An article published in this weeksLancet provides a multidisciplinary approach to treating tinnitus. The specialised care program appears to be affective for both mild and severe tinitius and researchers hope their strategies will be implemented widely and be of great help to suffers.

The Canadian folk rock singer Neil Young famously suffered from tinnitus and had to stop recording for some years, but the problem is very common and said to affect nearly a quarter of all people during their lives. We have all been to nightclubs or concerts and woken up the next day with that irritating dull or high pitched ring in our ears, but imagine if it just didn′t go away day after day. It′s has the makings of some prison torture.

Researchers combined cognitive behavior therapy with sound-based tinnitus retraining therapy and produced results that better current treatments. Cima and Johan Vlaeyen from Maastricht University in the Netherlands, who led the research explain: 

"The results are highly relevant for clinical practice because best practice for tinnitus has not been defined, and current treatment strategies are fragmented and costly."

For their investigation, researchers recruited nearly 500 adults with tinnitus; half were randomly assigned to stepped specialized care and the other half to usual care stratified by tinnitus severity and hearing ability in blocks of four. Validated questionnaires were used to measure health-related quality of life, tinnitus severity, and tinnitus impairment. 

The program ran for 12 months and patients in the specialized care group reported improved quality of life (effect size 0·24***) and decreased tinnitus severity (0·43) and impairment (0·45) compared with those receiving standard treatment.

The authors conclude that:

"We showed the effectiveness of specialized care compared with usual care not only after the first 3 months of first-step treatment, but also after the more intensive second-step treatment approach ended and 4 months of no treatment ... Our findings could lead to consensus in policy about best practice in treatment of tinnitus, standard choices in referral trajectories, and the implementation of standardized tinnitus assessment and thereby more easily comparable outcomes".

Scientists not involved with the work, made positive comments but noted that the stepped care approach was only over a relatively short duration.