Innovative and Multidisciplinary Treatment Protocol for Chronic Tinnitus (1063 Patients)

Background: Offer to patients with chronic tinnitus an innovative and standardized therapeutic approach within a multidisciplinary team.

Material: 1063 adults included after an initial assessment with interrogation, clinical examination, characteristics of the tinnitus and evaluation of its impact on daily life (VAS and THI questionnary), tonal and vocal audiometry with high frequencies.

Methods: Our protocol is based on a quadritherapy:

• Explanation of the hypersynchronization which generates tinnitus, similar to pain.
• Medical treatment using five antiepileptic drugs (Gabapentine, Carbamazepine, Lamotrigine, Topiramate, Clonazepam) prescribed at very low dosage, in a specific order and for a defined period (6 months), the failure of the first molecule leading directly to the prescription of the second of the list, and so on.
• Prescription of hearing aids: classical, with frequency transposition or duplication, inhibition by lateral amplification, or making of a custom colored noise.
• Emotional support with psychiatrists, neurologists, psychologists, sophrologists, speech therapists, neurofeedback and specialists of the pain.

Results: Among those 1063 patients, 1040 (97,80%) received the medical treatment. 23 were excluded, unable to receive antiepileptics for various reasons.

Concerning those 1040 patients, 77,60% get very good (34,65%) or good (42,95%) results with our protocol. Failure was observed with 109 patients (10,50%) and 123 patients (11,90%) were lost to follow-up.

The rate reach 85,90% for patients receiving antiepileptics and hearing aids.

Conclusions: Explanations were sufficient for some patients, others felt better with an emotional care, but in most cases we recommended medical treatment associated with hearing aids.

The efficiency of the protocol and the very low rate of side effects with the medical treatment allow us to validate it.

Early prescription of aids even for mild hearing impairment is the deciding factor of our protocol which is actually proposed in many referring health centers in France.