.
The study can be found in its entirety here.
Together, these two studies indicate that rank and file clinicians can effectively provide CBT to individuals with bothersome tinnitus. Further, the latter study cited above demonstrates that CBT can be effective when it is delivered using the internet, thus enabling CBT to be more accessible and cost-effective people in need of help. Given the relatively high prevalence of bothersome tinnitus, CBT or CBT-like approaches, such as mindfulness training, delivered either face-to-face or remotely via the internet can be an effective intervention provided by licensed hearing care professionals.
Source: JAMA, AJA