DESCRIPTION
Tinnitus describes the perception of any sound in the ear in the absence of an external stimulus and presents a malfunction in the processing of auditory signals; a hearing impairment, often noise-induced or related to aging, is commonly associated with tinnitus. Treatment is supportive in nature; there is no cure.
Tinnitus retraining, also referred to as tinnitus habituation therapy, is another treatment option, based on the theories of a researcher named Jastreboff. Jastreboff proposes that tinnitus itself is related to the normal background electrical activity in auditory nerve cells, but the key factor is the subject’s unpleasant perception of the noise, which is governed by an abnormal conditioned response in the extra-auditory limbic system. Tinnitus retraining focuses counseling and behavioral retraining on the associations induced by tinnitus perception. Specifically, the goal is not to eliminate the tinnitus itself, but to retrain the subcortical and cortical centers involved in processing the tinnitus signals. The counseling may require 4 to 6 one-hour visits over an 18-month period. As part of the overall therapy, maskers are used to induce habituation to the tinnitus. In contrast to the typical use of maskers, in retraining therapy, the masker is not intended to drown out or mask the tinnitus, but is set at a level such that the tinnitus can still be detected. This strategy is thought to enhance habituation by increasing the neuronal activity within the auditory system such that the tinnitus is difficult to detect.
POLICY
Tinnitus retraining therapy for the treatment of tinnitus is considered investigational.
The use of tinnitus maskers for the treatment of tinnitus is considered investigational.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Published scientific evidence in the form of well-designed studies in peer review journals is lacking regarding the effectiveness of tinnitus retraining therapy for the treatment of tinnitus.
Published scientific evidence in the form of well-designed studies in peer review journals is lacking regarding the effectiveness of tinnitus maskers for the treatment of tinnitus.
SOURCES
Bauer, C. A., & Brozoski, T. J. (2011). Effect of tinnitus retraining therapy on the loudness and annoyance of tinnitus: A controlled trial. Ear and Hearing, 32 (2), 145-155. (Level 3 Evidence - Independent study)
BlueCross BlueShield Association. Medical Policy Reference Manual. (5:2011). Treatment of tinnitus (8.01.39). Retrieved July 19, 2011 from BlueWeb. (32 articles and/or guidelines reviewed)
Complete Guide to Medicare Coverage Issues [Computer Software]. (2011, April). Tinnitus masking (NCD 50.6, p. 2-38). Ingenix.
Fioretti, A., Eibenstein, A., & Fusetti, M. (2011). New trends in tinnitus management. The Open Neurology Journal, 5, 12-17.
Frank, W., Konta, B., & Seiler, G. (2006). Therapy of unspecific tinnitus without organic cause. GMS Health Technology Assessment, 2 (Doc. 17), 1-24.
Han, B. I., Lee, H. W., Kim, T. Y., Lim, J. S., & Shin, K. S. (2009). Tinnitus: Characteristics, causes, mechanisms, and treatments. Journal of Clinical Neurology, 5 (1), 11-19.
Henry, J. A., Loovis, C., Montero, M., Kaelin, C., Anselmi, K. A., Coombs, R., et al. (2007). Randomized clinical trial: Group counseling based on tinnitus retraining therapy. Journal of Rehabilitation Research and Development, 44 (1), 21-32. (Level 2 Evidence - Independent study)
Phillips JS, McFerran D. Tinnitus Retraining Therapy (TRT) for tinnitus. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD007330. DOI: 10.1002/14651858.CD007330.pub2.
Seidman, M. D., Standring, R. T., & Dornhoffer, J. L. (2010). Tinnitus: Current understanding and contemporary management. Current Opinion in Otolaryngology & Head and Neck Surgery, 18 (5), 363-368.
U. S. Food and Drug Administration. (2008, March). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K073636. Retrieved July 19, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf7/K073636.pdf.
U. S. Food and Drug Administration. (2007, July). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K070599. Retrieved July 19, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf7/K070599.pdf.
U. S. Food and Drug Administration. (2006, June). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K061459. Retrieved July 19, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf6/K061459.pdf.
U. S. Food and Drug Administration. (2005, January). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K043274. Retrieved July 19, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf4/K043274.pdf.
ORIGINAL EFFECTIVE DATE: 12/1/2002
MOST RECENT REVIEW DATE: 8/11/2011
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