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.
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
Bartnik, G., Fabijanska, A., & Rogowski, M. (2001). Effects of tinnitus retraining therapy (TRT) for patients with tinnitus and subjective hearing loss versus tinnitus only. Scandinavian Audiology Supplementum, (52), 206-8. Abstract retrieved April 29, 2002 from PubMed database.
BlueCross BlueShield Association. Medical Policy Reference Manual. (2:2008). Treatment of tinnitus (8.01.39). Retrieved October 20, 2008 from BlueWeb.
Complete Guide to Medicare Coverage Issues [Computer Software]. (2008, July). Tinnitus masking (NCD 50.6, p. 2-36). St. Anthony Publishing.
Kroener-Herwig, B., Biesinger, E., Gerhards, F., Boebel, G., Verena Greimel, K., & Killer, W. (2000). Retraining therapy for chronic tinnitus. A critical analysis of its status. Scandinavian Audiology, 29 (2), 67-78. Abstract retrieved April 29, 2002 from PubMed database.
von Wedel, H., & von Wedel, U. C. (2000). An assessment of tinnitus retraining therapy. HNO, 48 (12), 887-901. Abstract retrieved April 29, 2002 from PubMed database.
ORIGINAL EFFECTIVE DATE: 12/1/2002
MOST RECENT REVIEW DATE: 12/11/2008
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