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Combo Therapy May Help Ease 'Ringing in the Ears'
Tinnitus can be frustrating for patients, hard to treat, researchers say
Friday, May 25, 2012
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 May 26 issue of 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.
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 counseling.
The second is "cognitive behavioral 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.
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 "specialized 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.
Specialized 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 specialized care that benefited people with both mild and severe tinnitus the most, the study found.
This specialized combination care really was not a dramatic departure from the tinnitus retraining therapy and cognitive behavioral 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 counseling 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.
In the United States, retraining therapy can cost $3,000 to $5,000 and require a commitment of two years, Seidman noted.
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