# Effectiveness of Telerehabilitation Interventions for Self-Management of Tinnitus: Update of a Systematic Review

## TL;DR

This review updates evidence on how well telerehabilitation helps manage tinnitus, showing it can reduce symptoms and is a promising alternative to in-person care.

## Contribution

The study provides an updated systematic review of telerehabilitation effectiveness for tinnitus self-management from 2022 to 2025.

## Key findings

- Telerehabilitation interventions effectively reduce tinnitus severity and distress.
- Smartphone apps are increasingly used and accessible for tinnitus self-management.
- Evidence certainty is low to moderate due to study limitations and biases.

## Abstract

Approximately 14% of the adult population has tinnitus, and current treatments are often costly and time-consuming. Telerehabilitation might reduce treatment costs without compromising effectiveness.

Telerehabilitation is a quickly evolving research topic. Therefore, this systematic review update aims to give an overview of the research concerning the effectiveness of telerehabilitation interventions for self-management of tinnitus published between 2022 and 2025.

This systematic review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020) guidelines. PubMed, ScienceDirect, Scopus, Web of Science, and Cochrane Library were consulted for eligible studies concerning a study intervention of any possible form of self-management or telerehabilitation for adult patients with subjective tinnitus as a primary complaint. The risk of bias (RoB) and certainty of all included studies were assessed respectively by the Cochrane RoB2-tool and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework.

In total, 24 papers were included, of which 6 studied multiple telerehabilitation forms. Internet-based cognitive behavioral therapy with guidance by a psychologist or audiologist was examined in 5 studies (n=619), self-help manuals in 1 study (n=10), technological self-help devices in 3 studies (n=286), smartphone apps in 13 studies (n=23,788), and other internet-based interventions in 5 studies (n=442). These rehabilitation categories were proven to be effective in decreasing tinnitus severity and relieving tinnitus distress as measured by tinnitus questionnaires.

The strength of this review is the gathering of recent studies on the very evolving topic of telerehabilitation for tinnitus. An important limitation of all included studies is that they raised some to great concerns of RoB. As a result, it is necessary to acknowledge that the overall certainty of the evidence ranged from low to moderate certainty. In addition, some crucial confounding parameters, such as the presence of hearing loss, hyperacusis, anxiety, depression, or sleeping problems, were not taken into consideration by all studies. This review gives an indication of the use of different telerehabilitation and self-management interventions for real-world clinical use, stating not only their possibilities but also their limitations. Overall, telerehabilitation was found to be effective in reducing tinnitus severity and distress. It forms a possible tool to improve the self-management capacities of the patient and the accessibility of tinnitus care as a replacement or an addition to in-person care. Nevertheless, barriers such as a lack of time, engagement, motivation, and openness of the patient, causing high dropout, should be taken into consideration. This review accentuated the shift from internet-based cognitive behavioral therapy to the growing interest in the use of smartphone apps, increasing the accessibility of the treatments even more.

PROSPERO CRD 42021285450; https://www.crd.york.ac.uk/PROSPERO/view/CRD42021285450