Skip to content
naulon

No retraction, correction or concern found when last checked on Nov 4, 2026.

Systematic review and meta‐analyses of randomized controlled trials examining tinnitus management

Derek J. Hoare, Victoria L. Kowalkowski, Sujin Kang and 1 more

The Laryngoscope · 2011 · Meta-analysis

doi:10.1002/lary.21825

Abstract

Objectives/Hypothesis: To evaluate the existing level of evidence for tinnitus management strategies identified in the UK Department of Health's Good Practice Guideline. Study Design: Systematic review of peer‐reviewed literature and meta‐analyses. Methods: Searches were conducted in PubMed, Cambridge Scientific Abstracts, Web of Science, and EMBASE (earliest to August 2010), supplemented by hand searches in October 2010. Only randomized controlled trials that used validated questionnaire measures of symptoms (i.e., measures of tinnitus distress, anxiety, depression) were included. Results: Twenty‐eight randomized controlled trials met our inclusion criteria, most of which provide moderate levels of evidence for the effects they reported. Levels of evidence were generally limited by the lack of blinding, lack of power calculations, and incomplete data reporting in these studies. Only studies examining cognitive behavioral therapy were numerous and similar enough to perform meta‐analysis, from which the efficacy of cognitive behavioral therapy (moderate effect size) appears to be reasonably established. Antidepressants were the only drug class to show any evidence of potential benefit. Conclusions: The efficacy of most interventions for tinnitus benefit remains to be demonstrated conclusively. In particular, high‐level assessment of the benefit derived from those interventions most commonly used in practice, namely hearing aids, maskers, and tinnitus retraining therapy needs to be performed.

Shown for reading. Its publisher allows quoting it, not republishing it.

References 62

  1. 1.

    Davis A, El Rafaie A. Epidemiology of tinnitus. Tinnitus Handbook. 2000;1-23.

    Not in our library

  2. 2.

    Steinmetz LG, Zeigelboim BS, Lacerda AB, Morata TC, Marques JM. The characteristics of tinnitus in workers exposed to noise. Braz J Otorhinolaryngol. 2009;75:7-14.

    Not in our library10.1016/s1808-8694(15)30825-9

  3. 3.

    Ferreira LMBD, Ramos J, Mendes EP. Characterization of tinnitus in the elderly and its possible related disorders. Braz J Otorhinolaryngol. 2009;75:249-255.

    Not in our library10.1016/s1808-8694(15)30786-2

  4. 4.

    Kröner-Herwig B, Zachriat C, Weigand D. Do patient characteristics predict outcome in the outpatient treatment of chronic tinnitus? Psychosoc Med. 2006;3.

    Not in our library

  5. 5.

    Provision of Services for Adults With Tinnitus. A Good Practice Guide. 2009.

    Not in our library

  6. 6.

    Newman CW, Jacobson GP, Spitzer JB. Development of the Tinnitus Handicap Inventory. Arch Otolaryngol Head Neck Surg. 1996;122:143-148.

    Not in our library10.1001/archotol.1996.01890140029007

  7. 7.

    Goebel G, Hiller W. The tinnitus questionnaire. A standard instrument for grading the degree of tinnitus. Results of a multicenter study with the tinnitus questionnaire. HNO. 1994;42:166-172.

    Not in our library

  8. 8.

    Beck AT, Steer RA, Ball R, Ciervo CA, Kabat M. Use of the Beck Anxiety and Depression Inventories for primary care with medical outpatients. Assessment. 1997;4:211-219.

    Not in our library10.1177/107319119700400301

  9. 9.

    Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica. 1983;67:361-370.

    Not in our library10.1111/j.1600-0447.1983.tb09716.x

  10. 10.

    Hoare DJ, Gander P, Collins L, Smith S, Hall DA. Management of tinnitus in English NHS Audiology Departments: an evaluation of current practice. J Eval Clin Pract. 2011.

    Not in our library10.1111/j.1365-2753.2010.01566.x

  11. 11.

    Oxman AD. Grading quality of evidence and strength of recommendations. BMJ. 2004;328:1490-1494.

    Not in our library10.1136/bmj.328.7454.1490

  12. 12.

    Dobie RA. A review of randomized clinical trials in tinnitus. Laryngoscope. 1999;109:1202-1211.

    Not in our library10.1097/00005537-199908000-00004

  13. 13.

    Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. BMJ. 2009;339:b2700.

    Not in our library10.1136/bmj.b2700

  14. 14.

    Hoare DJ, Stacey PC, Hall DA. The efficacy of auditory perceptual training for tinnitus: a systematic review. Ann Behav Med. 2010;40:313-324.

    Not in our library10.1007/s12160-010-9213-5

  15. 15.

    Dohoo I, Martin W, Stryhn H. Veterinary Epidemiologic Research. 2010.

    Not in our library

  16. 16.

    Duval S, Tweedie R. Trim and fill: a simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56:455-463.

    Not in our library10.1111/j.0006-341x.2000.00455.x

  17. 17.

    Henry JA, Loovis C, Montero M, et al. Randomized clinical trial: group counseling based on tinnitus retraining therapy. J Rehabil Res Dev. 2007;44:21-32.

    Not in our library10.1682/jrrd.2006.02.0018

  18. 18.

    Folmer RL, Griest SE, Meikle MB, Martin WH. Tinnitus severity, loudness, and depression. Otolaryngol Head Neck Surg. 1999;21:48-51.

    Not in our library10.1016/s0194-5998(99)70123-3

  19. 19.

    Henry JL, Wilson PH. The psychological management of tinnitus: comparison of a combined cognitive educational program, education alone and a waiting-list control. Int Tinnitus J. 1996;2:9-20.

    Not in our library

  20. 20.

    Kuk FK, Tyler RS, Russell D, Jordan H. The psychometric properties of a tinnitus handicap questionnaire. Ear Hear. 1990;11:434-445.

    Not in our library10.1097/00003446-199012000-00005

  21. 21.

    Wilson PH, Henry J, Bowen M, Haralambous G. Tinnitus reaction questionnaire: psychometric properties of a measure of distress associated with tinnitus. J Speech Hear Res. 1991;34:197-201.

    Not in our library

  22. 22.

    Kaldo V, Cars S, Rahnert M, Larsen HC, Andersson G. Use of a self-help book with weekly therapist contact to reduce tinnitus distress: a randomized controlled trial. J Psychosom Res. 2007;63:195-202.

    Not in our library10.1016/j.jpsychores.2007.04.007

  23. 23.

    Malouff JM, Noble W, Schutte NS, Bhullar N. The effectiveness of bibliotherapy in alleviating tinnitus-related distress. J Psychosom Res. 2010;68:245-251.

    Not in our library10.1016/j.jpsychores.2009.07.023

  24. 24.

    Stephens SD, Corcoran AL. A controlled study of tinnitus masking. Br J Audiol. 1985;19:159-167.

    Not in our library10.3109/03005368509078969

  25. 25.

    Biesinger E, Kipman U, Schätz S, Langguth B. Qigong for the treatment of tinnitus: a prospective randomized controlled study. J Psychosom Res. 2010;69:299-304.

    Not in our library10.1016/j.jpsychores.2010.04.013

  26. 26.

    Greimel KV, Leibetseder M, Unterrainer J, Albegger K. Can tinnitus be measured? Methods for assessment of tinnitus-specific disability and presentation of the Tinnitus Disability Questionnaire. HNO. 1999;47:196-201.

    Not in our library10.1007/s001060050382

  27. 27.

    Ireland CE, Wilson PH, Tonkin JP, Platt-Hepworth S. An evaluation of relaxation training in the treatment of tinnitus. Behav Res Ther. 1985;23:423-430.

    Not in our library10.1016/0005-7967(85)90170-6

  28. 28.

    Speilberger CD, Gorsuch RL, Lushene RE. STAI Manual. 1970.

    Not in our library

  29. 29.

    Weise C, Heinecke K, Rief W. Biofeedback-based behavioral treatment for chronic tinnitus: results of a randomized controlled trial. J Consutl Clin Psychol. 2008;76:1046-1057.

    Not in our library10.1037/a0013811

  30. 30.

    Andersson G, Stromgren T, Strom L, Lyttkens L. Randomized controlled trial of internet-based cognitive behavior therapy for distress associated with tinnitus. Psychosom Med. 2002;64:810-816.

    Not in our library10.1097/01.psy.0000031577.42041.f8

  31. 31.

    Abbott JA, Kaldo V, Klein B, et al. A cluster randomised trial of an internet-based intervention program for tinnitus distress in an industrial setting. Cogn Behav Ther. 2009;38:162-173.

    Not in our library10.1080/16506070902763174

  32. 32.

    Kaldo V, Levin S, Widarsson J, Buhrman M, Larsen HC, Andersson G. Internet versus group cognitive-behavioral treatment of distress associated with tinnitus: a randomized controlled trial. Behav Ther. 2008;39:348-359.

    Not in our library10.1016/j.beth.2007.10.003

  33. 33.

    Lovibond SH, Lovibond PF. Manual for Depression, Anxiety and Stress Scales. 1995.

    Not in our library

  34. 34.

    Andersson G, Porsaeus D, Wiklund M, Kaldo V, Larsen HC. Treatment of tinnitus in the elderly: a controlled trial of cognitive behavior therapy. Int J Audiol. 2005;44:671-675.

    Not in our library10.1080/14992020500266720

  35. 35.

    Reiss S, Peterson RA, Gurksy DM, McNally RJ. Anxiety severity, anxiety frequency and the prediction of fearfulness. Behav Res Ther. 1986;24:1-8.

    Not in our library10.1016/0005-7967(86)90143-9

  36. 36.

    Henry JL, Wilson PH. An evaluation of two types of cognitive intervention in the management of chronic tinnitus. Cogn Behav Ther. 1998;27:156-166.

    Not in our library

  37. 37.

    Kröner-Herwig B, Hebing G, van Rijn-Kalkmann U, Frenzel A, Schilkowsky G, Esser G. The management of chronic tinnitus—comparison of a cognitive-behavioural group training with yoga. J Psychosom Res. 1995;39:153-165.

    Not in our library10.1016/0022-3999(94)00098-p

  38. 38.

    Robinson SK, Viirre ES, Bailey KA, et al. A randomized controlled trial of cognitive-behavior therapy for tinnitus. Int Tinnitus J. 2008;14:119-126.

    Not in our library

  39. 39.

    Kröner-Herwig B, Frenzel A, Fritsche G, Schilkowsky G, Esser G. The management of chronic tinnitus: comparison of an outpatient cognitive-behavioral group training to minimal-contact interventions. J Psychosom Res. 2003;54:381-389.

    Not in our library10.1016/s0022-3999(02)00400-2

  40. 40.

    Hautzinger M, Bailer M. Allgemeine Depressionsskala. 1993.

    Not in our library

  41. 41.

    Zachriat C, Kröner-Herwig B. Treating chronic tinnitus: comparison of cognitive-behavioural and habituation-based treatments. Cogn Behav Ther. 2004;33:187-198.

    Not in our library10.1080/16506070410029568

  42. 42.

    Rief W, Weise C, Kley N, Martin A. Psychophysiologic treatment of chronic tinnitus: a randomized clinical trial. Psychosom Med. 2005;67:833-838.

    Not in our library10.1097/01.psy.0000174174.38908.c6

  43. 43.

    Davis PB, Wilde RA, Steed LG, Hanley PJ. Treatment of tinnitus with a customized acoustic neural stimulus: a controlled clinical study. Ear Nose Throat J. 2008;87:330-309.

    Not in our library

  44. 44.

    Crown S, Crisp AH. Manual of the Crown-Crisp Experiential Index. 1979.

    Not in our library

  45. 45.

    Herraiz C, Diges I, Cobo P, Aparicio JM, Toledano A. Auditory discrimination training for tinnitus treatment: the effect of different paradigms. Eur Arch Otorhinolaryngol. 2010;267:1067-1074.

    Not in our library10.1007/s00405-009-1182-6

  46. 46.

    Jastreboff PJ, Hazell JW. A neurophysiological approach to tinnitus: clinical implications. Br J Audiol. 1993;27:7-17.

    Not in our library10.3109/03005369309077884

  47. 47.

    Caffier PP, Haupt H, Scherer H, Mazurek B. Outcomes of long-term outpatient tinnitus-coping therapy: psychometric changes and value of tinnitus-control instruments. Ear Hear. 2006;27:619-627.

    Not in our library10.1097/01.aud.0000240504.77861.1a

  48. 48.

    Seydel C, Haupt H, Szczepek AJ, Klapp BF, Mazurek B. Long-term improvement in tinnitus after modified tinnitus retraining therapy enhanced by a variety of psychological approaches. Audiol Neurootol. 2010;15:69-80.

    Not in our library10.1159/000231632

  49. 49.

    Robinson SK, Viirre ES, Bailey KA, Gerke MA, Harris JP, Stein MB. Randomized placebo-controlled trial of a selective serotonin reuptake inhibitor in the treatment of nondepressed tinnitus subjects. Psychosom Med. 2005;67:981-988.

    Not in our library10.1097/01.psy.0000188479.04891.74

  50. 50.

    Sullivan M, Katon W, Russo J, Dobie R, Sakai C. A randomized trial of nortriptyline for severe chronic tinnitus. Effects on depression, disability, and tinnitus symptoms. Arch Intern Med. 1993;11:2251-2259.

    Not in our library

  51. 51.

    Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62.

    Not in our library10.1136/jnnp.23.1.56

  52. 52.

    Zöger S, Svedlund J, Holgers KM. The effects of sertraline on severe tinnitus suffering—a randomized, double-blind, placebo-controlled study. J Clin Psychopharmacol. 2006;26:32-39.

    Not in our library10.1097/01.jcp.0000195111.86650.19

  53. 53.

    Coles RRA, Lutman ME, Axelsson A, Hazell JWP, Aran J-M, Dauman R. Tinnitus severity gradings: cross-sectional studies. Tinnitus 91, Proceedings of the Fourth International Tinnitus Seminar, Bordeaux, France, August 27-30. 1991;453-455.

    Not in our library

  54. 54.

    Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32:50-55.

    Not in our library10.1111/j.2044-8341.1959.tb00467.x

  55. 55.

    Lectenberg R, Shulman A. Benzodiazepines in the treatment of tinnitus. J Laryngol Otol. 1984;98(suppl 9):271-276.

    Not in our library

  56. 56.

    Jalali MM, Kousha A, Naghavi SE, Soleimani R, Banan R. The effects of alprazolam on tinnitus: a cross-over randomized clinical trial. Med Sci Mon. 2009;15:I55-I60.

    Not in our library

  57. 57.

    Neri G, Baffa C, De Stefano A, et al. Management of tinnitus: oral treatment with melatonin and sulodexide. J Biol Regul and Homeost Agents. 2009;23:103-110.

    Not in our library

  58. 58.

    Rosenberg SI, Silverstein H, Rowan PT, Olds MJ. Effect of melatonin on tinnitus. Laryngoscope. 1998;108:305-310.

    Not in our library10.1097/00005537-199803000-00001

  59. 59.

    Langguth B, Goodey R, Azevedo A, et al. Consensus for tinnitus patient assessment and treatment outcome measurement: Tinnitus Research Initiative meeting, Regensburg, July 2006. Prog Brain Res. 2007;166:525-536.

    Not in our library10.1016/s0079-6123(07)66050-6

  60. 60.

    Adoga AA, Adoga AS, Obindo JT. Tinnitus and the prevalence of co-morbid psychological stress. Niger J Med. 2008;17:95-97.

    Not in our library10.4314/njm.v17i1.37365

  61. 61.

    Grunfeld EA, Gresty MA, Bronstein AM, Jahanshahi M. Screening for depression among neuro-otology patients with and without identifiable vestibular lesions. Int J Audiol. 2003;42:161-165.

    Not in our library10.3109/14992020309090425

  62. 62.

    Dohrmann K, Elbert T, Schlee W, Weisz N. Tuning the tinnitus percept by modification of synchronous brain activity. Restor Neurol Neurosci. 2007;25:371-378.

    Not in our library

Cited by papers we hold 3

Reads

Read by people on this page

None yet.

Checked or read by AI through naulon

None yet.

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.

Are you an author?

Is this your paper?

Claim it to add your note and be paid when agents cite it. Free.