title: Outcomes of long-term outpatient tinnitus-coping therapy: psychometric changes and value of tinnitus-control instruments.
abstract: OBJECTIVE
  Increasing tinnitus compliance and coping are desirable aims of successful treatment in chronic tinnitus. However, application of established procedures such as tinnitus retraining therapy (TRT) is often relatively short. In addition, the value of tinnitus control instruments (TCI) is questionable, especially for minor severity levels of tinnitus, and the comparability of treatment results is low. To evaluate long-term changes of tinnitus-related distress, defined psychometric data were collected in patients with compensated tinnitus (cT) or decompensated tinnitus (dT) during a standardized 2-yr outpatient tinnitus-coping therapy (TCT).
  
  
  METHODS
  In a prospective clinical investigation, the data of 70 tinnitus patients were recorded at the beginning and at 6-mo intervals, with a final investigation after 24 mo. The first group consisted of 40 patients with cT and dT who were randomly assigned to a treatment group and a waiting-list control group. After a period of 12 mo without treatment, the control group was treated similarly. The tinnitus questionnaire (TQ) of Goebel and Hiller, visual analog scales (VAS), and a severity questionnaire for tinnitus-associated complaints were used as psychodiagnostic instruments. Therapy components consisted of counseling, fitting patients with TCIs (TCI provision), auditory and relaxation training, and psychosomatic care if necessary. A second group of 30 patients with cT receiving TCT without TCI devices was investigated to evaluate the additive efficacy of TCI in cT.
  
  
  RESULTS
  The initial TQ score did not differ between the treatment group and the waiting-list control group. After 12 mo, the control group did not show any significant changes, but the treatment group had improved significantly. During TCT, the combined data of both groups showed a statistically significant decrease of the TQ score in dT (59.1 to 34.8) and cT (32.8 to 24.0). These changes were especially reflected by the subscales of cognitive and emotional distress and also by the VAS and the severity questionnaire. dT patients benefitted without dependence on age or duration of pre-existing tinnitus; for cT patients, this was true mainly of the younger and older subjects and for tinnitus lasting for less than 1 yr. TCI provision improved the efficacy of TCT in patients with cT.
  
  
  CONCLUSIONS
  The psychometric changes demonstrate a clear decrease of tinnitus-related distress in all severity levels of sufficiently treated chronic tinnitus. Long-term TCT induces improvement even up to the time of 24 mo. With TCIs established particularly in patients with dT, our results suggest that a supporting adjustment of TCI devices is helpful in cT to foster quicker rehabilitation. The outpatient interdisciplinary TCT, consisting of cognitive tinnitus desensitization, TCI provision, and psychosomatic support if required, represents a successful treatment strategy for both dT and cT patients.
authors.affiliation: Department of Otorhinolaryngology, Charité-University Medicine Berlin, Joint Facility of Free University and Humboldt-University, Campus Charité Mitte, Berlin, Germany. philipp.caffier@charite.de
authors.forename: Philipp P
authors.initials: PP
authors.lastname: Caffier
authors.forename: Heidemarie
authors.initials: H
authors.lastname: Haupt
authors.forename: Hans
authors.initials: H
authors.lastname: Scherer
authors.forename: Birgit
authors.initials: B
authors.lastname: Mazurek
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015928:Cognitive Behavioral Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011594:Psychometrics; D011795:Surveys and Questionnaires; D014012:Tinnitus / Q000628:therapy*; D016896:Treatment Outcome