A multidisciplinary systematic review of the treatment for chronic idiopathic tinnitus

• Published in: European archives of oto-rhino-laryngology 2017-05, Vol.274 (5), p.2079-2091
• Main Authors: Zenner, Hans-Peter, Delb, Wolfgang, Kröner-Herwig, Birgit, Jäger, Burkhard, Peroz, Ingrid, Hesse, Gerhard, Mazurek, Birgit, Goebel, Gerhard, Gerloff, Christian, Trollmann, Regina, Biesinger, Eberhard, Seidler, Harald, Langguth, Berthold
• Format: Article
• Language: English
• Subjects: Acoustic Stimulation - methods; Cognitive Therapy - methods; Diagnosis, Differential; Disease Management; Electric Stimulation Therapy - methods; Head and Neck Surgery; Hearing Loss - diagnosis; Humans; Medicine; Medicine & Public Health; Neurosurgery; Otorhinolaryngology; Review Article; Tinnitus - diagnosis; Tinnitus - physiopathology; Tinnitus - psychology; Tinnitus - therapy
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-016-4401-y

The majority of tinnitus patients are affected by chronic idiopathic tinnitus, and almost 60 different treatment modalities have been reported. The present study is a multidisciplinary systematic analysis of the evidence for the different forms of treatment for chronic tinnitus. The results are used to form the basis of an S3 guideline. A systematic search was carried out in PubMed and the Cochrane Library. The basis for presenting the level of evidence was the evidence classification of the Oxford Centre of Evidence-based Medicine. Whenever available, randomised controlled trials were given preference for discussing therapeutic issues. All systematic reviews and meta-analyses were assessed for their methodological quality, and effect size was taken into account. As the need for patient counselling is self-evident, specific tinnitus counselling should be performed. Due to the high level of evidence, validated tinnitus-specific, cognitive behavioural therapy is strongly recommended. In addition, auditory therapeutic measures can be recommended for the treatment of concomitant hearing loss and comorbidities; those should also be treated with drugs whenever appropriate. In particular, depression should be treated, with pharmacological support if necessary. If needed, psychiatric treatment should also be given on a case-by-case basis. With simultaneous deafness or hearing loss bordering on deafness, a CI can also be indicated. For auditory therapeutic measures, transcranial magnetic or direct current stimulation and specific forms of acoustic stimulation (noiser/masker, retraining therapy, music, and coordinated reset) for the treatment of chronic tinnitus the currently available evidence is not yet sufficient for supporting their recommendation.