Initial Response to Combination Therapies for Tinnitus: Lessons Learned From a Retrospective Analysis

Objective: To investigate the initial reduction of tinnitus effects by combining common therapies applicable in general otology clinics and establishing optimal treatment strategies. Study Design: Retrospective cohort study. Setting: A tertiary university hospital. Patients: Patients with nonpulsatile subjective tinnitus who visited the hospital between January and December 2022. Intervention(s): Combination therapies consisting of at least one of the directive counseling based on the neurophysiological model, hearing aids, medication, and/or neuromodulation were performed. Main Outcome Measure(s): Tinnitus Handicap Inventory (THI) questionnaire at both their initial visit and 1-month follow-up. Results: A total of 151 patients were enrolled. THI improvement of 20 points or more was observed in 31.8% of participants. One-way analysis of variance revealed that counseling had a significant reduction in THI, whereas neuromodulation, medication, and hearing aids did not. THI improvement was significantly associated with received counseling, severity of initial THI, and mean loudness discomfort level. Hearing aids and neuromodulation were not significant prognostic factors for improvement. Conclusion: Counseling alone is the best treatment for most patients with tinnitus. There will be other patients with tinnitus that, in addition to counseling, would benefit from hearing aids, medications, and/or certain forms of neuromodulation.