To the Editor The recent randomized clinical trial by Kallogjeri et al1 on the effect of the Brain Fitness Program-Tinnitus (BFP-T) to treat tinnitus was interesting, but several limitations made me question the conclusions drawn by the authors.
In their study, the authors claim that the BFP-T was associated with self-reported changes in attention, memory, and perception of tinnitus, possibly owing to neuroplastic changes involved in cognitive control. The tinnitus handicap inventory (THI), the primary outcome measure of this study, and the tinnitus functional index (TFI) are extensive and well-validated questionnaires to assess subjective changes in perception of tinnitus complaints, such as attention and cognitive control.2,3 In this study, no significant changes in THI and TFI score were found after the BFP-T intervention. Rather than basing their conclusions on the outcome of these questionnaires, the authors draw their conclusions merely on the answers to 2 nonvalidated questions to assess the participant’s change in tinnitus complaints. Moreover, no statistical tests were conducted to assess whether the answers to these questions significantly differed between the BFP-T and the control group. As the authors state, the answers to subjective questions are prone to expectation bias; the participants in the intervention group spend an hour a day for 8 weeks to improve their tinnitus and it is likely that this falsely made them believe that their tinnitus-related complaints had improved. This limitation in combination with the lack of any improvement on the validated questionnaires makes me believe that there is insufficient evidence to claim that the BFP-T leads to a subjective improvement in tinnitus. In addition, the extensive battery of cognitive tests administered before and after the BFP-T established that the BFP-T did not lead to any objective improvements in tinnitus-related cognitive impairments.
Stevelink R. Cognitive Training Program to Treat Tinnitus. JAMA Otolaryngol Head Neck Surg. Published online June 08, 2017. doi:10.1001/jamaoto.2017.0520