Idiopathic Tinnitus, and Tinnitus Retraining Therapy (TRT). Can an open-access program be used for Treatment?

Background: Tinnitus retraining therapy (TRT) is a widespread treatment for tinnitus and hyperacusis, although its effectiveness has been very much doubted in the last years. However, it is based on face-to-face education and a schedule. The use of smart devices (mobile phones, PCs, laptops) for TRT (smart-TRT) seems to offer numerous advantages. It has been questioned whether this new treatment is effective. The purpose of this trial was to compare the effectiveness of smart TRT. Methods: in this prospective trial 78 individuals (41 women, 37 men) with tinnitus. The prior audiograms either showed any degree of hearing loss (sensory type or conduction) or a mild degree of hearing loss (ability to hear sounds at 30 dB, n = 14 patients). The patients were treated with the application MyNoisenet, which produced white noise. All participants have also received counseling aiming to develop a neutral response to the conditions' sounds. The primary measure was the change in the Tinnitus Handicap Inventory (THI) score, and the secondary outcome measure was the change in the visual analog scale (VAS) score. A further outcome was the change in psychological burden as measured using the State-Trait Anxiety Inventory (STAI) Idiopathic questionnaire. The duration of TRT was 14,1 months (SD ±4,2 months). The findings of this group were compared with those of a corresponding group of patients (n=74) who, however, did not receive similar treatment (they were in the stage of initial treatment and evaluation). Results: THI scores decreased significantly among sequential measurements in tinnitus patients [median: 45 (24-65) before vs 36 (19-55) after, p = 0.009]. Tinnitus patients also exhibited a significant decrease in STAI1 [median: 43 (30-56.5) before vs 37 (26-49) after, p <0.001] and STAI2 scores [mean: 43.3 ± 12.8 before vs 37.6 ± 12.5 after, p <0.001] across all assessments. The VAS score was significantly decreased [median: 6 (5-7) before vs 5 (4-5.5) after, p < 0.001) The final clinical response (final test score) was associated with the severity of the initial symptomatology but did not differ significantly between patients with normal audiograms and those with mild hearing loss. Conclusion: Tinnitus can be effectively treated with the systemic use of smart TRT. This approach is very effective in lowering the symptoms of tinnitus and hyperacusis as well as the associated suffering. Additionally, it also allows for a significant decrease in concurrent mental symptoms like depression.