Evaluation of Long-Term Efficacy and Quality of Life of Tinni-tus Retraining Therapy in Patients with Chronic Tinnitus: A Meta-Analysis
Abstract
Background: Chronic tinnitus significantly impacts patients' quality of life, with no consensus on the long-term efficacy of different interventions. This study aimed to evaluate the long-term effects of tinnitus retraining therapy (TRT) through a systematic review and meta-analysis.
Methods: Following PRISMA guidelines, literature was searched across eight databases up to November 2024. Ten randomized controlled trials were selected. A random-effects model was used to calculate weighted mean differences (MD) and 95% confidence intervals (CI) for Tinnitus Handicap Inventory (THI) and Visual Analog Scale (VAS) scores.
Results: Compared to control groups, TRT significantly improved THI scores (MD = -8.72, 95% CI: -16.65 to -0.79, P=0.03) and showed a trend toward improving VAS scores (MD = -2.78, 95% CI: -5.57 to 0.02, P=0.05). Heterogeneity was high (I²=90-96%), but sensitivity analysis confirmed stable results.
Conclusion: TRT has a significant long-term therapeutic effect on chronic tinnitus. Future studies should increase sample sizes, standardize interventions, and optimize review processes to reduce heterogeneity and define optimal TRT strategies.
1. Park KW, Kullar P, Malhotra C, et al (2023). Current and emerging therapies for chronic subjective tinnitus. J Clin Med, 12(20):6555.
2. Czornik M, Malekshahi A, Mahmoud W, et al (2022). Psychophysiological treatment of chronic tinnitus: A review. Clin Psychol Psychother, 29(4):1236-1253.
3. Boecking B, Brueggemann P, Rose M, et al (2023). [Chronic tinnitus: An interplay between somatic and psychological fac-tors]. HNO, 71(11):719-730.
4. Simões JP, Neff PKA, Langguth B, et al (2021). The progression of chronic tinni-tus over the years. Sci Rep, 11(1):4162.
5. Folmer RL (2023). Unresolved issues asso-ciated with transcranial magnetic stimu-lation (TMS) treatment of chronic tinni-tus. J Clin Med, 12(14):4648.
6. Liu H (2022). Toxic medicine used in Tradi-tional Chinese Medicine for cancer treatment: are ion channels involved? J Tradit Chin Med, 42(6):1019-1022.
7. Dalrymple SN, Lewis SH, Philman S (2021). Tinnitus: diagnosis and management. Am Fam Physician, 103(11):663-671.
8. Kumar M, Sahoo L, Sahoo KS (2023). Effect of tinnitus retraining therapy in normal hearing individual with subjective tinni-tus: an observational study. Indian J Oto-laryngol Head Neck Surg, 75(Suppl 1):596-604.
9. Gold SL, Formby C, Scherer RW (2021). The tinnitus retraining therapy counsel-ing protocol as implemented in the tin-nitus retraining Therapy Trial. Am J Au-diol, 30(1):1-15.
10. Sendesen E, Colak H (2025). Neural mark-ers associated with improved tinnitus perception after tinnitus retraining ther-apy. Int J Audiol, 64((5):481-487.
11. Tarnowska KA, Ras ZW, Jastreboff PJ (2022). A data-driven approach to clini-cal decision support in tinnitus retrain-ing therapy. Front Neuroinform, 16:934433.
12. Jin Z, Zhang W, Liu H, et al (2022). Poten-tial therapeutic application of local an-esthetics in cancer treatment. Recent Pat Anticancer Drug Discov, 17(4):326-342.
13. Chatterjee N, Chattopadhyay D, Chatterjee I (2021). Management of tinnitus in covid-19 outbreak- a comparative study between mindfulness based tinnitus stress reduction and tinnitus retraining therapy. Int Tinnitus J, 25(1):29-33.
14. Lapenna R, Molini E, Cipriani L, et al (2021). Long-term results of tinnitus re-training therapy in patients who failed to complete the program. Audiol Res, 11(1):1-9.
15. Rodriguez CR, Piccirillo JF, Rodebaugh TL et al (2023). Acceptability of cognitive behavioral therapy for tinnitus: a study with veterans and nonveterans. Am J Audiol, 32(3):593-603.
16. Altissimi G, Musacchio A, Pace A, et al (2024). Sound therapy in patients with tinnitus: traditional sound generators vs. mobile apps. Eur Rev Med Pharmacol Sci, 28(11):3781-3786.
17. Alonso-Valerdi LM, Ibarra-Zárate DI, Torres-Torres AS, et al (2023). Compara-tive analysis of acoustic therapies for tinnitus treatment based on auditory event-related potentials. Front Neurosci, 17:1059096.
18. Tinnitus Retraining Therapy Trial Re-search Group; Scherer RW, Formby C (2019). Effect of tinnitus retraining ther-apy vs standard of care on tinnitus-related quality of life: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg, 145(7):597-608.
19. Suh MW, Park MK, Kim Y, et al (2023). The treatment outcome of smart device-based tinnitus retraining therapy: pro-spective cohort study. JMIR Mhealth Uhealth, 11:e38986.
20. Jia XD, Li YK, Xie CC, et al (2024). Effects of transcranial direct current stimulation combined with tinnitus retraining thera-py on sleep disorders in patients with chronic tinnitus. Eur Rev Med Pharmacol Sci, 28(5):1768-1776.
21. Tong Z, Deng W, Huang X, et al (2023). Ef-ficacy of tailor-made notched music training versus tinnitus retraining thera-py in adults with chronic subjective tin-nitus: a randomized controlled clinical trial. Ear Hear, 44(4):670-681.
22. Henry JA, Stewart BJ, Griest S, et al (2016). Multisite randomized controlled trial to compare two methods of tinnitus inter-vention to two control conditions. Ear Hear, 37(6):e346-e359.
23. Parazzini M, Del Bo L, Jastreboff M, et al (2011). Open ear hearing aids in tinnitus therapy: An efficacy comparison with sound generators. Int J Audiol, 50(8):548-553.
24. Hatanaka A, Ariizumi Y, Kitamura K (2008). Pros and cons of tinnitus retraining therapy. Acta Otolaryngol,128(4):365-368.
25. Han JJ, Lee JH, Oh SH, et al (2015). As-sessing the effects of tinnitus retraining therapy in patients lost to follow-up: a telephone survey. Otol Neurotol, 36(4):581-587.
26. Forti S, Costanzo S, Crocetti A, et al (2009). Are results of tinnitus retraining therapy maintained over time? 18-month follow-up after completion of therapy. Audiol Neurotol, 14(5):286-289.
27. Cima RF, Maes IH, Joore MA, et al (2012). Specialised treatment based on cogni-tive behaviour therapy versus usual care for tinnitus: a randomised controlled trial. Lancet, 379(9830):1951-1959.
28. Cuevas-Romero AR, Alonso-Valerdi LM, Intriago-Campos LA, et al (2022). An electroencephalography-based database for studying the effects of acoustic ther-apies for tinnitus treatment. Sci Data, 9(1):500.
29. Sacchetto L, Monzani D, Apa E, et al (2023). The effect of alpha-lipoic acid in the treatment of chronic subjective tin-nitus through the tinnitus handicap in-ventory scores. Audiol Res, 13(4):484-494.
30. Ward A, Farengo-Clark D, McKenna DB, et al (2024). Clinical management of TP53 mosaic variants found on germline genetic testing. Cancer Genet, 284-285:43-47.
31. Joergensen ML, Hyvärinen P, Caporali S, et al (2022). Broadband amplification as tinnitus treatment. Brain Sci, 12(6):719.
32. Simonetti P, Vasconcelos LG, Gândara MR, et al (2022). Hearing aid effective-ness on patients with chronic tinnitus and associated hearing loss. Braz J Oto-rhinolaryngol, 88 Suppl 3(Suppl 3):S164-S170.
33. Luyten TR, Jacquemin L, Van Looveren N, et al (2020). Bimodal Therapy for Chronic Subjective Tinnitus: A Random-ized Controlled Trial of EMDR and TRT Versus CBT and TRT. Front Psychol, 11:2048.
34. Kim SH, Kim I, Kim H (2024). Easing the burden of tinnitus: A narrative review for exploring effective pharmacological strategies. Cureus, 16(2):e54861.
35. Alashram AR (2025). Effects of tinnitus re-training therapy on patients with tinni-tus: a systematic review of randomized controlled trials. Eur Arch Otorhinolaryngol, 282(2):571-587.
36. Ravi P, Samayan K, Sivagnanapandian D (2025). Tinnitus Retraining Therapy: In Person Versus Mobile Application Based - Two Case Scenarios. Indian J Otolaryngol Head Neck Surg, 77(2):1142-1146.
2. Czornik M, Malekshahi A, Mahmoud W, et al (2022). Psychophysiological treatment of chronic tinnitus: A review. Clin Psychol Psychother, 29(4):1236-1253.
3. Boecking B, Brueggemann P, Rose M, et al (2023). [Chronic tinnitus: An interplay between somatic and psychological fac-tors]. HNO, 71(11):719-730.
4. Simões JP, Neff PKA, Langguth B, et al (2021). The progression of chronic tinni-tus over the years. Sci Rep, 11(1):4162.
5. Folmer RL (2023). Unresolved issues asso-ciated with transcranial magnetic stimu-lation (TMS) treatment of chronic tinni-tus. J Clin Med, 12(14):4648.
6. Liu H (2022). Toxic medicine used in Tradi-tional Chinese Medicine for cancer treatment: are ion channels involved? J Tradit Chin Med, 42(6):1019-1022.
7. Dalrymple SN, Lewis SH, Philman S (2021). Tinnitus: diagnosis and management. Am Fam Physician, 103(11):663-671.
8. Kumar M, Sahoo L, Sahoo KS (2023). Effect of tinnitus retraining therapy in normal hearing individual with subjective tinni-tus: an observational study. Indian J Oto-laryngol Head Neck Surg, 75(Suppl 1):596-604.
9. Gold SL, Formby C, Scherer RW (2021). The tinnitus retraining therapy counsel-ing protocol as implemented in the tin-nitus retraining Therapy Trial. Am J Au-diol, 30(1):1-15.
10. Sendesen E, Colak H (2025). Neural mark-ers associated with improved tinnitus perception after tinnitus retraining ther-apy. Int J Audiol, 64((5):481-487.
11. Tarnowska KA, Ras ZW, Jastreboff PJ (2022). A data-driven approach to clini-cal decision support in tinnitus retrain-ing therapy. Front Neuroinform, 16:934433.
12. Jin Z, Zhang W, Liu H, et al (2022). Poten-tial therapeutic application of local an-esthetics in cancer treatment. Recent Pat Anticancer Drug Discov, 17(4):326-342.
13. Chatterjee N, Chattopadhyay D, Chatterjee I (2021). Management of tinnitus in covid-19 outbreak- a comparative study between mindfulness based tinnitus stress reduction and tinnitus retraining therapy. Int Tinnitus J, 25(1):29-33.
14. Lapenna R, Molini E, Cipriani L, et al (2021). Long-term results of tinnitus re-training therapy in patients who failed to complete the program. Audiol Res, 11(1):1-9.
15. Rodriguez CR, Piccirillo JF, Rodebaugh TL et al (2023). Acceptability of cognitive behavioral therapy for tinnitus: a study with veterans and nonveterans. Am J Audiol, 32(3):593-603.
16. Altissimi G, Musacchio A, Pace A, et al (2024). Sound therapy in patients with tinnitus: traditional sound generators vs. mobile apps. Eur Rev Med Pharmacol Sci, 28(11):3781-3786.
17. Alonso-Valerdi LM, Ibarra-Zárate DI, Torres-Torres AS, et al (2023). Compara-tive analysis of acoustic therapies for tinnitus treatment based on auditory event-related potentials. Front Neurosci, 17:1059096.
18. Tinnitus Retraining Therapy Trial Re-search Group; Scherer RW, Formby C (2019). Effect of tinnitus retraining ther-apy vs standard of care on tinnitus-related quality of life: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg, 145(7):597-608.
19. Suh MW, Park MK, Kim Y, et al (2023). The treatment outcome of smart device-based tinnitus retraining therapy: pro-spective cohort study. JMIR Mhealth Uhealth, 11:e38986.
20. Jia XD, Li YK, Xie CC, et al (2024). Effects of transcranial direct current stimulation combined with tinnitus retraining thera-py on sleep disorders in patients with chronic tinnitus. Eur Rev Med Pharmacol Sci, 28(5):1768-1776.
21. Tong Z, Deng W, Huang X, et al (2023). Ef-ficacy of tailor-made notched music training versus tinnitus retraining thera-py in adults with chronic subjective tin-nitus: a randomized controlled clinical trial. Ear Hear, 44(4):670-681.
22. Henry JA, Stewart BJ, Griest S, et al (2016). Multisite randomized controlled trial to compare two methods of tinnitus inter-vention to two control conditions. Ear Hear, 37(6):e346-e359.
23. Parazzini M, Del Bo L, Jastreboff M, et al (2011). Open ear hearing aids in tinnitus therapy: An efficacy comparison with sound generators. Int J Audiol, 50(8):548-553.
24. Hatanaka A, Ariizumi Y, Kitamura K (2008). Pros and cons of tinnitus retraining therapy. Acta Otolaryngol,128(4):365-368.
25. Han JJ, Lee JH, Oh SH, et al (2015). As-sessing the effects of tinnitus retraining therapy in patients lost to follow-up: a telephone survey. Otol Neurotol, 36(4):581-587.
26. Forti S, Costanzo S, Crocetti A, et al (2009). Are results of tinnitus retraining therapy maintained over time? 18-month follow-up after completion of therapy. Audiol Neurotol, 14(5):286-289.
27. Cima RF, Maes IH, Joore MA, et al (2012). Specialised treatment based on cogni-tive behaviour therapy versus usual care for tinnitus: a randomised controlled trial. Lancet, 379(9830):1951-1959.
28. Cuevas-Romero AR, Alonso-Valerdi LM, Intriago-Campos LA, et al (2022). An electroencephalography-based database for studying the effects of acoustic ther-apies for tinnitus treatment. Sci Data, 9(1):500.
29. Sacchetto L, Monzani D, Apa E, et al (2023). The effect of alpha-lipoic acid in the treatment of chronic subjective tin-nitus through the tinnitus handicap in-ventory scores. Audiol Res, 13(4):484-494.
30. Ward A, Farengo-Clark D, McKenna DB, et al (2024). Clinical management of TP53 mosaic variants found on germline genetic testing. Cancer Genet, 284-285:43-47.
31. Joergensen ML, Hyvärinen P, Caporali S, et al (2022). Broadband amplification as tinnitus treatment. Brain Sci, 12(6):719.
32. Simonetti P, Vasconcelos LG, Gândara MR, et al (2022). Hearing aid effective-ness on patients with chronic tinnitus and associated hearing loss. Braz J Oto-rhinolaryngol, 88 Suppl 3(Suppl 3):S164-S170.
33. Luyten TR, Jacquemin L, Van Looveren N, et al (2020). Bimodal Therapy for Chronic Subjective Tinnitus: A Random-ized Controlled Trial of EMDR and TRT Versus CBT and TRT. Front Psychol, 11:2048.
34. Kim SH, Kim I, Kim H (2024). Easing the burden of tinnitus: A narrative review for exploring effective pharmacological strategies. Cureus, 16(2):e54861.
35. Alashram AR (2025). Effects of tinnitus re-training therapy on patients with tinni-tus: a systematic review of randomized controlled trials. Eur Arch Otorhinolaryngol, 282(2):571-587.
36. Ravi P, Samayan K, Sivagnanapandian D (2025). Tinnitus Retraining Therapy: In Person Versus Mobile Application Based - Two Case Scenarios. Indian J Otolaryngol Head Neck Surg, 77(2):1142-1146.
| Files | ||
| Issue | Vol 55 No 1 (2026) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v55i1.20971 | |
| Keywords | ||
| Chronictinnitus Tinnitus retraining therapy (TRT) Long-term effects QoL Meta-analysis | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Wang M, Xiao N, Yao Q, Chen M, Zhu W. Evaluation of Long-Term Efficacy and Quality of Life of Tinni-tus Retraining Therapy in Patients with Chronic Tinnitus: A Meta-Analysis. Iran J Public Health. 2026;55(1):40-52.
