We thank our correspondent for his comments and discussion points, which actually address important questions of tinnitus classification and especially treatment.
S3 guidelines are tasked with collecting after strict scientific assessment the best possible evidence and document this. For this reason, therapeutic approaches that are not confirmed by randomized studies or meta-analyses are not included in the recommendations, even though these may provide relief in individual cases, albeit often in the sense of a placebo effect (1). This is also true for physiotherapeutic interventions, which undoubtedly improve the patient‘s overall and improve craniomandibular dysfunction, for example, but cannot influence the tinnitus pathophysiologically.
The mentioned, very rare (<1%) objective tinnitus corresponds to the perception of a pathological chance in close proximity to the ear, which often does not require therapy.
We are, however, convinced that chronic tinnitus is not an independent disease entity but a neuro-otological entity, which may, however, be the expression of a somatization disorder with tinnitus as the somatic correlate (2). However, this entails the opportunity by gaining via the somatic approach and the successful treatment options (improved hearing, etc) a pathway into the comorbidities that increase the suffering, such as anxiety, depression, and insomnia, whether psychotherapeutically or medically.
Whether the comorbidities are increased by means of the tinnitus problem or develop only as a consequence is relevant for successful treatment in so far as it means that psychosomatic approaches have to be seen in a differentiated way. The treatment itself—we agree with Dr. Wörz—should follow the guideline with rational and appropriate approaches.
The measures recommended in the guidelines (counseling, hearing improvement, and psychotherapeutic interventions) can achieve in most tinnitus patients an alleviation of their suffering to the point where they don‘t notice/pay attention to/perceive their tinnitus.
Footnotes
Conflict of interest statement
Prof. Hesse is medical director and a co-partner of the Tinnitus Clinic at Bad Arolsen Hospital. He has received payment for legal opinions on the topic of tinnitus. He is the spokesman of the scientific advisory board of the German Tinnitus League (Deutsche Tinnitus-Liga), a board member of the Association of Central German Otorhinolaryngologists (Vereinigung mitteldeutscher HNO-Ärzte), a consultant to HNO Update, and a scientific advisor to the Tinnitus and Hearing Foundation Charité.
Prof. Mazurek has received support for research projects from terzo-Institut, Dr. Willmar Schwane GmbH & Co. KG, the Heinz and Heide Dürr Foundation, the Tinnitus and Hearing Foundation, Resaphene, and in connection with the EU projects UNITI, TIN-ACT, and TIGER. Travel costs and congress fees were taken over by Infecto Pharm, Dr. Willmar Schwane GmbH & Co. KG, MED-EL, the German Otorhinolaryngological Training Society (Deutsche Fortbildungsgesellschaft für HNO-Ärzte), and Geers. She is a board member of the German Tinnitus and Hearing Foundation (Deutsche Stiftung Tinnitus und Hören) and a member of the scientific advisory board of the German Tinnitus League (Deutsche Tinnitus-Liga). She has received third-party funding for projects in connection with the EU program HORIZON 2020.
References
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