Intervention Review

Cognitive behavioural therapy for tinnitus

  1. Pablo Martinez-Devesa1,*,
  2. Rafael Perera2,
  3. Megan Theodoulou3,
  4. Angus Waddell4

Editorial Group: Cochrane Ear, Nose and Throat Disorders Group

Published Online: 8 SEP 2010

Assessed as up-to-date: 5 MAY 2010

DOI: 10.1002/14651858.CD005233.pub3

Database Title

Additional Information

How to Cite

Martinez-Devesa P, Perera R, Theodoulou M, Waddell A. Cognitive behavioural therapy for tinnitus. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD005233. DOI: 10.1002/14651858.CD005233.pub3.

Author Information

  1. 1

    John Radcliffe Hospital - West Wing, ENT Department, Oxford, UK

  2. 2

    University of Oxford, Department of Primary Health Care, Oxford, UK

  3. 3

    University of Oxford, Department of Psychiatry, Oxford, UK

  4. 4

    Great Western Hospital, ENT Department, Swindon, UK

*Pablo Martinez-Devesa, ENT Department, John Radcliffe Hospital - West Wing, Headley Way, Oxford, OX3 9DU, UK. devesa@doctors.org.uk.

Publication History

  1. Publication Status: Edited (conclusions changed)
  2. Published Online: 8 SEP 2010

SEARCH

ARTICLE TOOLS

View Full Article (HTML) Summary (58K)Standard (361K)Full (408K)
 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Background

This is an update of a Cochrane Review originally published in Issue 1, 2007 of The Cochrane Library.

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. 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 CBT is effective in the management of patients suffering from tinnitus.

Search methods

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; PsycINFO; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 6 May 2010.

Selection criteria

Randomised controlled trials in which patients with unilateral or bilateral tinnitus as their main symptom received cognitive behavioural treatment.

Data collection and analysis

One review author (PMD) assessed every report identified by the search strategy. Three authors (PMD, AW and MT) assessed the methodological quality and applied inclusion/exclusion criteria. Two authors (PMD and RP) extracted data and conducted the meta-analysis. The four authors contributed to the final text of the review.

Main results

Eight trials comprising 468 participants were included.

For the primary outcome of subjective tinnitus loudness we found no evidence of a difference between CBT and no treatment or another intervention (yoga, education and 'minimal contact - education').

In the secondary outcomes we found evidence that quality of life scores were improved in participants who had tinnitus when comparing CBT to no treatment or another intervention (education and 'minimal contact education'). We also found evidence that depression scores improved when comparing CBT to no treatment. We found no evidence of benefit in depression scores when comparing CBT to other treatments (yoga, education and 'minimal contact - education').

There were no adverse/side effects reported in any trial.

Authors' conclusions

In six studies we found no evidence of a significant difference in the subjective loudness of tinnitus.

However, we found a significant improvement in depression score (in six studies) and quality of life (decrease of global tinnitus severity) in another five studies, suggesting that CBT has a positive effect on the management of tinnitus.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Cognitive behavioural therapy for tinnitus

Tinnitus can be described as the experience of sound in the ear or in the head. Subjective tinnitus is not heard by anyone else. At present no particular treatment for tinnitus has been found effective in all patients.

Cognitive behavioural therapy was originally developed as a treatment for depression and then also used for anxiety, insomnia and chronic pain. It is a form of psychological treatment that uses relaxation, remodelling thoughts and challenging situations to improve the patient's attitude towards tinnitus.

The objective of this review was to assess whether cognitive behavioural therapy is effective in the management of patients suffering from tinnitus.

Eight trials (468 participants) are included in this review. Data analysis did not demonstrate any significant effect in the subjective loudness of tinnitus. We found, however, a significant improvement in the depression associated with tinnitus and quality of life (decrease of global tinnitus severity), suggesting that cognitive behavioural therapy has a positive effect on the way in which people cope with tinnitus.

Further research should use a limited number of validated questionnaires in a more consistent way and with a longer follow up to assess the long-term effect of cognitive behavioural therapy in patients with tinnitus.

 

Resumen

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Antecedentes

Terapia cognitivoconductual para el tinnitus

Ésta es una actualización de una revisión Cochrane publicada originalmente en el número 1, 2007 de The Cochrane Library.

El tinnitus es una percepción auditiva que puede describirse como la experiencia de sonido, en el oído o en la cabeza, en ausencia de estímulo acústico externo. El tratamiento cognitivoconductual (TCC) emplea relajación, reestructuración cognitiva de los pensamientos y exposición a la exacerbación de situaciones para promover la habituación y puede beneficiar a los pacientes de tinnitus, como puede hacerlo el tratamiento de trastornos psicológicos asociados.

Objetivos

Evaluar si la TCC es eficaz para el tratamiento de los pacientes con tinnitus.

Estrategia de búsqueda

Se hicieron búsquedas en el Registro de Ensayos del Grupo Cochrane de Enfermedades de Oído, Nariz y Garganta (Cochrane Ear, Nose and Throat Disorders Group); Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials, CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; PsycINFO; ISRCTN y fuentes adicionales de ensayos publicados y no publicados. La fecha de la búsqueda más reciente fue el 6 de mayo 2010.

Criterios de selección

Ensayos controlados aleatorios donde los pacientes con tinnitus unilateral o bilateral como síntoma principal recibieron terapia cognitivoconductual.

Obtención y análisis de los datos

Un autor de la revisión (PMD) evaluó cada informe identificado mediante la estrategia de búsqueda. Tres autores (PMD, AW y MT) evaluaron la calidad metodológica y aplicaron los criterios de inclusión/exclusión. Dos autores (PMD y RP) extrajeron los datos y realizaron el metanálisis. Los cuatro autores colaboraron en el texto final de la revisión.

Resultados principales

Se incluyeron ocho ensayos con 468 participantes.

Para el resultado primario de volumen subjetivo del tinnitus, no se encontraron pruebas de una diferencia entre la TCC y ningún tratamiento u otra intervención (yoga, educación y “educación de contacto mínimo”).

En los resultados secundarios, se encontraron pruebas acerca de que las puntuaciones de calidad de vida mejoraron en los participantes que tuvieron tinnitus, al comparar TCC con ningún tratamiento u otra intervención (educación y “educación de contacto mínimo”). También se encontraron pruebas acerca de que las puntuaciones de depresión mejoraron al comparar TCC con ningún tratamiento. No se encontraron pruebas del beneficio en las puntuaciones de depresión al comparar TCC con otros tratamientos (yoga, educación y “educación de contacto mínimo”).

No se informaron efectos adversos/secundarios en los ensayos.

Conclusiones de los autores

En seis estudios, no se hallaron pruebas de una diferencia significativa en el volumen subjetivo del tinnitus.

Sin embargo, se encontró una mejoría significativa en la puntuación de depresión (en seis estudios) y la calidad de vida (disminución de la gravedad general del tinnitus) en otros cinco estudios, lo que sugiere que la TCC tiene un efecto positivo en el tratamiento del tinnitus.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano

View Full Article (HTML) Summary (58K)Standard (361K)Full (408K)