jueves, 4 de febrero de 2010
Cognitive behavioural therapy for tinnitus
Foto: The Centre For Cognitive-Behavioural Therapy
68 Lombard Street, EC3V 9LV (Central London)
Martinez-Devesa P, Waddell A, Perera R, Theodoulou M
Cognitive behavioural therapy for tinnitus
The Cochrane Database of Systematic Reviews 2010 Issue 1,
Tinnitus can be described as the experience of sound, in the ear or in the head. Subjective tinnitus is not heard by anyone else. At present no particular treatment for tinnitus has been found effective in all patients.
Cognitive behavioural therapy was originally developed as a treatment for depression and then also used for anxiety, insomnia and chronic pain. It is a form of psychological treatment that consists of the use of relaxation, remodelling thoughts and use challenging situations to improve the patient's attitude towards tinnitus.
The objective of this review was to assess whether cognitive behavioural therapy is effective in the management of patients suffering from tinnitus.
Six trials (285 participants) are included in this review. Data analysis did not demonstrate any significant effect in the subjective loudness of tinnitus, or in the depression associated with tinnitus. We found, however a significant improvement in the quality of life (decrease of global tinnitus severity) suggesting that cognitive behavioural therapy has a positive effect on the way in which people cope with tinnitus.
Further research should use a limited number of validated questionnaires in a more consistent way and with a longer follow up to assess the long-term effect of cognitive behavioural therapy (or other intervention trials) on tinnitus.
Tinnitus is an auditory perception that can be described as the experience of sound, in the ear or in the head, in the absence of external acoustic stimulation (not usually audible to anyone else). At present no specific therapy for tinnitus is acknowledged to be satisfactory in all patients.
Cognitive behavioural therapy (CBT) uses relaxation, cognitive restructuring of the thoughts and exposure to exacerbating situations in order to promote habituation and may benefit tinnitus patients, as may the treatment of associated psychological conditions.
To assess whether cognitive behavioural therapy is effective in the management of patients suffering from tinnitus.
Our search included the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2006), MEDLINE and EMBASE. The last search date was June 2006.
Randomised controlled trials in which patients with unilateral or bilateral tinnitus as main symptom received cognitive behavioural treatment.
Data collection and analysis
One review author (PMD) assessed every report identified by the search strategy. The four review authors assessed the methodological quality, applied inclusion/exclusion criteria and extracted data.
Six trials comprising 285 participants were included.
1. Primary outcome: subjective tinnitus loudness
CBT compared to a waiting list control group: we found no significant difference (Standardised Mean Difference (SMD) 0.06 (95% CI -0.25 to 0.37)).
CBT compared to another intervention (Yoga, Education, Minimal Contact - Education and Education): we found no significant difference (SMD 0.1 (95% CI -0.22 to 0.42)).
2. Secondary outcomes
CBT compared to a waiting list control group: we found no significant difference in either group (SMD 0.29 (95%CI -0.04 to 0.63)).
CBT compared to another intervention (Yoga, Education and Minimal Contact - Education): we found no significant difference (SMD 0.01 (95% CI -0.43 to 0.45)).
b) Quality of life
CBT compared to a waiting list control group: we found a significant difference in favour of CBT versus the waiting list group (SMD 0.7 (95% CI 0.33 to 1.08)).
CBT compared to another intervention (Education, Minimal Contact - Education and Education): we also found a significant difference between CBT and the other intervention control group (SMD 0.64 (95% CI 0.29 to 1.00)).
There were no adverse/side effects reported in any trial.
We did not find a significant difference in the subjective loudness of tinnitus, or in the associated depression. However we found a significant improvement in the quality of life (decrease of global tinnitus severity) of the participants, thus suggesting that cognitive behavioural therapy has an effect on the qualitative aspects of tinnitus and contributes positively to the management of tinnitus.
Fuente: This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1,
This record should be cited as: Martinez-Devesa P, Waddell A, Perera R, Theodoulou M. Cognitive behavioural therapy for tinnitus. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD005233. DOI: 10.1002/14651858.CD005233.pub2.