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Laryngorhinootologie 2016; 95(S 01): S155-S191
DOI: 10.1055/s-0041-108946
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Evidenz- und Evidenzlücken der Tinnitustherapie

Evidence and Lack of Evidence in the Treatment of Tinnitus
G. Hesse
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Publication History

Publication Date:
29 April 2016 (online)

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Zusammenfassung

Für die Behandlung von Ohrgeräuschen werden eine schier unübersichtliche Vielzahl von Verfahren erprobt und v. a. verkauft, leider nicht immer sachgerecht und evidenzbasiert untersucht. Eine kausale, den Tinnitus abschaltende Therapie gibt es nach wie vor nicht, ja eigentlich kann es sie nicht geben, hat man die verschiedenen Entstehungsmechanismen verstanden. Dennoch oder deshalb kehren im Verlauf der letzten Jahrzehnte wellen- und modeartig medizinische Interventionen wieder, die praktisch nie den Nachweis stabiler und belastbarer Behandlungserfolge erbringen können. In diesem Referat werden praktisch alle gängigen Therapieverfahren besprochen, gewürdigt und diskutiert und bezüglich vorliegender oder eben nicht bestehender Evidenz bewertet. Dabei sollte Evidenz neben der externen Evidenz durch Studien auch die interne Evidenz, d. h. die Erfahrung des Arztes und die Bedürfnisse des Patienten mit einbeziehen.

Während für praktisch alle direkten Verfahren, die entweder die Kochlea oder bestimmte Hirnregionen wie insbesondere den auditorischen Kortex stimulieren oder modulieren wollen, keine Evidenz besteht oder erreicht wird, so gibt es Therapieverfahren, die sich in der klinischen Praxis bewährt haben und die zumindest einen gewissen Evidenzgrad und v. a. auch nachweisbare Effektstärken generieren. Dazu gehören besonders Habituationstherapien und psychotherapeutische Verfahren, besonders wenn sie mit konkreten Maßnahmen zur Verbesserung der Hörwahrnehmung (Hörgeräte, CI, Hörtherapien) verknüpft werden.

Abstract

A broad variety of therapeutic regimen is proposed, introduced and sold against tinnitus, but most of these approaches lack scientific validation and evidence. Up to date a causal, tinnitus eliminating therapy is not available. Most probably this will not be possible at all, as the mechanism of tinnitus generation are multiple and include peripheral as well as central or cortical reactions. Like in fashion and design however, therapeutic medical interventions against tinnitus come in waves again and again over the last decades, without being able to prove lasting and scientifically evident effects.

This review presents, discusses and assesses almost all available therapies regarding their evidence. Evidence should include besides external evidence through publications and available data also internal evidence, e.g. including experience of the therapist and needs of the patients.

Almost all interventions that try to influence the inner ear or the auditory cortex either pharmaceutically or by direct stimulation or modulation do not reach evidence. However, there are procedures that have proven to be effective and show at least certain degrees of evidence with proven strength of effect. These are habituation therapies and psychotherapeutic interventions like cognitive behavioural therapy, especially when they are combined with concrete measures to improve auditory perception like hearing-aids, cochlear implants or hearing-therapy.

Schlüsselwörter

Tinnitustherapie - chronischer Tinnitus - Psychosomatische Komorbidität - Evidenz-basierte Medizin

Key words

Tinnitustherapy - chronic tinnitus - psychosomatic comorbidity - evidence based medicine
 

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