Gender Differences in Tinnitus Treatment Outcomes

Summary by John A. Coverstone, AuD

A group of researchers from the

University of Antwerp (Belgium) recently looked at whether women and men respond differently to tinnitus treatment. 1 They did this by analyzing outcomes for an array of tinnitus treatment methods performed at the university hospital and comparing outcomes for men and women.

The university hospital uses a range of treatment options for tinnitus, including those used in this study: tinnitus retraining therapy with cognitive behavioral therapy (TRT+CBT); tinnitus retraining therapy with eye movement desensitization and reprocessing therapy (TRT+EMDR); physical therapy for those having problems with the neck or jaw; and high-definition transcranial direct current stimulation, or electrical stimulation of the brain. EMDR therapy has not been commonly discussed in this publication. It involves a patient being presented with emotionally charged memories in brief doses while they simultaneously focus on an external stimulus. The goal is to lessen negative responses and decrease distress caused by negative memories, experiences, or stimuli.

The tinnitus treatment study included 316 patients. The Tinnitus Functional Index (TFI) was used as the primary measure of tinnitus severity and tinnitus improvement post-treatment. A 13-point reduction in overall TFI score was considered to be meaningful, based on prior research. Each patient completed the TFI, along with any other questionnaires that were relevant to their condition, before and after treatment, and again three months after treatment.

The authors found that gender differences in TFI score varied across different treatments. For treatments the authors called “orofacial physiotherapy,” women benefited more than men. This appears to align with previous data showing that temporomandibular joint (TMJ) disorders were twice as prevalent in women than in men. 2 This effect may therefore reflect greater incidence of the condition rather than more effective treatment.

High-definition transcranial direct current stimulation (HD-tDCS) was used to target an area of the brain called the dorsolateral prefrontal cortex. This area is associated with gating of sensory stimuli — in other words, it decides which stimuli we see and hear. One theory of tinnitus is that the neural pathways of the dorsolateral prefrontal cortex are damaged and therefore sounds that would normally be blocked are allowed to enter the auditory cortex and be perceived. When analyzing data from HD-tDCS, there was a greater benefit to women than to men. The authors also noted a prior study that also showed that tDCS is more effective in women. 3

Conversely, males in this study benefited more from TRT+CBT than did females. There is no expected gender difference in the outcomes of psychotherapy and so this finding is intriguing. Treatment provided using TRT+EMDR yielded no significant differences in outcomes for men and women. It should be noted that significant improvement in TFI scores were found in both men and women using both these treatment methods.

Although the population was somewhat small for each treatment type, gender effects were noted in most cases. More research would need to be performed with a larger population, but these results do indicate that men and women respond differently to different types of treatment. It cannot be stated definitively that men or women are helped more by a certain treatment type, because it may be that one gender responds more quickly while the other needs more time to experience effective treatment. Of course, choosing an appropriate treatment modality is also driven by other factors, such as type and severity of tinnitus and presence of an underlying psychological disorder. Nonetheless, in the future the gender of the patient may play a role in determining the most effective or most efficient treatment for tinnitus.

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3 A. Van der Wal, T. Luyten, E. Cardon, L. Jacquemin, O. M. Vanderveken, V. Topsakal,…A. Gilles. (2020). Sex differences in the response to different tinnitus treatment. Frontiers in Neuroscience, 14, article 222. https://doi. org/10.3389/fnins.2020.00422 C. H. Bueno, D. D. Pereira, M. P. Pattussi, P. K. Grossi, & M. L. Grossi. (2018). Gender differences in temporomandibular disorders in adult populational studies: A systematic review and meta-analysis. Journal of Oral Rehabilitation, 45, 720–729. E. Frank, M. Schecklmann, M. Landgrebe, J. Burger, P. Kreuzer, T. B. Poeppl,…B. Langguth. (2012). Treatment of chronic tinnitus with repeated sessions of prefrontal transcranial direct current stimulation: Outcomes from an open-label pilot study. Journal of Neurology, 259, 327–333.