In Reply: Broad Band Noise May be Preferable, Even After Controlling the Pretreatment Severity of Tinnitus Induced Distress

We are very grateful to the author(s) of this letter for taking the time to read and respond to our article [1]. With all our respect, we reviewed their thoughtful letter which raised the important issue concerning the optimal stimulus for sound therapy implemented in tinnitus retraining therapy (TRT). The major issue that they wanted to point out was that the broadband noise TRT (bTRT) group had more severe tinnitus (Tinnitus Handicap Inventory [THI]=54.22±22.41) compared to mixed noise TRT (mTRT) (THI=42.5±22.27) and narrowband noise TRT (nTRT) (THI=48.25±25.56) group. And since patients with more severe tinnitus tend to show higher improvements compared to those with milder form of tinnitus [2], it seems possible that the superior performance of bTRT could also be contributed by the tinnitus severity factor. Their recommendation was to perform a future study with subjects who have almost equal baseline tinnitus severity scores or to perform an analysis of covariance (ANCOVA) with the baseline tinnitus severity (e.g., THI score) as the covariate. We agree with the shortcoming of our article that the authors have pointed out. The tendency of better outcome in the more severe tinnitus groups has also been found in previously published article regarding the prognostic factors of TRT [3]. Although we tried to control all confounding factors, a few variables which might influence the outcomes were basically not manageable, because of the retrospective design of our study. Accordingly, in this correspondence article we have reanalyzed our data and tried to advocate that broad band noise therapy may be preferable in TRT, even after controlling the pretreatment severity of tinnitus induced distress.

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