(PP1404) Virtual Reality for Managing Chronic Tinnitus: A Randomized Controlled Trial

Lead Presenter(s)

Jenna Worms

Doctoral Student
Long Island Doctor of Audiology Consotrium
Port Washington, New York, United States

Presenter(s)

AD

Aniruddha K. Deshpande, PhD

Associate Professor & Director, The Hear-Ring Lab
Hofstra University
Hempstead, New York, United States
Ishan S. Bhatt, PhD

Associate Professor
University of Iowa
Iowa City, Iowa, United States

Abstract:
Sound therapy and stress reduction techniques are routinely used for tinnitus management. Virtual reality (VR) has helped manage chronic conditions such as intractable pain. It has also shown to significantly affect areas mediated by the limbic system, which helps maintain tinnitus. Therefore, VR may be an effective tinnitus management technique. The aim of the present study was to investigate the efficacy of VR combined with conventional sound therapy as compared to conventional sound therapy alone on characteristics of tinnitus. Results of this randomized controlled trial showed improved tinnitus loudness and Tinnitus Functional Index scores after receiving sound therapy with VR.

Summary:
Tinnitus is the sensation of hearing a “ringing” or “buzzing” in the ears without the presence of any external stimuli. It is commonly associated with hearing loss and other underlying medical conditions. Possible causes include tonotopic reorganization in the auditory cortex (Ghazaleh et al., 2017), noise exposure (Shargorodsky et al., 2010), underlying conditions (Basso et al., 2020), and the use of certain medications (Bhatt et al., 2016). Tinnitus can often affect patients’ emotional well-being, causing increased anxiety levels (Pattyn et al., 2016). Although there is currently no ‘cure’ for tinnitus, effective management techniques do exist, including mindfulness/relaxation training (McKenna et al., 2017), and sound therapy (Tyler et al., 2017).

Therapy techniques using virtual reality (VR) have proven to reduce anxiety in patients with chronic conditions, such as anxiety (Gorini & Riva, 2008), and to have significant effects on domains mediated by the limbic system (Parsons & Rizzo, 2008). Tinnitus is a chronic condition with established involvement of the limbic system. The aim of the present study was to investigate the effect of VR in conjunction with conventional sound therapy for management of chronic tinnitus.

Twenty adults between the ages of 18 and 76 years with continuous, chronic, subjective tinnitus were recruited for this study. Participants were split into two randomly divided groups of ten and each received two therapy sessions, one week apart. The control intervention provided conventional sound therapy alone and the experimental intervention provided conventional sound therapy with a VR viewing. The sound therapy component consisted of the Zen Aqua program from Widex USA, Inc. module on Noah (Simonetti et al., 2018). Participants set the volume at a comfortable level and sounds were played for 15 minutes via computer loudspeakers. The VR component consisted of the viewing of a 15-minute silent video, portraying natural views such as flowing streams, lakes, beaches, etc., via specialized VR goggles while listening to the same sound therapy component described above. One group received the control followed by the experimental intervention and the other received the experimental followed by the control intervention. Tinnitus loudness, Tinnitus Functional Index (TFI; Meikele et al., 2012), and minimum masking level (MML) scores were recorded before and after each intervention.

A multilevel mixed-effects linear regression model accounting for confounding variables revealed that tinnitus loudness and TFI scores reduced significantly after the experimental intervention compared to the control intervention. The MML differences were not statistically significant, but mean values were reduced after the experimental intervention compared to the control intervention.

The results revealed that the participants in this study benefitted from receiving VR combined with sound therapy in a laboratory setting. Tinnitus loudness levels, MMLs, and TFI scores were reduced after the sound therapy and VR session compared to the standalone sound therapy session. While further research is needed to confirm the use of VR and sound therapy as an effective management technique, the results of this study demonstrate that it is a promising potential strategy.

Learning Objectives:

Upon completion, participants will be able to describe how virtual reality combined with conventional sound therapy can effectively mitigate the perception of tinnitus.