Comparative Effectiveness of Sound Therapy, transcranial direct current stimulation, and low-level laser therapy for Chronic Tinnitus Management
,
Abstract
Background and Aim: Tinnitus, the perception of sound without an external source, can significantly impact one’s quality of life. Although no definitive cure exists, various treatments aim to reduce symptoms. This study aimed to evaluate the results of the sound therapy, transcranial direct current stimulation (tDCS), and low-level laser therapy (LLLT) in managing chronic tinnitus.
Methods: In a randomized clinical trial, 78 adults with chronic tinnitus and normal hearing were divided into three groups to receive either sound therapy, (tDCS), (LLLT). All participants received treatment over six weeks. Psychoacoustically, we assessed tinnitus pitch, loudness, minimum masking level (MML), and residual inhibition (RI). Loudness and distress were also measured using visual analog scales (VAS), and functional impact was evaluated using the Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (TFI). Auditory Brainstem Response (ABR) testing was performed to assess neural conduction.
Results: All interventions significantly reduced tinnitus loudness, MML, and distress (p < 0.05). Sound therapy showed the most significant improvements in THI, TFI, and VAS scores. No significant changes were found in ABR latencies. Post-hoc analysis revealed greater benefits in the sound therapy group for THI and TFI compared to the others.
Conclusion: While all approaches showed promise in reducing tinnitus symptoms, sound therapy proved to be the most successful intervention. To improve procedures and investigate customized strategies, more research is required.
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9. Neff P, Langguth B, Schecklmann M, Hannemann R, Schlee W. Comparing Three Established Methods for Tinnitus Pitch Matching With Respect to Reliability, Matching Duration, and Subjective Satisfaction. Trends Hear. 2019;23:2331216519887247. [DOI:10.1177/2331216519887247]
10. Alsarhan HW. Treatment of tinnitus with tinnitus retraining therapy in Iraq. Iraqi J Commun Med. 2012;25(2):179-85.
11. Kehrle HM, Granjeiro RC, Sampaio AL, Bezerra R, Almeida VF, Oliveira CA. Comparison of auditory brainstem response results in normal-hearing patients with and without tinnitus. Arch Otolaryngol Head Neck Surg. 2008;134(6):647-51. [DOI:10.1001/archotol.134.6.647]
12. Harvey LA. Statistical testing for baseline differences between randomised groups is not meaningful. Spinal Cord. 2018;56(10):919. [DOI:10.1038/s41393-018-0203-y]
13. Meikle MB, Henry JA, Griest SE, Stewart BJ, Abrams HB, McArdle R, et al. The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Ear Hear. 2012;33(2):153-76. [DOI:10.1097/AUD.0b013e31822f67c0]
14. Adamchic I, Langguth B, Hauptmann C, Tass PA. Psychometric evaluation of visual analog scale for the assessment of chronic tinnitus. Am J Audiol. 2012;21(2):215-25. [DOI:10.1044/1059-0889(2012/12-0010)]
15. ECDEU Assessment Manual for Psychopharmacology: Publication ADM 76-338. Rockville, MD: National Institute of Mental Health, Psychopharmacology Research Branch; 1976. p. 217-22.
16. Hall JW. New handbook of auditory evoked responses. 1st ed. Boston: Pearson; 2007.
17. Tyler RS, Perreau A, Powers T, Watts A, Owen R, Ji H, et al. Tinnitus Sound Therapy Trial Shows Effectiveness for Those with Tinnitus. J Am Acad Audiol. 2020;31(1):6-16. [DOI:10.3766/jaaa.18027]
18. Shekhawat GS, Vanneste S. Optimization of Transcranial Direct Current Stimulation of Dorsolateral Prefrontal Cortex for Tinnitus: A Non-Linear Dose-Response Effect. Sci Rep. 2018;8(1):8311. [DOI:10.1038/s41598-018-26665-1]
19. Dundas JE, Thickbroom GW, Mastaglia FL. Perception of comfort during transcranial DC stimulation: effect of NaCl solution concentration applied to sponge electrodes. Clin Neurophysiol. 2007;118(5):1166-70. [DOI:10.1016/j.clinph.2007.01.010]
20. Drviš P, Trotić R, Ries M, Ajduk J, Muslim A, Klančnik M, et al. Low level laser therapy (LLLT) for chronic tinnitus. Laser in Medicine. 2013;1(2):1-5.
21. Jin IK, Choi SJ, Ku M, Sim Y, Lee T. The Impact of Daily Hours of Sound Therapy on Tinnitus Relief for People With Chronic Tinnitus: A Randomized Controlled Study. J Speech Lang Hear Res. 2022;65(8):3079-99. [DOI:10.1044/2022_JSLHR-21-00651]
22. Durai M, Searchfield GD. A Mixed-Methods Trial of Broad Band Noise and Nature Sounds for Tinnitus Therapy: Group and Individual Responses Modeled under the Adaptation Level Theory of Tinnitus. Front Aging Neurosci. 2017;9:44.
23. Tinnitus Retraining Therapy Trial Research Group; Scherer RW, Formby C. Effect of Tinnitus Retraining Therapy vs Standard of Care on Tinnitus-Related Quality of Life: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. 2019;145(7):597-608. [DOI:10.1001/jamaoto.2019.0821]
24. Garin P, Gilain C, Van Damme JP, de Fays K, Jamart J, Ossemann M, et al. Short- and long-lasting tinnitus relief induced by transcranial direct current stimulation. J Neurol. 2011;258(11):1940-8. [DOI:10.1007/s00415-011-6037-6]
25. Souza DDS, Almeida AA, Andrade SMDS, Machado DGDS, Leitão M, Sanchez TG, et al. Transcranial direct current stimulation improves tinnitus perception and modulates cortical electrical activity in patients with tinnitus: A randomized clinical trial. Neurophysiol Clin. 2020;50(4):289-300. [DOI:10.1016/j.neucli.2020.07.002]
26. Pal N, Maire R, Stephan MA, Herrmann FR, Benninger DH. Transcranial Direct Current Stimulation for the Treatment of Chronic Tinnitus: A Randomized Controlled Study. Brain Stimul. 2015;8(6):1101-7. [DOI:10.1016/j.brs.2015.06.014]
27. Wang TC, Tyler RS, Chang TY, Chen JC, Lin CD, Chung HK, et al. Effect of Transcranial Direct Current Stimulation in Patients With Tinnitus: A Meta-Analysis and Systematic Review. Ann Otol Rhinol Laryngol. 2018;127(2):79-88. [DOI:10.1177/0003489417744317]
28. Vanneste S, De Ridder D. Noninvasive and invasive neuromodulation for the treatment of tinnitus: an overview. Neuromodulation. 2012;15(4):350-60. [DOI:10.1111/j.1525-1403.2012.00447.x]
29. Yadollahpour A, Bayat A, Rashidi S, Saki N, Karimi M. Dataset of acute repeated sessions of bifrontal transcranial direct current stimulation for treatment of intractable tinnitus: A randomized controlled trial. Data Brief. 2017;15:40-6. [DOI:10.1016/j.dib.2017.09.006]
30. Dehkordi MA, Einolghozati S, Ghasemi SM, Abolbashari S, Meshkat M, Behzad H. Effect of low-level laser therapy in the treatment of cochlear tinnitus: a double-blind, placebo-controlled study. Ear Nose Throat J. 2015;94(1):32-6.
31. Teggi R, Bellini C, Piccioni LO, Palonta F, Bussi M. Transmeatal low-level laser therapy for chronic tinnitus with cochlear dysfunction. Audiol Neurootol. 2009;14(2):115-20. [DOI:10.1159/000161235]
32. Cuda D, De Caria A. Effectiveness of combined counseling and low-level laser stimulation in the treatment of disturbing chronic tinnitus. Int Tinnitus J. 2008;14(2):175-80.
33. Engelke M, Basso L, Langguth B, Zeman F, Schlee W, Schoisswohl S, et al. Estimation of Minimal Clinically Important Difference for Tinnitus Handicap Inventory and Tinnitus Functional Index. Otolaryngol Head Neck Surg. 2025. [DOI:10.1002/ohn.1217]
34. Lv H, Liu C, Wang Z, Zhao P, Cheng X, Yang Z, et al. Altered functional connectivity of the thalamus in tinnitus patients is correlated with symptom alleviation after sound therapy. Brain Imaging Behav. 2020;14(6):2668-78. [DOI:10.1007/s11682-019-00218-0]
35. Mondelli MFCG, Cabreira AF, Matos IL, Ferreira MC, Rocha AV. Sound Generator: Analysis of the Effectiveness of Noise in the Habituation of Tinnitus. Int Arch Otorhinolaryngol. 2021;25(2):e205-12. [DOI:10.1055/s-0040-1713377]
36. Roberts LE, Eggermont JJ, Caspary DM, Shore SE, Melcher JR, Kaltenbach JA. Ringing ears: the neuroscience of tinnitus. J Neurosci. 2010;30(45):14972-9. [DOI:10.1523/JNEUROSCI.4028-10.2010]
37. Shekhawat GS, Stinear CM, Searchfield GD. Modulation of Perception or Emotion? A Scoping Review of Tinnitus Neuromodulation Using Transcranial Direct Current Stimulation. Neurorehabil Neural Repair. 2015;29(9):837-46. [DOI:10.1177/1545968314567152]
38. Schlee W, Schecklmann M, Lehner A, Kreuzer PM, Vielsmeier V, Poeppl TB, et al. Reduced variability of auditory alpha activity in chronic tinnitus. Neural Plast. 2014;2014:436146. [DOI:10.1155/2014/436146]
2. Henry JA, Reavis KM, Griest SE, Thielman EJ, Theodoroff SM, Grush LD, et al. Tinnitus: An Epidemiologic Perspective. Otolaryngol Clin North Am. 2020;53(4):481-99. [DOI:10.1016/j.otc.2020.03.002]
3. Bhatt JM, Lin HW, Bhattacharyya N. Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States. JAMA Otolaryngol Head Neck Surg. 2016;142(10):959-65. [DOI:10.1001/jamaoto.2016.1700]
4. Bae EB, Lee JH, Song JJ. Single-Session of Combined tDCS-TMS May Increase Therapeutic Effects in Subjects With Tinnitus. Front Neurol. 2020;11:160. [DOI:10.3389/fneur.2020.00160]
5. Park KW, Kullar P, Malhotra C, Stankovic KM. Current and Emerging Therapies for Chronic Subjective Tinnitus. J Clin Med. 2023;12(20):6555. [DOI:10.3390/jcm12206555]
6. Yadollahpour A, Rashidi S, Saki N, Kunwar PS, Mayo-Yáñez M. Repeated Bilateral Transcranial Direct Current Stimulation over Auditory Cortex for Tinnitus Treatment: A Double-Blinded Randomized Controlled Clinical Trial. Brain Sci. 2024;14(4):373. [DOI:10.3390/brainsci14040373]
7. Bashir A, Khan N, Rehman AU, Lohana P, Shiblee SA, Asif N. The Effectiveness of Low-Level Laser Therapy in Treating Tinnitus: A Randomized Controlled Trial. Indus Journal of Bioscience Research. 2025;3(4):528-37. [DOI:10.70749/ijbr.v3i4.1111]
8. Boedts M, Buechner A, Khoo SG, Gjaltema W, Moreels F, Lesinski-Schiedat A, Becker P, MacMahon H, Vixseboxse L, Taghavi R, Lim HH, Lenarz T. Combining sound with tongue stimulation for the treatment of tinnitus: a multi-site single-arm controlled pivotal trial. Nat Commun. 2024 Aug 19;15(1):6806. [DOI:10.1038/s41467-024-50473-z]
9. Neff P, Langguth B, Schecklmann M, Hannemann R, Schlee W. Comparing Three Established Methods for Tinnitus Pitch Matching With Respect to Reliability, Matching Duration, and Subjective Satisfaction. Trends Hear. 2019;23:2331216519887247. [DOI:10.1177/2331216519887247]
10. Alsarhan HW. Treatment of tinnitus with tinnitus retraining therapy in Iraq. Iraqi J Commun Med. 2012;25(2):179-85.
11. Kehrle HM, Granjeiro RC, Sampaio AL, Bezerra R, Almeida VF, Oliveira CA. Comparison of auditory brainstem response results in normal-hearing patients with and without tinnitus. Arch Otolaryngol Head Neck Surg. 2008;134(6):647-51. [DOI:10.1001/archotol.134.6.647]
12. Harvey LA. Statistical testing for baseline differences between randomised groups is not meaningful. Spinal Cord. 2018;56(10):919. [DOI:10.1038/s41393-018-0203-y]
13. Meikle MB, Henry JA, Griest SE, Stewart BJ, Abrams HB, McArdle R, et al. The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Ear Hear. 2012;33(2):153-76. [DOI:10.1097/AUD.0b013e31822f67c0]
14. Adamchic I, Langguth B, Hauptmann C, Tass PA. Psychometric evaluation of visual analog scale for the assessment of chronic tinnitus. Am J Audiol. 2012;21(2):215-25. [DOI:10.1044/1059-0889(2012/12-0010)]
15. ECDEU Assessment Manual for Psychopharmacology: Publication ADM 76-338. Rockville, MD: National Institute of Mental Health, Psychopharmacology Research Branch; 1976. p. 217-22.
16. Hall JW. New handbook of auditory evoked responses. 1st ed. Boston: Pearson; 2007.
17. Tyler RS, Perreau A, Powers T, Watts A, Owen R, Ji H, et al. Tinnitus Sound Therapy Trial Shows Effectiveness for Those with Tinnitus. J Am Acad Audiol. 2020;31(1):6-16. [DOI:10.3766/jaaa.18027]
18. Shekhawat GS, Vanneste S. Optimization of Transcranial Direct Current Stimulation of Dorsolateral Prefrontal Cortex for Tinnitus: A Non-Linear Dose-Response Effect. Sci Rep. 2018;8(1):8311. [DOI:10.1038/s41598-018-26665-1]
19. Dundas JE, Thickbroom GW, Mastaglia FL. Perception of comfort during transcranial DC stimulation: effect of NaCl solution concentration applied to sponge electrodes. Clin Neurophysiol. 2007;118(5):1166-70. [DOI:10.1016/j.clinph.2007.01.010]
20. Drviš P, Trotić R, Ries M, Ajduk J, Muslim A, Klančnik M, et al. Low level laser therapy (LLLT) for chronic tinnitus. Laser in Medicine. 2013;1(2):1-5.
21. Jin IK, Choi SJ, Ku M, Sim Y, Lee T. The Impact of Daily Hours of Sound Therapy on Tinnitus Relief for People With Chronic Tinnitus: A Randomized Controlled Study. J Speech Lang Hear Res. 2022;65(8):3079-99. [DOI:10.1044/2022_JSLHR-21-00651]
22. Durai M, Searchfield GD. A Mixed-Methods Trial of Broad Band Noise and Nature Sounds for Tinnitus Therapy: Group and Individual Responses Modeled under the Adaptation Level Theory of Tinnitus. Front Aging Neurosci. 2017;9:44.
23. Tinnitus Retraining Therapy Trial Research Group; Scherer RW, Formby C. Effect of Tinnitus Retraining Therapy vs Standard of Care on Tinnitus-Related Quality of Life: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. 2019;145(7):597-608. [DOI:10.1001/jamaoto.2019.0821]
24. Garin P, Gilain C, Van Damme JP, de Fays K, Jamart J, Ossemann M, et al. Short- and long-lasting tinnitus relief induced by transcranial direct current stimulation. J Neurol. 2011;258(11):1940-8. [DOI:10.1007/s00415-011-6037-6]
25. Souza DDS, Almeida AA, Andrade SMDS, Machado DGDS, Leitão M, Sanchez TG, et al. Transcranial direct current stimulation improves tinnitus perception and modulates cortical electrical activity in patients with tinnitus: A randomized clinical trial. Neurophysiol Clin. 2020;50(4):289-300. [DOI:10.1016/j.neucli.2020.07.002]
26. Pal N, Maire R, Stephan MA, Herrmann FR, Benninger DH. Transcranial Direct Current Stimulation for the Treatment of Chronic Tinnitus: A Randomized Controlled Study. Brain Stimul. 2015;8(6):1101-7. [DOI:10.1016/j.brs.2015.06.014]
27. Wang TC, Tyler RS, Chang TY, Chen JC, Lin CD, Chung HK, et al. Effect of Transcranial Direct Current Stimulation in Patients With Tinnitus: A Meta-Analysis and Systematic Review. Ann Otol Rhinol Laryngol. 2018;127(2):79-88. [DOI:10.1177/0003489417744317]
28. Vanneste S, De Ridder D. Noninvasive and invasive neuromodulation for the treatment of tinnitus: an overview. Neuromodulation. 2012;15(4):350-60. [DOI:10.1111/j.1525-1403.2012.00447.x]
29. Yadollahpour A, Bayat A, Rashidi S, Saki N, Karimi M. Dataset of acute repeated sessions of bifrontal transcranial direct current stimulation for treatment of intractable tinnitus: A randomized controlled trial. Data Brief. 2017;15:40-6. [DOI:10.1016/j.dib.2017.09.006]
30. Dehkordi MA, Einolghozati S, Ghasemi SM, Abolbashari S, Meshkat M, Behzad H. Effect of low-level laser therapy in the treatment of cochlear tinnitus: a double-blind, placebo-controlled study. Ear Nose Throat J. 2015;94(1):32-6.
31. Teggi R, Bellini C, Piccioni LO, Palonta F, Bussi M. Transmeatal low-level laser therapy for chronic tinnitus with cochlear dysfunction. Audiol Neurootol. 2009;14(2):115-20. [DOI:10.1159/000161235]
32. Cuda D, De Caria A. Effectiveness of combined counseling and low-level laser stimulation in the treatment of disturbing chronic tinnitus. Int Tinnitus J. 2008;14(2):175-80.
33. Engelke M, Basso L, Langguth B, Zeman F, Schlee W, Schoisswohl S, et al. Estimation of Minimal Clinically Important Difference for Tinnitus Handicap Inventory and Tinnitus Functional Index. Otolaryngol Head Neck Surg. 2025. [DOI:10.1002/ohn.1217]
34. Lv H, Liu C, Wang Z, Zhao P, Cheng X, Yang Z, et al. Altered functional connectivity of the thalamus in tinnitus patients is correlated with symptom alleviation after sound therapy. Brain Imaging Behav. 2020;14(6):2668-78. [DOI:10.1007/s11682-019-00218-0]
35. Mondelli MFCG, Cabreira AF, Matos IL, Ferreira MC, Rocha AV. Sound Generator: Analysis of the Effectiveness of Noise in the Habituation of Tinnitus. Int Arch Otorhinolaryngol. 2021;25(2):e205-12. [DOI:10.1055/s-0040-1713377]
36. Roberts LE, Eggermont JJ, Caspary DM, Shore SE, Melcher JR, Kaltenbach JA. Ringing ears: the neuroscience of tinnitus. J Neurosci. 2010;30(45):14972-9. [DOI:10.1523/JNEUROSCI.4028-10.2010]
37. Shekhawat GS, Stinear CM, Searchfield GD. Modulation of Perception or Emotion? A Scoping Review of Tinnitus Neuromodulation Using Transcranial Direct Current Stimulation. Neurorehabil Neural Repair. 2015;29(9):837-46. [DOI:10.1177/1545968314567152]
38. Schlee W, Schecklmann M, Lehner A, Kreuzer PM, Vielsmeier V, Poeppl TB, et al. Reduced variability of auditory alpha activity in chronic tinnitus. Neural Plast. 2014;2014:436146. [DOI:10.1155/2014/436146]
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How to Cite
1.
Naji BA, Mohammed Khani G, Ruhbakhsh N. Comparative Effectiveness of Sound Therapy, transcranial direct current stimulation, and low-level laser therapy for Chronic Tinnitus Management. Aud Vestib Res. 2025;.
