Smartphone-based tinnitus retraining therapy in Meniere's disease patients following vestibular ablation: a feasibility study

Abstract

Purpose To evaluate the feasibility and preliminary outcomes of smartphone-delivered Tinnitus Retraining Therapy (TRT) in Meniere's disease patients with persistent tinnitus following intratympanic gentamicin ablation. Methods This prospective exploratory clinical study enrolled 23 patients with unilateral Meniere's disease who had undergone intratympanic gentamicin ablation >= 6 months prior and experienced chronic tinnitus. Patients underwent a 6-month TRT program combining smartphone-based broadband noise therapy (6 h daily) with directive counselling. Primary outcomes were Tinnitus Handicap Inventory (THI) and Beck Depression Inventory (BDI) scores assessed at baseline, 1, 3, and 6 months. Secondary measures included psychoacoustic parameters (tinnitus pitch, loudness, minimum masking level). Fifteen patients (65.2%) completed the protocol. Results Among completers (n = 15), median THI scores decreased from 38.00 (IQR: 28.00-56.00) at baseline to 20.00 (IQR: 8.00-40.00) at 6 months (mean reduction 15.74 points; p = 0.03). Improvements were evident by 3 months and sustained through 6 months. BDI scores remained stable (baseline median: 10.00, IQR: 6.00-15.00; 6-month median: 9.00, IQR: 4.00-13.00; p = 0.23). Psychoacoustic parameters showed no significant changes (all p > 0.05). Baseline analysis revealed positive correlations between tinnitus loudness and hearing threshold (rs= 0.56, p = 0.01), age and tinnitus loudness (rs = 0.44, p = 0.03), and THI and BDI scores (rs = 0.50, p = 0.01). Eight participants (34.8%) discontinued treatment primarily due to sound intolerance. Conclusions This feasibility study suggests that smartphone-delivered TRT is a feasible approach that may be associated with reductions in tinnitus handicap scores in post-gentamicin Meniere's patients, without measurable changes in acoustic characteristics. The observed THI reduction (15.74 points) is comparable to published conventional TRT outcomes, though the absence of a control group precludes causal inference. The 34.8% attrition rate, primarily due to sound intolerance, highlights the need for improved patient selection and adherence strategies. These preliminary findings warrant confirmation in larger controlled trials. This accessible approach addresses an important therapeutic gap, though attrition rates suggest need for improved adherence strategies.