Tinnitus management by Internet/smartphone‑based
applications
Description of the condition
Tinnitus can be described as the perception of sound in the absence of external acoustic
stimulation (Luxon 1993)1 . The quality of the perceived sound can vary enormously from simple
sounds such as whistling or humming to complex sounds such as music. The patient may hear a
single sound or multiple sounds.
Tinnitus may be perceived in one or both ears, within the head or outside the body. The
symptom may be continuous or intermittent. Tinnitus is described in most cases as subjective meaning that it cannot be heard by anyone other than the patient. While, for the patient, this
perception of noise is very real, because there is no corresponding external sound it can be
considered a phantom, or false, perception.
Objective tinnitus is a form of tinnitus which can be detected by an examiner, either unaided or
using a listening aid such as a stethoscope or microphone in the ear canal. This is much less
common and usually has a definable cause such as sound generated by blood flow in or around
the ear, elevated level of spontaneous otoacoustic emissions (SOAEs) or unusual activity of the
tiny muscles within the middle ear. Tinnitus may be associated with normal hearing thresholds
or any degree of hearing loss and can occur at any age, with higher incidence in the age group
between 50 and 70 years (Davis 2000)2.
It is important to distinguish between clinically significant and non-significant tinnitus (Davis
2000)2 and several different classifications have been proposed (Dauman 1992; McCombe 2001;
Stephens 1991)3,4,5. Dauman, for example, makes a distinction between 'normal' (lasting less
than five minutes, occurring less than once a week and experienced by most people) and
'pathological' tinnitus (lasting more than five minutes, occurring more than once a week and
usually experienced by people with hearing loss). Tinnitus can also be divided into clinical
tinnitus, when the sufferers are actively seeking help, and people who experience tinnitus but
are well habituated and not seeking help.
Aetiology
Almost any form of disorder involving the outer, middle or inner ear or the auditory nerve may
be associated with tinnitus (Brummett 1980; Shea 1981) 6,7. However, it is possible to have
severe tinnitus with no evidence of any aural pathology. Conversely, tinnitus can even persist
without a peripheral auditory system: unilateral tinnitus is a common presenting symptom of
vestibular schwannomas (acoustic neuromas), which are rare benign tumours of the vestibulocochlear nerve. When these neuromas are removed by a trans labyrinthine route, the cochlear
nerve can be severed. Despite the effective removal of their peripheral auditory mechanisms,
60% of these patients retain their tinnitus postoperatively with no apparent change in the
characteristics (Baguley 1992) 8. This suggests the fundamental importance of the central
auditory pathways in the maintenance of the symptom, irrespective of the initial mode of
generation being the cochlea or the vestibulo-cochlear nerve. Many environmental factors can
also cause tinnitus, mostly related to the effect of noise on the auditory system and resultant
damage to the microstructures in the cochlea. The most relevant and frequently reported are:
acute acoustic trauma (AAT) (for example, explosions or gunfire ; airbag inflation; toy pistols ;
exposure to occupational noise; 'urban noise pollution' and exposure to recreational and
amplified music. 9
Diagnosis
Firstly a patient with tinnitus may undergo a basic clinical assessment. This will include the
relevant otological, general and family history, and an examination focusing on the ears, teeth
and neck and scalp musculature. Referral to a specialist is likely to involve a variety of other
investigations including a full audiological test battery of pure-tone audiometry, speech
audiometry, tympanometry and stapedial reflexes as well as specific tinnitus evaluation tests
pitch and loudness match, minimal masking levels and residual inhibitions. Persistent, unilateral
tinnitus and pulsatile tinnitus may be due to a specific disorder of the auditory pathway.
Special audiological test batteries include auditory brainstem responses and
videonystagmography, which are important to ascertain any retrocochlear pathology, and
imaging of the cerebellopontine angle, which is important to exclude, for example, a vestibular
schwannoma (acoustic neuroma) - a rare benign tumour of the vestibular nerve. Other
pathologies, such as glomus tumours, meningiomas, multiple sclerosis, adenomas, vascular
lesions or neurovascular abnormalities may also be detected by imaging (Marx 1999; Weissman
2000) 10.
Treatment
There are two levels of management regarding treatment of tinnitus:
i) Habituation of reaction; which aims to decrease the psychological effects of tinnitus (such as
insomnia, depression and anxiety) and
ii) Habituation of perception; which aims to decrease the tinnitus sensation so that the sufferer
will stop hearing the sounds altogether (Jastreboff 2000) 11.
At present there are different management protocols which show considerable success in
achieving the first goal, although no specific therapy for tinnitus is acknowledged to be
satisfactory in all patients regarding the second goal. The majority of patients who complain of
tinnitus also have a significant hearing impairment. For these patients a hearing aid will be the
first line of treatment. Not only will this help their hearing disability and handicap but the
severity of their tinnitus may be reduced. A wide range of management protocols have been
proposed for the treatment of tinnitus.
Pharmacological interventions include cortisone (Koester 2004) 12, vasodilators,
benzodiazepines, lidocaine and spasmolytic drugs. The use of anticonvulsants in treating tinnitus
is the subject of a Cochrane Review (Hoekstra 2011) 13. Antidepressants are commonly
prescribed for tinnitus, however, two reviews showed that there is no indication that tricyclic
antidepressants have a direct effect on the tinnitus sensation, unless depression is caused by or
associated with the tinnitus complaint (Baldo 2012; Robinson 2007) 14,15 . Although a number
of studies have suggested that Ginkgo biloba may be of benefit in the treatment of tinnitus
(Ernst 1999; Rejali 2004) 16,17, a Cochrane Review showed that there was no evidence that it is
effective where tinnitus was the primary complaint (Hilton 2004) 18. Hyperbaric oxygen therapy
(HBOT) can improve oxygen supply to the inner ear which is suggested to result in an
improvement in tinnitus, however a Cochrane Review found insufficient evidence to support
this (Bennett 2012) 19. Studies have been carried out into the effect of cognitive behavioural
therapy (CBT) on tinnitus and Cochrane Review has shown that CBT can have an effect on the
qualitative aspects of tinnitus and can improve patients' ability to manage the condition
(Martinez-Devesa 2010) 20 . Other options for the management of patients with tinnitus include
transcranial magnetic stimulation (Meng 2011) 21, music therapy (Argstatter 2008)22,
reflexology, hypnotherapy, mindfulness and traditional Chinese medicine (TCM), including
acupuncture (Li 2009)23. This review considers the role of sound therapy devices in tinnitus.
Description of the intervention
Sound therapy devices were introduced on the principle of distraction: that if a level of noise,
usually 'white noise' is introduced it can reduce the contrast between the tinnitus signal and
background activity in the auditory system, with a decrease in the patient's perception of their
tinnitus (Vernon 1977) 24. It has long been known that appropriate external sounds can
diminish or even render tinnitus inaudible. Spaulding in 1903 used a piano to match the
frequency of tinnitus in his patients - he subsequently played a note at a similar frequency,
increasing the volume until the tinnitus became inaudible (Spaulding 1903) 25. In the 1920s,
Jones and Knudsen developed a portable machine which could be used as a tinnitus masker
(Jones 1928) 26. More recently, Vernon pioneered the introduction of hearing aid-like devices
designed to produce noise in the ear (Vernon 1977) 24. Initial approaches to sound therapy
involved 'complete masking' whereby the masking noise is raised in intensity until the tinnitus
becomes inaudible (Coles 1997) 27.
In the early 1980s a large, complex study of sound therapy devices included white noise
generators and combination hearing aids and noise generators (Hazell 1985; Stephens 1985)
28,29. Further work stemming from this study showed that rather than using a volume of noise
that would mask tinnitus, a low (minimally appreciable) level white noise treatment could be
used to achieve downregulation ("habituation of the disordered auditory perception"). This was
based on the principle that if the patient cannot hear their tinnitus (as in complete masking)
then they will not be able to habituate to it (Jastreboff 1995; McKinney 1995) 30,31. Another
important benefit that was suggested from using sound therapy was the concept of 'sound
enrichment', in which the white noise also acts as a source of stimulation to the central auditory
system to compensate for the loss of auditory stimulation arising from the cochlea in patients
with hearing loss. This would prevent sensory deprivation, which is one of the theories of
tinnitus generation. It is important to emphasise that sound enrichment is intended to achieve
audiological masking not immediate residual inhibition.
Subsequent research has refined the instruments and sought biological evidence for this theory.
Low-level white noise (noise generators)is offered regularly as an elementin many management
protocols for tinnitus, rather than 'maskers' aimed at 'complete or partial masking' of the
tinnitus in the audiological sense of the word. The effective use of noise generators involves
determining the optimal volume for the device and this will depend on the philosophy behind
the management protocol. Protocols targeting partial or complete masking aim to establish a
masking level that patients find more acceptable than their tinnitus (Vernon 2003) 32.
Often patients are able to achieve effective tinnitus masking at sound levels that are not very
loud, however if the masking needs to be raised to an uncomfortable level to mask the tinnitus
then that patient is not an ideal candidate for masking. If the philosophy is towards sound
therapy and sound enrichment, then the noise generator is adjusted to a level where the patient
can hear both their own tinnitus and the external noise at the same time and the adjustment
seeks to establish the 'blending point'. This protocol is used in tinnitus retraining therapy
(Jastreboff 2000) 33.
Currently, sound therapy devices tend to be worn as in the ear or behind the ear (BTE) devices.
They can output a broad spectrum of white noise or they may be focused to the frequency band
of the patient's tinnitus. They may be combined with a hearing aid to augment a patient's
hearing. Sound therapy devices can also take the form of CDs and music cassettes that play a
similar white noise or music but through conventional stereophonic equipment. All of these
forms of devices are considered in this review.
References:
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2. Davis A, El Refaie A. Epidemiology of tinnitus. In: Richard Tyler editor(s). Tinnitus
Handbook. San Diego: Singular Publishing Group, 2000.
3. Dauman R, Tyler RS. Some considerations on the classification of tinnitus. Proceedings
of the Fourth International Tinnitus Seminar, Bordeaux. 1992:225-9.
4. McCombe A, Baguley D, Coles R, McKenna L, McKinney C, Windle-Taylor P. Guidelines
for the grading of tinnitus severity: the results of a working group commissioned by the
British Association of Otolaryngologists – Head and Neck Surgeons. Clinical
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consensus. Audiology 1991;20:185-200.
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1981;4:149-50.
8. Baguley DM, MoHat DA, Hardy DG. What is the effect of translabyrinthine acoustic
schwannoma removal upon tinnitus?. Journal of Laryngology and Otology
1992;106:329-31.
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tinnitus in adults. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.:
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treatment of tinnitus and hyperacusis patients. Journal of the American Academy of
Audiology 2000;11(3):162-77.
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and prognosis. MMW Fortschritte der Medizin 2004;146(1-2):23-4, 26-8; quiz 29-30.
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Database of Systematic Reviews 2011, Issue 7.
14. Baldo P, Doree C, Lazzarini R, Molin P, McFerran DJ. Antidepressants for patients with
tinnitus. Cochrane Database of Systematic Reviews 2012, Issue 9.
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2007;166:263-71.
16. Ernst E, Stevinson C. Ginkgo biloba for tinnitus: a review. Clinical Otolaryngology
1999;24:164-7.
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randomized placebo-controlled double-blind trial and meta-analysis of randomized
trials. Clinical Otolaryngology 2004;29(3):226-31.
18. Hilton M, Stuart E. Ginkgo biloba for tinnitus. Cochrane Database of Systematic Reviews
2004, Issue 2.
19. Bennett MH, Kertesz T, Yeung P. Hyperbaric oxygen for idiopathic sudden sensorineural
hearing loss and tinnitus. Cochrane Database of Systematic Reviews 2012, Issue 10.
20. Martinez-Devesa P, Waddell A, Perera R, Theodoulou M. Cognitive behavioural therapy
for tinnitus. Cochrane Database of Systematic Reviews 2010, Issue 9.
21. Meng Z, Liu S, Zheng Y. Repetitive transcranial magnetic stimulation for tinnitus.
Cochrane Database of Systematic Reviews 2011, Issue 10.
22. Argstatter H, Krick C, Bolay HV. Music therapy in chronic tonal tinnitus. Heidelberg
model of evidence-based music therapy. HNO 2008;56(7):678-85.
23. Li Y, Zeng RF, Zheng D. Acupuncture for tinnitus. Cochrane Database of Systematic
Reviews 2009, Issue 4.
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1977;2:124-31.
25. Spaulding JA. Tinnitus: with a plea for its more accurate musical notation. Archives of
Otolaryngology 1903;32:263-72.
26. Jones IH, Knudsen VO. Certain aspects of tinnitus, particularly treatment. Laryngoscope
1928;38:597-611.
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Butterworth-Heinemann, 1997.
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clinical study of tinnitus maskers. British Journal of Audiology 1985;19:65-146.
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Audiology 1985;19:159-67.
30. Jastreboff PJ. Processing of the tinnitus signal within the brain. Proceedings of the FiLh
International Tinnitus Seminar. Portland: American Tinnitus Association, 1995:498-9.
31. McKinney CJ, Hazell JWP, Graham RL. Retraining therapy - outcome measures.
Proceedings of the FiLh International Tinnitus Seminar. Portland: American Tinnitus
Association, 1995:498-9.
32. Vernon JA. Masking devices and alprazolam treatment for tinnitus. Otolaryngologic
Clinics of North America 2003;36:307-20.
33. Jastreboff PJ, JastreboH MM. Tinnitus retraining therapy (TRT) as a method for
treatment of tinnitus and hyperacusis patients. Journal of the American Academy of
Audiology 2000;11(3):162-77.
In recent years, there has been a growing interest in the internet and smartphone-based
technologies for the management of individuals with tinnitus. There is a broad spectrum of
approaches relevant to the treatment of tinnitus, which could be through experimental studies
or through products that are marketed that have been reported in the literature. They include
questionnaires, auditory treatments, internet-based cognitive behavioral therapy (iCBT) [24],
and games present in different operating systems, including web/android/iOS for tinnitus
monitoring and management. There are number of studies carried out in line with internetdelivered cognitive behavioural therapy (iCBT) and have reported mostly positive effects on
tinnitus-related distress and other associated symptoms in comparison to many other forms of
treatments [4, 43]. However, a review of the other treatment procedures using the internet and
smartphone platform except for iCBT is very scarce. The goal of this review is to underline the
role of existing internet-based and smartphone technologies for the betterment of
tinnitusrelated problems.
Method
The study was undertaken to investigate the efficacy of smartphone- and internet-based
services for tinnitus management. The review solely comprises original scientific articles that
report on the treatment of tinnitus and, also, a dedicated section to showcase the market
overview other than the main review.
Efficacy of treatment
The studies reviewed considered various smartphone- or computer-based internet applications
in treating tinnitus and were found to be beneficial in the treatment of tinnitus. However, the
results varied as the outcome measures used also varied which included different
questionnaires and rating scales along with quantitative analysis in a few studies. All the studies
considered measured the outcome of the treatment using a questionnaire along with a rating
scale for annoyance and loudness, except for the mobile serious game, which was measured by
calculating the average playing time of an individual. However, this mobile application
considered only two participants with tinnitus and hence making it difficult to generalize. The
details of different outcome measures used in evaluating the efficacy of treatment are provided
in Table 1.
Discussion
With the introduction of mobile applications for different health-related management, there is a
proliferation of apps even for the management of tinnitus. However, most of the apps are more
concentrated in providing different types of sound, whereas few apps are providing other
benefits, also including counseling, education, and sound generators. A detailed discussion of
the apps that have empirical data is provided in this section. A review of Cochrane library by
Hobson et al. [18] along with Clinical Practice guideline by the American Academy of
Otolaryngology-Head and Neck Surgery Foundation [41] concluded that cognitive behavioral
therapy (CBT) had the strongest evidence base for tinnitus management. Internet-based CBT
(iCBT) is an approach that delivers cognitive behavioral therapy via the internet. It was found
that currently, this method is the best-documented and most researched treatment option
when it comes to internetbased services. Acceptance and commitment therapy (ACT) can be
delivered in a self-help format via the internet as well [44]. A study by Hesser et al. [17]
compared iACT with iCBT and revealed a substantial improvement for both iCBT and iACT, with
no signifcant diference between the two treatments. Self-help intervention has been an
alternative for traditional face-to-face intervention as individuals who are unwilling and access
denied are free to work at home at their own pace. Few of the advantages that internetdelivered interventions provide include that it can reach vast audience with interactive
functions, easily adapt to the needs of an individual, provide a sense of seclusion for the user [3,
27, 42]. However, the cons of internet-delivered interventions include a high rate of withdrawal
and non-usage attrition, especially when the intervention lacks guidance [2, 9], but there is
mixed evidence in case of tinnitus management.
Tinnitus E‑programme
The primary aim of E-tinnitus was to provide a resource to the professionals in the health care
sector, although it is designed in such a way that even people with tinnitus can use this program
independently. The therapy design was customizable and was user-led making the program
more beneficial for the user. The users predominantly control the program;
however, they are also provided with the option of contacting a therapist (second author).
Different aspects of tinnitus are covered in this program, which includes the role of psychological mechanisms in tinnitus (psycho-education), education about tinnitus along with attention
focus, and relaxation exercises. Unlike many other treatment programs, TEP terminates with a
4-week maintenance period wherein the users have the advantage of revisiting the program and
practice the skills required by them. One of the first evaluations did on tinnitus patients using
the TEP program demonstrated potential findings. There is also a platform for the users to
contact each other, known as the “peer-to-peer access.” Featherstone (2012) evaluated the
treatment outcome in 23 patients with tinnitus. On comparison of the scores obtained using the
tinnitus questionnaire at baseline and after the 10-week session, there was a reduction in the
scores for tinnitus distress for 47% of the participants. One of the major disadvantages of this
program is that a precise mechanism by which tinnitus distress reduces is not established.
Mobile serious game
It is based on the fact that in individuals with tinnitus, the inhibitory mechanism in the brain that
is the noise-canceling system is dysfunctional. Hence, such disorders characterized by
neuroplastic changes can be treated by training procedures that enhance the compensatory
mechanisms. This approach might attract the attention of younger adults with tinnitus as it is in
the form of a game wherein the participants are instructed to identify the direction of the
sound.
Compared to traditional approaches, the positives of this approach are higher enjoyment;
anytime, accessibility can be made more competitive by increasing the game difficulty level as
well as provide immediate feedback to the users. A few of the challenges faced by this method
were related to sensors that required the application of several filters based on the operating
systems along with 3D audio features of the game. A user study was conducted to check the
applicability of the game. Although the game was developed mainly for individuals with tinnitus,
the user study included just two individuals with tinnitus, which serves as a shortcoming of
validation. The overall analysis depicted a difference in reaction or playing time with different
operating systems (iOS=9.8 s; Windows=15.8 s; Android=12.1 s). Despite the differences in
playing time for different platforms, it was concluded that all of them were acceptable in a
clinical context.
Tinnitus coach app
This app was designed for users to identify the situations of distress during tinnitus and apply a
suitable coping strategy among many such strategies. It consisted of four sections: sampler,
learning nook, add and use plans and find support. The benefits of this app were that all the
sections were easily comprehensible and also users could find extended support when needed.
Also, the “add and use” section could be customized according to the user requirements.
Although the app was user-friendly, few problems were identified during the usability testing
phase and the problems being, confusion with the label buttons, insufficient user instructions,
and intext input areas. During the field study phase, participants were provided with an
additional smartphone (iPhone 5S) due to privacy reasons. However, this served as one of the
drawbacks of the study as few participants considered for the field study declared that they
discontinued the use of the app as they had to carry an extra phone with them.
Harmonic web‑based customized sound therapy
The advantage of this method was that they promoted the use of Air Drives Interactive Stereo
Earphone (Mad Catz Inc, San Diego, CA), which does not isolate the person undergoing therapy
from other environmental sounds. The speaker is positioned outside the ear, and the sounds are
transmitted via the tragal cartilage helping in reducing acoustic isolation. Also, the use of MP3
players 2 GB Sansa Clip MP3 player (San Disk, Milpitas, CA) further added in cost-effective
management as most of them can afford this over other sound generators. The option to select
unilateral or bilateral tinnitus helps in balancing the pitch-matched sound quality in both ears to
allow for asymmetry and hearing loss. The customized sound therapy file is constructed on an
individual basis by procuring all the different information stages of the web-based procedure.
The customized sound is composed of multiple narrow-band noise peaks centered at the
frequency of tinnitus and its first and fifth harmonics, with its width being one-half the octave
center frequency.
The advantage is that although it sounds like white noise, the amount of energy required is
greatly reduced by centering at the tinnitus frequency. The efficacy of this form of treatment
was good. It was found that 81% of the patients reported a significant reduction in tinnitus
loudness and annoyance, whereas 16% reported no change in these aspects. Only a small group
of people, that is, 3% had an increased sensation of tinnitus loudness and annoyance.
Tailor‑made notch music therapy delivered
through smart phone The cons of the study include no control group, which reduced or limited
the statistical significance. Also, it included participants who had chronic tinnitus alone. Hence, it
is unclear whether this form of therapy would provide improvement in individuals with other
degrees of tinnitus.
However, the improvement was good with this therapy form and is found to be more benefcial
in individuals whose tinnitus is of recent onset of fewer than 3 months. Grapp et al. [10] stated
that notch music therapy could result in increasing the severity of tinnitus in individuals with an
acute form of tinnitus. One of the reasons for betterment in chronic tinnitus patients could be
that the maladaptive reorganization of the auditory cortex is more susceptible to chronic than
an acute form of tinnitus and hence, the higher chance of restoration in them. Therefore, there
is no empirical data that suggest an improvement of tinnitus effects in a mild or moderate form
of tinnitus, which acts as a disadvantage to these groups. A few other drawbacks include costly
hearing equipment along with repetitive music listening which is required for reorganization.
There was no attempt made to check the long-term outcome of the combined treatment.
However, it is impossible to decide that the efficacy of treatment was solely by tailor-made
notch music therapy, as Gingko Biloba’s treatment was also provided complimentary to it. The
study could have been better if there were three groups that received different treatments;
notch music therapy alone, Gingko Biloba treatment alone and, a combination of these two
approaches so that there would have been a clear tracking of the efficacy of different methods.
The positives of notch music training would be making the therapy process enjoyable with music
customized according to the needs of the seeker. Also, the mode of delivery and instructions are
made easier at the receiver’s end. On a general note, with advancements in technology,
smartphone apps are more widely accepted and accessible than computer-based internet
applications. One of the major disadvantages would be portability. Also, mobile apps are
preferred over websites due to the ease in approaching the treatment and also the appeal that
an app would provide. Mobile applications are also known for their faster performance than the
websites. The data storage happens locally, making it easy to retrieve. Therefore, smartphonedelivered tinnitus therapy is a more promising method in terms of both cost and clinical
outcomes.
Conclusions
Although there seems to be a virtual gap in understanding the pathophysiology of tinnitus and
the possible treatments for the same, the treatment options have increased on a time axis.
Currently, individuals suffering from tinnitus are showing improvement with counseling, sound
therapy, and cognitive behavioral therapy along with other medical/drug therapies. However, it
is always encouraging to have a treatment form with an internet or web-based platform for
those users who have a barrier for a face-to-face session. This systematic literature review
shows that there is a similar improvement in both the traditional as well as an internet-delivered
form of tinnitus treatment in individuals with tinnitus. Looking towards the future treatment of
tinnitus, the development of new apps or internet-delivered tinnitus treatment would have a
huge impact. Hence, more user-friendly and therapy-assisted applications are required.
Limitations and future directions
Few of the apps were more often aimed in the direction of the patients or the end-users rather
than the therapist or the health care professionals. The usability of the app would be good if the
end-users can rely on a therapist for queries. Future studies must work on addressing the
efficacy of the app and validate the applications on different operating platforms having
participants consisting of individuals with tinnitus. As tinnitus is a highly variable condition,
there has to be some effort made in checking whether if there is a maintenance of the coping
strategies learned through the app by conducting few tests periodically.
Study
Greenwell et al.
Schickler et al.
Launched on
June 2009
2016
Characteristics
CBT-based process
-education and psychoeducation about tinnitus
-relaxation exercises
-attentional focus exercise
Audio Defense
Population type (n)
Individuals with tinnitus (n=23)
Rehabilitative strategy studied
TEP (Tinnitus EProgram)
Included 24 participants among
whom 2 participants had tinnitus
(n=24)
Mobile serious games
Outcome
Self-designed questionnaire and THI; It was administered as a base line as
well as after 10 weeks of TEP usage Showed a significant reduction in
tinnitus distress
Mode of delivery
Internet-delivered
Advantages
Easily accessible by people with tinnitus can contact the therapist for
assistance available for free Offers downloadable information sheets and
digital audio files Program structure can be modified as per the needs
anytime available Higher enjoyment Immediate feedback
Step-wise increase the ingame difficulty
Disadvantages
Not formally evaluated [formally evaluated by the Nottingham Hearing
Biological Research Unit (NHBRU), part of the National Institute of Health
Research (NIHR) the UK] The precise mechanism by which tinnitus distress
reduces is not established.
47% of patients with mild to severe degree of tinnitus distress before the
treatment reported no presence of distress after the treatment
The study included only two individuals with tinnitus
Efficacy of the
treatment
The study compared the applicability on different platforms
outcome measures were average playing time and angle of fset
Results indicated a difference in playing time and angle
of fsets across platforms; however, all mobile platforms were
appropriate for clinical context
Android-iOS, Windows
Not applicable as only two individuals had tinnitus
Study
Henry et al.
Mahboubi et al
Young et al.
Launched on
July 2017
August 2012
Septembre 2016
Characteristics
Incorporates those taught as a part of
progressive Tinnitus Management (PTM)
Includes four steps: (1) finding the tinnitus type;
(2) re-matching tinnitus frequency to eliminate octave
confusion; (3) to select if tinnitus is unilateral or
bilateral; (4) Download the customized sound file from
website to MP3 player
Tailor-made notch music is delivered after
registering to the application for 30–60 min per day
for 3 months
Population type (n)
Individuals with bothersome tinnitus (n=25)
Individuals with bothersome tinnitus (n=32)
Individuals with chronic tinnitus (n=26)
Rehabilitative strategy
studied
Tinnitus coach app (prototype)
Harmonic webbased sound therapy
Tailor-made notch music therapy delivered through
smart phone
Outcome
General tinnitus questionnaire Tinnitus
Functional Index (TFI) App usage data were
extracted from the phones Exit interview after
the termination of treatment using the app
Tinnitus Handicap Inventory (THI). Also, a visual
analog scale that measures the efects of tinnitus
in terms of loudness, noticeable time, annoyance,
and disruption of daily life.
Mode of delivery
iOS (not installed on the participant’s phone
due to privacy reasons; all participants were
provided with iPhone 5 s for the study)
Consisted of FAQs, so that participants could
easily solve their issues
Tinnitus loudness and annoyance were measured by
visual analog scales (VAS) before and after treatment
If there was a reduction in the loudness and annoyance
of tinnitus, the duration of reduction was recorded in
residual inhibition Mean, SD, range along with a
reduction in loudness and residual inhibition was
compared using non-parametric tests.
Web-based procedure (internet delivered)
Promoted the use of stereo earphones that help in
acoustic isolation not much assistance was required in
carrying out the procedure
The precise mechanism by which tinnitus distress
reduces is provided; based on the notion that
maladaptive auditory cortex reorganization causes
tinnitus.
Absence of a control group the interaction effect
between the treatment methods was not found.
Advantages
Disadvantages
Efficacy of the
treatment
Overall app navigation was difficult
Individuals who had hissing/ buzzing tinnitus showed
more reduction in tinnitus loudness (92.3) compared to
tonal/ ringing (57.9) due to the characteristic of the
harmonic sound delivered The sample size is small
Lack of a control group for comparison
81% had reduced tinnitus distress, 16% reported no
change, and 3% had an increased sensation
Table 1 Profiling of the studies included in the systematic review
Smartphone application
THI scores improved from 33.9±18.9 to 23.1±15.2
Individuals with TEP (Tinnitus E-Self-designed Internet-deliv-Easily accessible
Not formally
47% of patients
[12]
process
-education and psychoeducation about tinnitus
-relaxation exercises
-attentional focus exercises
tinnitus (n = 23) Program)
questionnaire and THI
It was adminis- tered as a base- line as well as after 10 weeks of TEP usage
Showed a signifi- cant reduction in tinnitus distress
ered
by people with tinnitus
Can contact the therapist for assistance
Available for free Offers download- able informa- tion sheets and digital audio
files Program structure can be modified as per the needs
evaluated [for- mally evaluated by the Notting- ham Hearing Biological Research Unit (NHBRU),
part of the National Insti- tute of Health Research (NIHR) the UK]
The precise mechanism by which tinnitus distress reduces is not estab- lished
with mild to severe degree of tinnitus distress before the treat- ment reported no presence of distress after the treatment
Schickler et al.
–
Included 24 Mobile serious
The study
Android iOS
anytime available
The study
Not applicable
[37]
participants among whom 2 partici- pants had tinnitus (n = 24)
game
compared the applicability on different platforms
Outcome measures were average playing time and Angle offset
Results indicated a difference in playing time and angle offsets across platforms; how- ever, all mobile platforms were appropriate for
Windows
Higher enjoy- ment
Immediate feed- back
Step-wise increase the in- game difficulty
included only two individuals with tinnitus
as only two individuals had tinnitus
clinical context