Audiol Neurootol. 2006;11(5):276-86. 2006 May 23.
A modified version of tinnitus retraining therapy: observing long-term outcome and predictors.
Mazurek B, Fischer F, Haupt H, Georgiewa P, Reisshauer A, Klapp BF.
Tinnitus Centre, Department of Otorhinolaryngology, Charite--University Medicine Berlin, Berlin, Germany. birgit.mazurek@charite.de
Tinnitus retraining therapy (TRT) in Germany includes not only directive counseling and sound therapy but also stress management and facultative psychotherapeutic treatment. The aim of the present study was to investigate the impact of this modified version of TRT on certain tinnitus-related aspects of distress and variables that may predict treatment outcome. Clinical data from 92 patients undergoing outpatient TRT in the Charite Tinnitus Centre were evaluated retrospectively over 1 year. Treatment outcome was defined by changes in specific areas of tinnitus-related distress and assessed by the Tinnitus Questionnaire. Changes in audiometric frequency and loudness of tinnitus were examined by regular audiometric testing. The overall Tinnitus Questionnaire score was significantly reduced after 1 year. Severely affected tinnitus sufferers (decompensated tinnitus) profited more than less affected patients (compensated tinnitus). In cases of indicated psychotherapy, improvement was significant for the patients who took advantage of psychotherapeutic treatment during TRT but was not significant for those who interrupted or dismissed an indicated psychotherapy. Changes in tinnitus-specific areas of distress were most pronounced in the scales for emotional and cognitive distress and intrusiveness. Significant changes in sleep disturbances, auditory perceptual difficulties and somatic complaints were observed in patients with decompensated tinnitus. In patients with chronic tinnitus, modified TRT may lead to significant subjective improvement in certain tinnitus-related symptoms like emotional and cognitive distress and intrusiveness. Particularly patients suffering from severe tinnitus distress take advantage of therapy. Careful psychotherapeutic diagnostics and therapies and, if necessary, motivation to make use of psychotherapy seem to be essential preconditions for therapeutic success in patients with severe psychosomatic comorbidity. Copyright 2006 S. Karger AG, Basel.
Anales Otorrinolaringol Ibero Am. 2001;28(1):75-85
Therapy perspectives in subjective tinnitus
Lacosta Nicolas JL, Garcia Cano J.
Hospital San Millan (Servicio de O.R.L.), Logrono.
The AA. of this article have achieved a bibliographical perusal about treatment of subjective tinnitus, including even papers based on controlled clinical trials. Pharmacologic agents are settled on vasodilators of cochlear microcirculation (nimodipine, trimetazidine, Ginkgo biloba extract, misoprostol), lidocaine, the anxiolitics (alprazolam, corazepam) and the antidepressants (nortrityline). Comments sonorous amplification. Also are displayed, because of their benefits, the relaxation techniques (biofeeback, hypnotherapy, acupuncture and yoga) and psychological counseling
British Journal of Audiology 1999 Aug;33(4):201-10.
A meta-analytic review of psychological treatments for tinnitus
Andersson G, Lyttkens L.
Department of Psychology, Uppsala University, Sweden. Gerhard.Andersson@psyk.uu.se
Meta-analysis is a technique of combining results from different trials in order to obtain estimates of effects across studies. Meta-analysis has, as yet, rarely been used in audiological research. The aim of this paper was to conduct a meta-analysis on psychological treatment of tinnitus. The outcomes of 18 studies, including a total of 24 samples and up to 700 subjects, were included and coded. Included were studies on cognitive/cognitive-behavioural treatment, relaxation, hypnosis, biofeedback, educational sessions and problem-solving. Effect sizes for perceived tinnitus loudness, annoyance, negative affect (e.g. depression) and sleep problems were calculated for randomized controlled studies, pre-post-treatment design studies and follow-up results. Results showed strong to moderate effects on tinnitus annoyance for controlled studies (d = 0.86), pre-post designs (d = 0.5) and at follow-up (d = 0.48). Results on tinnitus loudness were weaker and disappeared at follow-up. Lower effect sizes were also obtained for measures of negative affect and sleep problems. Exploratory analyses revealed that cognitive-behavioural treatments were more effective on ratings of annoyance in the controlled studies. It is concluded that psychological treatment for tinnitus is effective, but that aspects such as depression and sleep problems may need to be targeted in future studies.
Clini Excell Nurse Pract. 1998 Mar;2(2):73-82.
Subjective idiopathic tinnitus
Billue JS.
Department of Community Nursing, Medical College of Georgia, Augusta 30912, USA.
One out of every five individuals experiences tinnitus. Tinnitus is the tenth most common presenting complaint among the elderly in primary care. Although tinnitus is often associated with hearing loss, chronic noise exposure, and medications, its etiology frequently goes undetected. Diagnosis of subjective idiopathic tinnitus is established by a comprehensive health history, physical examination, and office and laboratory diagnostic assessments. Patients who suffer from this chronic symptom report a dwindling in their quality of life, primarily because of the annoyance factor associated with tinnitus. Activities of daily living are affected in proportion to the intensity of the tinnitus. Examples of nonpharmacologic management include hearing aids for those with hearing loss, hypnotherapy, counseling, and masking. A number of medications have demonstrated some efficacy in the treatment of tinnitus. Ultimately, the practitioner is concerned with helping the individual live with subjective idiopathic tinnitus by promoting self-care activities to improve both physical and mental-emotional health.
European Journal of Clinical Hypnosis 1996 Issue II,
Hypnoptherapy in the treatment of tinnitus: Report on a pilot study/
Halama, Peter
Two comparing cohorts were assembled in order to judge the efficiency of therapy: The first cohort was composed of 30 patients (18 women and 12 men) with an average age of 49.6 + – 13.6 (from 26 up to 74 years). They had been suffering for 7.6 + – 5.4 years (from 1 to 25 years) from therapy-resistant tinnitus: (n=9 right-sided, n=17 left-sided and n=4 bilateral). Possible reasons were: N=10 acute deafness, n=3 acute deafness more than once (recurrent attacks of acute deafness), n=8 whiplash injuries of the cervical column, n=4 after head injury, n =2 otosclerosis and n=3 suspicion of local infection. This study is of pilot character and is meant to give an impulse to doctors, especially to neuro-otologists, otolaryngologists and neurologists, to study hypnotherapy in order to apply it to patients. Although the statistics for this controlled parallel group study show significant results, they should be judged only as “good trends”, because the control group was not interviewed all the time and the assessment of tinnitus intensity was carried out subjectively. Objective measurements (e.g. synthesiser technique) should be included in future. The author believes hypnotherapy in groups should be funded by insurance companies and that psychoanalysis is not useful in the therapy of neuro-otological diseases.
Journal of Laryngol Otol. 1996 Feb;110(2):117-20.
Client centred hypnotherapy in the management of tinnitus--is it better than counselling?
Mason JD, Rogerson DR, Butler JD.
Department of Otorhinolaryngology, Derbyshire Royal Infirmary, Derby, UK.
The aim of this study was to assess whether client centred hypnotherapy (CCH) which required three sessions with a trained therapist was superior to a single counselling session in reducing the impact of tinnitus. Patients were randomly allocated to receive either counselling (n = 42) or CCH (n = 44). The outcome measures were: tinnitus loudness match, subjective tinnitus symptom severity score, trend of linear analogue scale, request for further therapy and whether the patient had an impression of improvement in their tinnitus after treatment. CCH was no better than counselling in reducing the impact of tinnitus using the three quantative measures of tinnitus, and requests for further follow up. The only significant difference between the two therapies was that 20 (45.5 per cent) of the CCH group reported a general sense of improvement compared to six (14.3 per cent) in the counselling group, this is significant p < 0.01. The study did not demonstrate whether this was a genuine hypnotic effect or simply a response to the additional attention from the therapist.
American Journal of Clinical Hypnosis. 1995 Apr;37(4):294-9.
Client-centered hypnotherapy for tinnitus: who is likely to benefit?
Mason J, Rogerson D.
Derbyshire Royal Infirmary, United Kingdom.
In this study we prospectively analyzed 41 patients, 15 females and 26 males with a mean age of 54, who underwent three sessions of client-centered hypnotherapy for their tinnitus. Of these patients, 28 (68%) showed some benefit for their tinnitus 3 months after completing their hypnosis, and 13 (32%) showed no evidence of improvement for their tinnitus. Hearing loss was associated with a nonbeneficial outcome for tinnitus treated with hypnotherapy. Of the nonbeneficial group, 46% had a hearing loss of 30 db or more in their better-hearing ear compared to less than 15% in the beneficial group, a significant difference (X2 = 6.34, df = 1, p < 0.02). Client-centered hypnotherapy can be offered to anyone who wants to have therapy for their tinnitus; in those with significant hearing loss the benefit may be less.
Psychother Psychosom Med Psychol. 1996 Mar-Apr;46(3-4):147-52.
Effects of relaxation therapy as group and individual treatment of chronic tinnitus
Winter B, Nieschalk M, Stoll W
HNO-Universitatsklinik Munster.
Forty-two patients, suffering from chronic tinnitus, participated in our psychological orientated treatment consisting of relaxation therapy with autogenic training according to J. H. Schultz. The results of individual therapy are compared with group therapy. Using visual analogy scales the therapeutical efficiency can be tested. The individual estimated loudness and annoyance of tinnitus are registered as well as a general emotional status. The results show a positive short-time effect in most cases. A reduction of tinnitus loudness and annoyance after individual and group therapy is seen directly. A positive effect throughout the whole treatment is only found in individual therapy. Concerning the group therapy, many of our patients reported an increase of the pretherapeutical estimation of tinnitus loudness and -annoyance. We believe that the permanent confrontation with the tinnitus problem may advance the psychological conflict in many cases. Therefore psychological management of tinnitus should be concentrated on a temporary limited support aiming to the neglect of tinnitus sensation.
American Journal of Clinical Hypnosis. 1995 Apr;37(4):294-9.
Client-centered hypnotherapy for tinnitus: who is likely to benefit?
Mason J, Rogerson D.
Derbyshire Royal Infirmary, United Kingdom.
In this study we prospectively analyzed 41 patients, 15 females and 26 males with a mean age of 54, who underwent three sessions of client-centered hypnotherapy for their tinnitus. Of these patients, 28 (68%) showed some benefit for their tinnitus 3 months after completing their hypnosis, and 13 (32%) showed no evidence of improvement for their tinnitus. Hearing loss was associated with a nonbeneficial outcome for tinnitus treated with hypnotherapy. Of the nonbeneficial group, 46% had a hearing loss of 30 db or more in their better-hearing ear compared to less than 15% in the beneficial group, a significant difference (X2 = 6.34, df = 1, p < 0.02). Client-centered hypnotherapy can be offered to anyone who wants to have therapy for their tinnitus; in those with significant hearing loss the benefit may be less.
Ear Nose Throat Journal. 1994 May;73(5):309-12, 315.
Hypnosis as an aid for tinnitus patients
Kaye JM, Marlowe FI, Ramchandani D, Berman S, Schindler B, Loscalzo G.
Medical College of Pennsylvania, Philadelphia 19129.
This study was undertaken to evaluate hypnosis versus stress management as therapeutic modalities in the treatment of tinnitus. Participants were recruited from the local tinnitus association and the Otolaryngology Division of the Department of Surgery. The instruments were the following standardized tests (NIMH Diagnostic Int. Schedule; SCL 90R, Beck Depression Inventory) in addition to a tinnitus questionnaire. Improvement was shown on 5 separate scales, some alleviated by both types of treatment and others singularly by hypnosis or stress management. The data reinforce the use of behavioral techniques and suggest that different techniques may be more appropriate for specific symptoms.
Audiology. 1993 May-Jun;32(3):205-12.
Comparison between self-hypnosis, masking and attentiveness for alleviation of chronic tinnitus
Attias J, Shemesh Z, Sohmer H, Gold S, Shoham C, Faraggi D.
Institute for Noise Hazards Research and Evoked Potentials Laboratory, IDF Chaim Sheba Medical Center, Tel Aviv, Israel.
The efficacy of self-hypnosis (SH), masking (MA) and attentiveness to the patient's complaints (AT) in the alleviation of tinnitus was evaluated. Forty-five male patients close in age with chronic tinnitus related to acoustic trauma were assigned to three matched subgroups: SH, AT or MA. The therapeutic stimuli in the SH and MA sessions, recorded on audio cassettes, were given to the patients for use when needed. Self-hypnosis significantly reduced the tinnitus severity; Attentiveness partially relieved the tinnitus; Masking did not have any significant effect.
Audiology. 1993;32:205-212.
A controlled trial of hypnotherapy in tinnitus
Marks NJ, Karl H, Onisiphorou C.
A group of 14 patients with unilateral tinnitus were selected because of the constant nature of their tinnitus, and its resistance to all other forms of therapy. They were subjected to hypnosis in three forms in random order. The induction of a trance state alone formed the control arm of the trial. Compared to this were the effects of 'ego boosting' and active suppression of tinnitus whilst in a trance state. One of the 14 patients showed a highly significant response to the latter treatment as judged by visual analogue scales. Five of the 14 patients (36%) found the induction of a hypnotic state of value. This seemed to help them tolerate their tinnitus better, although its loudness and quality were unaltered.
American Journal of Clinical Hypnosis 1991 Apr;33(4):254-62.
Client-therapist collaboration in the preparation of hypnosis interventions: case illustrations
Cochrane GJ.
Therapists can use hypnosis in a variety of situations to help clients utilize their own resources effectively. In both heterohypnosis and tape-assisted self-hypnosis, the respectful collaboration of therapist and client in the development of specific intervention strategies can be effective. I have described four cases to illustrate the collaborative aspect of heterohypnosis in a surgical setting and tape-assisted self-hypnosis for anxiety, tinnitus, and situational depression. In each case the clients were willing and able participants.
Scandinavian Audiology 1990; 19, 245-249.
Efficacy of self-hypnosis for tinnitus relief
Attias J, Shemesh Z, Shoham C, Shahar A, Sohmer H.
Institute for Noise Hazards Research, Chaim Sheba Medical Centre, Ramat-Gan, Israel.
The efficacy of self-hypnosis (SH) on tinnitus relief was compared with two control procedures: 1) presentation of a brief auditory stimulus (BAS) to the ear with tinnitus; 2) waiting list (WL), i.e. patients receiving no formal treatment. The results have shown that 73% of SH subjects reported disappearance of tinnitus during treatment sessions, as compared with only 24% in the BAS group. Moreover, the short-term (1 week) and long-term (2 months) symptom profiles of only SH subjects revealed a significant improvement. Thus, SH may well be a beneficial method for the relief of tinnitus.
British Medical Bulletin 43:983-998 (1987)
Tinnitus and its management
R R A Coles and R S Hallam
MRC Institute of Hearing Research, University of Nottingham Nottingham_Royal National Throat, Nose and Ear Hospital London
A comprehensive classification system is required for tinnitus because of its diverse aetiologies. Prevalence depends on the degree of tinnitus considered, ranging from close to 100% if non-clinical tinnitus is included to 0.5% who are severely affected. Severity probably depends more on the patient's reaction than on tin nitus loudness. Apart from aetiological and general audiological investigations, measurements of tinnitus are useful-particularly those relating to its maskability. Management methods include: (1) explanation of cause, nature and prognosis; (2) treatment of the cause if possible (rarely); (3) various psychological measures such as cognitive therapy, relaxation training therapy sometimes supplemented by biofeedback, lay counselling or hypnotherapy; (4) hearing aid(s) and/or tin nitus masker(s); (5) drugs to reduce the tinnitus or its effects.
Clin Otolaryngol Allied S ci. 1985 Feb;10(1):43-6.
A controlled trial of hypnotherapy in tinnitus.
Marks NJ, Karl H, Onisiphorou C.
A group of 14 patients with unilateral tinnitus were selected because of the constant nature of their tinnitus, and its resistance to all other forms of therapy. They were subjected to hypnosis in three forms in random order. The induction of a trance state alone formed the control arm of the trial. Compared to this were the effects of 'ego boosting' and active suppression of tinnitus whilst in a trance state. One of the 14 patients showed a highly significant response to the latter treatment as judged by visual analogue scales. Five of the 14 patients (36%) found the induction of a hypnotic state of value. This seemed to help them tolerate their tinnitus better, although its loudness and quality were unaltered.
International Journal of Clinical and Experimental Hypnosis. 1983 Apr;31(2):90-7.
An alternative method of treating tinnitus: relaxation-hypnotherapy primarily through the home use of a recorded audio cassette
Brattberg G.
Thirty-two patients, diagnosed with tinnitus, were treated with hypnosis. Treatment consisted of one hour consultation with the physician followed by four weeks of daily home practice while listening to an audio-tape recording of approximately 15 minutes duration. Twenty-two of the patients treated learned in one month to disregard the disturbing noise, a considerable gain in the ratio of therapy to time required.
Contemporary Hypnosis Vol 16 Issue 2 Pages 68-80
Treating anxiety with self-hypnosis and relaxation
Lucy M. O'Neill, Amanda J. Barnier, Professor Kevin McConkey
University of New South Wales, Sydney, New South Wales, Australia 2052, Australia
The outcome and process of treating subclinical anxiety with self-hypnosis and relaxation were compared. Twenty individuals who presented for treatment for stress, anxiety, and worry were assessed (for anxiety and self-hypnotizability), exposed to a 28-day treatment programme (which involved daily measures of outcome and process variables), and re-assessed (for anxiety). It was found that both self-hypnosis and relaxation alleviated anxiety pre- to post-treatment. Although there was no difference in the outcome data, throughout treatment self-hypnosis rather than relaxation was associated with a greater sense of treatment efficacy and expectation and with a greater sense of cognitive and physical change. The findings are discussed in terms of the expectational and experiential aspects of self-hypnosis, and their potential role in the perception, progress and impact of using self-hypnosis in therapy. Copyright © 1999 British Society of Experimental and Clinical Hypnosis
