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Evaluation and Treatment of Tinnitus: Comparative Effectiveness
Comparative Effectiveness Reviews, No. 122
Investigators: M Kathleen Pichora-Fuller, PhD, Pasqualina Santaguida, PhD, Amanda Hammill, MA, Mark Oremus, PhD, Brian Westerberg, MD, Usman Ali, MD, MSc, Christopher Patterson, MD, and Parminder Raina, PhD.
Author Information and AffiliationsStructured Abstract
Objectives:
A review was undertaken to evaluate the peer-reviewed literature on three areas of tinnitus management for the following Key Questions (KQs): (1) measures used to assess patients for management needs (KQ1); (2) effectiveness of treatments (KQ2); and (3) identification of prognostic factors (KQ3).
Data sources:
MEDLINE®, Embase®, CINAHL®, PsycINFO®, AMED©, and Cochrane CENTRAL were searched from January 1970 to June 2012. An extensive grey literature search, which included documents from regulatory and tinnitus-related organizations, was also undertaken.
Review methods:
Standardized systematic review methodology was employed. Eligibility criteria included English-language studies of adults with subjective idiopathic (nonpulsatile) tinnitus; excluded studies involved tinnitus as the result of middle-ear pathologies or focused on methods to determine psychosomatic tinnitus. For KQ2, all pharmacological/food supplement, medical/surgical, sound/technological, and psychological/behavioral interventions aimed at ameliorating tinnitus symptoms were eligible (except stapedectomy or tympanoplasty). Randomized controlled trials with placebo controls or head-to-head trials were eligible for all KQs.
Results:
From 9,725 citations, 52 eligible publications were extracted for data. None were eligible for KQ1 or KQ3. From the 52 publications eligible for KQ2, 17 evaluated pharmacological interventions; 11 evaluated medical interventions (low-level laser, acupuncture, transcranial magnetic stimulation); 5 evaluated sound technologies; and 19 evaluated psycholocal/behavioral interventions. Data on adverse effects were generally poorly collected and reported.
Conclusions:
There is low strength of evidence (SOE) indicating that cognitive behavioral therapy interventions improve tinnitus-specific quality of life relative to inactive controls. For pharmacological interventions, SOE is low for improvements to subjective loudness from neurotransmitter drugs versus placebo; insufficient for antidepressants, other drugs, and food supplements with respect to subjective loudness; and insufficient for all other outcomes. There is insufficient SOE to suggest that medical interventions improve outcomes relative to inactive controls; sleep and global quality of life were not evaluated for medical interventions. The SOE for the adverse effect of sedation in pharmacological studies was judged insufficient. Future research should address the substantial gaps identified for KQ1 and KQ3. For KQ2, future research should concentrate on improving collection of adverse effects, calculating sample size, and specifying doses for interventions.
Contents
- Preface
- Acknowledgments
- Key Informants
- Technical Expert Panel
- Peer Reviewers
- Executive Summary
- Introduction
- Methods
- Results
- KQ1 In patients with symptoms of tinnitus (e.g., ringing in the ears, whooshing sounds, etc.) what is the comparative effectiveness of methods used to identify patients for further evaluation or treatment?
- KQ2 In adults with subjective idiopathic (nonpulsatile) tinnitus, what is the comparative effectiveness (and/or potential harms) of medical/surgical, sound treatment/technological, or psychological/behavioral interventions, including combinations of interventions?
- KQ3 For adults with subjective idiopathic tinnitus, what prognostic factors, patient characteristics, and/or symptom characteristics affect final treatment outcomes?
- Discussion
- References
- Appendix A Search Strategy
- Appendix B Data Extraction Forms
- Appendix C Excluded Studies
- Appendix D Publications Not Eligible for Extraction
- Appendix E Characteristics of Included Studies Evidence Tables
- Appendix F List of Ongoing Clinical Trials Evaluating Interventions To Treat Idiopathic Tinnitus Registered in Clinicaltrials.gov
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10060-I, Prepared by: McMaster University Evidence-based Practice Center, Hamilton, Ontario, Canada
Suggested citation:
Pichora-Fuller MK, Santaguida P, Hammill A, Oremus M, Westerberg B, Ali U, Patterson C, Raina P. Evaluation and Treatment of Tinnitus: Comparative Effectiveness. Comparative Effectiveness Review No. 122. (Prepared by the McMaster University Evidence-based Practice Center under Contract No. 290-2007-10060-I.) AHRQ Publication No. 13-EHC110-EF. Rockville, MD: Agency for Healthcare Research and Quality; August 2013. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the McMaster University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10060-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
- 1
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