Clin Exp Otorhinolaryngol.  2013 Dec;6(4):214-218.

Small-Group Counseling in a Modified Tinnitus Retraining Therapy for Chronic Tinnitus

• Park SN
• Bae SC
• Kim DK
• Park YS
• Yeo SW
• Park SY

Abstract

OBJECTIVES
The authors have treated chronic tinnitus patients using a combination of a simplified tinnitus retraining therapy (TRT) and medications, which we called modified TRT. In this clinical setting, we have attempted small-group counseling to find a time-effective equivalent of individual counseling. The aim of the present study was to evaluate the effectiveness of small-group counseling by comparing the treatment outcomes between individual and small-group counseling.
METHODS
The patients who had distressing chronic tinnitus with normal hearing or mild hearing loss were included. The subjects were placed into the small-group (group 1:4) or the individual (group 1:1) counseling group, and underwent a modified TRT composed of a single session of directive counseling and ambient sound stimulation. In addition, alprazolam (0.25 mg) and ginkgo biloba extract (80 mg) were administered orally to the subjects for 3 months. The 3- and 6- month outcomes were assessed using the follow-up rates and tinnitus severity scores: awareness, tinnitus handicap inventory (THI), loudness, annoyance, and effect on life. The treatment responses were classified as improvement, no changes, and worsening.
RESULTS
Of the total 149 patients (77 in group 1:1; 72 in group 1:4), 104 patients completed the protocol at 3 months, and 55 patients at 6 months. The follow-up rates were similar in both groups. Over the period of 6 months, all scores declined significantly except the loudness score at 3 months in both groups. Treatment responses showed no between-group differences. The success rate based on THI was 70% in group 1:1, and 64% in group 1:4 at 6 months.
CONCLUSION
The small-group counseling of our modified TRT was comparable to the individual counseling for tinnitus relief. We suggest that this protocol can be implemented effectively in any crowded otolaryngology clinics.

Keyword

Tinnitus; Tinnitus retraining therapy; Directive counseling; Benzodiazepines

MeSH Terms

Alprazolam
Benzodiazepines
Counseling*
Directive Counseling
Follow-Up Studies
Ginkgo biloba
Hearing
Hearing Loss
Humans
Otolaryngology
Tinnitus*
Alprazolam
Benzodiazepines

Figure

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  Fig. 1 Changes in tinnitus severity scores at 3 months after modified tinnitus retraining therapy. All scores except LD improved significantly in both groups (*P<0.05 vs. pretreatment scores, paired t-test). AW, awareness; LD, loudness; AN, annoyance; EOL, effect on daily life; THI, tinnitus handicap inventory. Error bars indicate SE.

• 

  Fig. 2 Changes in tinnitus severity scores at 3- and 6-months after modified tinnitus retraining therapy. The pretreatment scores are not different between the groups (t test). All scores declined significantly throughout 6 months without between-group difference (*P<0.01 vs. pre-Tx scores, repeated-measures ANOVA). The slow declines from the 3- to 6-month values are not statistically significant. Data presented in the table are mean±SD. Error bars indicate SE. AW, awareness; LD, loudness; AN, annoyance; EOL, effect on daily life; THI, tinnitus handicap inventor.

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  Fig. 3 Therapeutic outcomes based on each tinnitus severity score at the 3-month assessment. Data presented are number of patients. Improvement/worsening=a decrease/an increase of ≥ 20 points in the AW score; ≥ 2 points in each of the LD, AN, and EOL score; ≥ 20% with respect to the initial value in the THI score. 1:1=group 1:1 (n=52); 1:4=group 1:4 (n=52), chi-square test. AW, awareness; LD, loudness; AN, annoyance; EOL, effect on daily life; THI, tinnitus handicap inventor.

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  Fig. 4 Therapeutic outcomes based on each tinnitus severity score at the 6-month assessment. 1:1=group 1:1 (n=27); 1:4=group 1:4 (n=28), chi-square test. AW, awareness; LD, loudness; AN, annoyance; EOL, effect on daily life; THI, tinnitus handicap inventor.

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