Estimates indicate that 10% to 15% of the population in industrialized nations is affected by tinnitus, a condition for which there is no definitive treatment. Customized acoustic therapy is an emerging treatment for tinnitus that, in theory, targets the implicated neural pathways. A prospective study by Australian researchers, published in Clinical Otolaryngology, examines a novel, web-based form of customized acoustic therapy for patients with tinnitus.
“The theory behind the treatment is acoustic desensitization. Patients self-select the frequency of their tinnitus, and the platform
produces a matching sound,” John-Charles Hodge, MBBS, MA, MRCS, FRACS, explains. “They then play back the treatment sounds during the day or at night to train the brain to ignore them.”
During the trial, 58 participants underwent 6 weeks of the customized acoustic therapy, which was delivered for up to 2 hours each day on a smartphone, tablet, or computer and integrated into their normal daily activities. “Our goal was to incorporate digital technology and platforms into tinnitus therapy so that patients in more remote communities who have difficulty getting face-to-face appointments could benefit from this type of care,” Dr. Hodge says.
A novel five-question tinnitus scale called FiveQ was administered at baseline and each week of treatment to assess efficacy. The impact of tinnitus on sleep concentration, relaxation, hearing, and activities of daily living are graded on a 100-point scale. “Standard QOL questionnaires for tinnitus are long and clunky, so we developed a shorter version, which has been correlated with the other validated instruments,” Dr. Hodge notes.
Improvements Based on Tinnitus Duration & Severity
Most of the participants were male (N=43) and the age range was 55-74. In 49 individuals, tinnitus was bilateral, and 39 reported hearing loss. “One of the surprises for us was that, in some people who reported high-frequency hearing loss associated with high-frequency tinnitus, the hearing loss resolved after acoustic therapy,” says Dr. Hodge
Improvements in symptom severity scores were seen in 67.2% of participants, while 6.9% had no change and 25.9% experienced a decline from baseline.
The researchers observed a trend toward better results in patients who had tinnitus for less than 10 years, although responses also were seen in a significant percentage of those with symptoms for more than 10 years (83% vs 60%). The same was true in all groups with mild to catastrophic tinnitus; for those with slight tinnitus, no change was reported (Figure). When examining the impact of tinnitus frequency in relation to outcomes, the authors found that response to therapy was significantly better in participants with tinnitus frequencies of less than 2,000 Hz (P<0.001).
FiveQ Results and Clinical Implications
In the cohort overall, the baseline mean score on the FiveQ of 40.8 fell to 31.5 after 6 weeks of acoustic
therapy, with the downward trend seen as early as week 1 and continuing in statistically significant fashion until the treatment endpoint. No differences were found in treatment compliance between treatment responders and non-responders.
While the study results show that web-based acoustic therapy is accessible and effective for tinnitus, longer-term clinical studies are needed to confirm the authors’ observations of initial benefit.
According to Dr. Hodge, however, the FiveQ is ready for clinical use. When it shows that an adult has tinnitus, he recommends an assessment of mental health, ototoxic drug history, vitamin levels, sleep adequacy, noise exposure, and physical issues that could be causing the condition. “Checking for the basics, such as zinc, magnesium, and vitamin B12 deficiencies, and physical issues, such as temporomandibular disorders or cervical spine dysfunction, is key in these patients,” says Dr. Hodge.
