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Hearing management

Updated 14 December 2017

Combo therapy may ease tinnitus

One in five people suffers from tinnitus, the annoying and sometimes severely debilitating condition often referred to as "ringing in the ears," and new research may offer some hope for relief for these patients.

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One in five people suffers from tinnitus, the annoying and sometimes severely debilitating condition often referred to as "ringing in the ears," and new research may offer some hope for relief for these patients.

Although the condition currently has no cure, researchers in the Netherlands found that combining two existing therapies may help more than either single therapy alone. Their report is published in The Lancet.

The strategies used in the study aren't new, noted Dr Eric Smouha, an associate professor of otolaryngology and director of otology and neurotology at Mount Sinai School of Medicine in New York City, who was not involved with the study. However, the finding "shows hope for these people", he said.

Tinnitus can be incredibly frustrating for doctors and patients alike, added another expert, Dr Michael Seidman, director of otologic/neurotologic surgery at the Henry Ford Health System in Detroit, because there is no cure for the condition and even good treatments are elusive.

Remedy for tinnitus

Smouha also pointed out that doctors look for an underlying cause but usually can't find one.

Finding a remedy - if there is one - is very much a trial-and-error adventure, Seidman said. Dietary modifications (such as cutting out caffeine or alcohol, herbs including Ginkgo biloba), therapy, and even some drugs (such as anti-anxiety medications to facilitate sleep) may help some patients.

Right now, clinicians often rely on one of two main treatments for tinnitus. One, called "tinnitus retraining therapy," involves exposing the patient to another, more neutral sound to mask the tinnitus, along with counselling.

The second is "cognitive behavioural therapy," which includes correcting distorted thought patterns, relaxation techniques and mindfulness instruction.

To date, though, no one has investigated how the two work together, said study authors Rilana Cima and colleagues, from Maastricht University in the Netherlands.

How the study was done

For this study, about 500 adults with tinnitus were assigned to the combination therapy group, or to "usual" care, which itself was very intensive, involving more than two hours of initial testing followed by multiple visits with a social worker.

Those assigned to the combination therapy, referred to as "specialised care," showed more improvement in health-related quality of life over the course of a year, a reduction in the severity of the tinnitus, as well as less impairment from the condition, the investigators found.

Specialised care included the same initial testing period as usual care, followed by assessment by a clinical psychologist and group sessions with movement therapists, physical therapists, speech therapists and social workers.

In the end, it was the uber-intensive specialised care that benefited people with both mild and severe tinnitus the most, the study found.

This specialised combination care really was not a dramatic departure from the tinnitus retraining therapy and cognitive behavioural therapy used individually in the United States, Seidman said.

And it's unclear if this intensive combination approach, which relies on the expertise of many different specialists, could be implemented in the United States with its different population and vastly different health care system, Smouha said.

"What they did is very intensive, consisting of hours and hours of counselling and coming back for sessions," Smouha pointed out. And the combination therapy used in the study really "doesn't differ much from what we refer to as tinnitus retraining therapy," he added.

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Dr Kara Hoffman graduated from UCT in 2004, thereafter she completed her year of community service in Durban. In 2010 she completed her Masters Degree in Paediatric Aural Rehabilitation from UKZN. In 2016, she became a Doctor of Audiology through the University of Arizona (ATSU). Dr Hoffman and her partner Lauren Thompson opened a fully diagnostic audiology practice called Thompson & Hoffman Audiology Inc. In 2011 with world-class technology and equipment to be able to offer the broad public all hearing-related services including hearing testing for adults and babies, vestibular (balance) assessments and rehabilitation, industrial audiology, hearing devices, central auditory processing assessments for school-aged children, school screening, neonatal hearing screening programmes at Alberlito and Parklands Hospital, cochlear implants and other implantable devices, medicolegal assessments and advanced electroacoustic assessments of hearing. Thompson and Hoffman Audiology Inc. are based at Alberlito Hospital in Ballito, St Augustines Hospital in Durban and at 345 Essenwood Road, Musgrave. The practices are all wheelchair friendly. There are three audiologists that practice from Thompson & Hoffman – including Dr Kara Hoffman, Lauren Thompson & Minette Lister. The practice boasts professional, highly qualified, and extensive diagnostic services where all your hearing healthcare needs can be met. The additional licensing in vestibular assessment and rehabilitation, paediatric rehabilitation and cochlear implantation places this practice in one of the top specialist audiological positions in South Africa, with a wealth of experience in all clinical areas of audiology and is a very well respected and sought-after practice.

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