Internet-Based Interventions for Adults With Hearing Loss, Tinnitus, and Vestibular Disorders: A Systematic Review and Meta-Analysis.
Eldré W Beukes, Vinaya Manchaiah, Peter M Allen and 2 others
PMID 31328660WHAT IT FOUND
Internet-based CBT significantly reduces tinnitus distress and associated anxiety, depression, and insomnia.
However, evidence for hearing loss interventions is inconclusive and low quality. No firm conclusions can be drawn for vestibular disorders as only one study met inclusion criteria.
Key findings
01Internet-based interventions for tinnitus showed a medium overall effect size for reducing distress compared to controls.
02Internet-based interventions for hearing loss did not show a statistically significant reduction in hearing disability compared to inactive or active controls.
03Internet-based interventions for tinnitus significantly improved secondary outcomes including anxiety, depression, and insomnia, but not quality of life.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The quality of evidence for hearing loss interventions was rated as low to very low due to high heterogeneity and underpowered analyses. Only one study was included for vestibular disorders, preventing meta-analysis and limiting conclusions in this area. Attrition rates were high in some studies, particularly for hearing loss interventions (mean 32%), which may bias results. The review included studies only from three countries (Sweden, Germany, UK), which may limit generalizability to other populations. Most included studies were efficacy trials rather than effectiveness trials, meaning they tested if the intervention works under ideal conditions rather than in routine clinical practice.
Declared interests
The authors declared no conflicts of interest. Funding sources were not explicitly detailed in the provided text, but the study was registered with PROSPERO.
The easy way to misread this
Do not interpret the null finding for hearing loss interventions as proof that they are ineffective. The analysis was underpowered and heterogeneous, and a sensitivity analysis excluding one high-attrition study suggested a potential moderate benefit. Similarly, do not assume Internet-based vestibular rehabilitation is unsupported; the lack of data synthesis reflects a scarcity of eligible studies, not a lack of effect in the single included trial.