Educational Counseling for Tinnitus Management: A Scoping Review of Intervention Structure, Content, and Outcomes

Jung Suk Yang; In-Ki Jin

doi:10.7874/jao.2025.00486

J Audiol Otol > Volume 30(2); 2026 > Article

Yang and Jin: Educational Counseling for Tinnitus Management: A Scoping Review of Intervention Structure, Content, and Outcomes

Review

Journal of Audiology and Otology 2026;30(2):73-82.

Published online: April 20, 2026

DOI: https://doi.org/10.7874/jao.2025.00486

Educational Counseling for Tinnitus Management: A Scoping Review of Intervention Structure, Content, and Outcomes

Jung Suk Yang¹

, In-Ki Jin²

¹Department of Speech Pathology and Audiology, Graduate School, Hallym University, Chuncheon, Korea

²Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, College of Natural Sciences, Hallym University, Chuncheon, Korea

Address for correspondence In-Ki Jin, PhD Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, College of Natural Sciences, Hallym University, 1 Hallymdaehak-gil, Chuncheon 24252, Korea Tel +82-33-248-2221 Fax +82-33-256-3420 E-mail ikjin@hallym.ac.kr

Received August 14, 2025 Revised November 5, 2025 Accepted January 3, 2026

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Educational counseling is a fundamental component of tinnitus management; however, its structure, content, and clinical outcomes vary. This scoping review analyzed ten peer-reviewed studies to inform the development of standardized, evidence-based protocols. Three studies evaluated educational counseling alone, whereas seven combined it with other therapeutic approaches. Most interventions delivered key content during an initial session. Six studies employed individual face-to-face formats, whereas four compared delivery modes, including individual versus group or traditional versus technology-assisted methods. Counseling content was typically derived from expert consensus or prior research, and three studies explicitly described the theoretical rationales underlying their counseling frameworks. Core topics included auditory anatomy and tinnitus pathophysiology, although these topics were occasionally omitted from brief sessions. Nine studies presented practical management strategies, and five studies tailored content using individual hearing and tinnitus profiles. All studies used self-report measures, with the Tinnitus Handicap Inventory being the most common. Some studies reported improvements from counseling alone, whereas others showed outcome differences when counseling was combined with hearing aids or sound therapy, or delivered in alternative formats. This heterogeneity underscores the need for clearer and more standardized clinical protocols, as outcomes may vary depending on the content provided, patient characteristics, delivery method, patient’s understanding, and application of information.

Keywords: Tinnitus · Counseling · Patient education · Tinnitus management.

Introduction

Tinnitus refers to the perception of sound without a corresponding external auditory stimulus [1,2]. It is estimated that approximately 14.4% of the adult population experiences tinnitus during their lifetime, with nearly 2% reporting significant disruptions to daily functioning, including sleep disturbances, difficulty concentrating, and emotional distress [2,3]. In addition to its impact on individual well-being, tinnitus contributes to a broader societal burden by impairing communication, occupational performance, and psychological health [4]. These challenges can lead to social withdrawal, reduced quality of life, and increased demands on healthcare systems and resources.

The clinical presentation of tinnitus varies considerably among individuals in sound characteristics, perceived loudness and duration, and level of associated distress. Its etiology is multifactorial, involving auditory system abnormalities, psychological factors, neurophysiological mechanisms, and autonomic nervous system involvement [5-7]. This complexity necessitates the use of individualized, multidimensional treatment approaches.

Various interventions, such as hearing aid amplification, sound therapy, multisensory stimulation, and cognitive behavioral therapy (CBT), have been employed to manage tinnitus symptoms. However, treatment outcomes often vary owing to differences in underlying causes, symptom profiles, and patient-specific factors [4,8].

Educational counseling plays an essential role in helping individuals better understand tinnitus, reduce emotional distress, and address maladaptive beliefs related to the condition. It can be offered independently or in combination with other treatment modalities [1,9]. Despite its clinical significance, no standardized protocols have been universally adopted for tinnitus counseling [9]. In many cases, structured approaches based on tinnitus retraining therapy (TRT), CBT, or expert consensus are used as practical alternatives [1,10].

Given these considerations, this review aimed to analyze key studies utilizing educational counseling in tinnitus management, with a focus on intervention structure, content, and clinical effectiveness. The findings are intended to inform the development of standardized, evidence-based protocols for clinical practice.

Materials and Methods

In this review, educational counseling for tinnitus was conceptualized as a structured or semi-structured therapeutic process in which clinicians provide tailored information, explanation, or psychological support to enhance patients’ understanding and management of tinnitus. The primary goals of education counseling are to reframe maladaptive beliefs, reduce tinnitus-related distress, and encourage adaptive coping and self-management through collaborative education and clinician-patient communication. The term encompasses a wide range of counseling modalities described in the literature, such as supportive counseling (emotionally focused and empathic), directive counseling (information-oriented and corrective), CBT-based approaches (cognitive restructuring and behavioral adjustment) [11], TRT-based counseling (habituation within a neurophysiological framework) [12], psychotherapeutic methods emphasizing acceptance or mindfulness [13], motivational interviewing [14], self-management and coping-skills programs [15], group or family-involved formats [16], and digital or web-based interventions [17]. For the purposes of this scoping review, the expression “educational counseling” was applied in an inclusive manner, referring to the full spectrum of these approaches irrespective of theoretical orientation, delivery format (individual, group, or digital), or integration with sound therapy or hearing aid rehabilitation. This comprehensive definition was adopted to capture the diversity of educational and counseling strategies currently used in tinnitus management.

This scoping review followed the methodological framework proposed by Arksey and O’Malley [18] and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines [19]. The primary aim was to identify and map existing studies on tinnitus interventions incorporating educational counseling, either as a standalone treatment or in combination with other modalities, with particular emphasis on the structure, content, and clinical outcomes of the counseling component. A systematic literature search was conducted between February 1 and February 28, 2025 using the PubMed and Google Scholar databases. A consistent, concept-based search strategy was applied across both databases, using unified Boolean expressions targeting tinnitus and educational counseling (Table 1). All retrieved records were imported into the Zotero reference manager (version 6.0; Corporation for Digital Scholarship), where duplicate entries (n=3,762) were automatically removed. The initial Google Scholar search returned 18,300 records. However, due to export limitations and the presence of non-scholarly or low-relevance materials in Google Scholar results, the records were refined by year and keyword subsets using Harzing’s Publish or Perish software (version 8.18.5091.9307). This process yielded 9,200 records, which were imported into Zotero for deduplication and screening. Non-original articles, such as systematic reviews and meta-analyses, retrieved during the search, were excluded in accordance with the eligibility criteria, and the number of excluded records is reported in the PRISMA-ScR flow diagram (Fig. 1).

Studies published between January 1, 2010, and December 31, 2024, were eligible for inclusion. No restrictions were placed on geographic location or clinical setting. The eligibility criteria were defined according to the Population-Concept-Context framework recommended by the Joanna Briggs Institute (JBI) [20]. Studies were included if they involved individuals with tinnitus and implemented educational counseling as a primary or adjunctive intervention, with outcomes related to tinnitus severity, psychological burden, or quality of life. The exclusion criteria encompassed non-original articles such as reviews, meta-analyses, editorials, interviews, and case reports. The detailed inclusion and exclusion criteria are provided in Table 2.

Two reviewers independently screened the titles and abstracts, followed by full-text reviews to determine final eligibility. Disagreements were resolved through decision and consensus. The key characteristics of each study, including the author, publication year, study design, sample size, and details of the counseling intervention, were extracted using a standardized data collection form. Data elements included delivery format (e.g., individual or group sessions), provider type, content focus, session duration, and outcome measures. The extracted data were organized into tables to facilitate crossstudy comparisons. In accordance with the JBI Manual for Evidence Synthesis [20] and PRISMA-ScR guidelines, a formal quality appraisal of the included studies was not conducted, as it is not a mandatory component of scoping reviews. The primary purpose of this review was to map and describe the existing evidence on educational counseling for tinnitus management. This statement has been added to enhance methodological transparency.

Results and Discussion

This review synthesizes findings from the existing literature on educational counseling for tinnitus, focusing on its structural components, content, and clinical outcomes. It also identifies factors that may influence counseling effectiveness and inform future clinical applications. Ten studies were included in the review. Of these, three investigated educational counseling as a standalone intervention, whereas seven combined it with other therapeutic modalities. Table 3 provides an overview of study design, intervention type, counseling structure, and outcomes, whereas Table 4 summarizes theoretical rationales, key counseling topics, and supplementary materials used.

Number and duration of educational counseling sessions

Four studies implemented educational counseling in a single session [16,21-23]. In four other studies [24-27], all educational content was delivered in the initial session, with follow-up sessions primarily used to answer participants’ questions and provide support. The durations of these single or initial sessions varied considerably: five studies reported durations ranging from 60 to 150 min [22-24,26,27], one reported a 30-min session [16], and two did not specify duration [21,25]. In contrast, two studies delivered content over multiple sessions for self-directed learning, with total durations ranging from 108 to 300 min [28,29].

The variation observed in the number and duration of counseling sessions may reflect differences in patients’ clinical and psychological needs, such as tinnitus severity, emotional distress, and readiness to engage in treatment [30]. While some individuals may achieve sufficient benefit from brief counseling, others may require repeated or extended sessions to support ongoing adjustment and coping. Moreover, the diversity in counseling formats identified in this review indicates a lack of standardized protocols, which may complicate comparisons across studies and limit the consistency of interpretation.

Counseling providers and delivery formats

Six studies adopted an individual one-on-one (1:1) format with counselors and participants [21-26]. Two studies compared different delivery formats. Park, et al. [16] examined traditional face-to-face individual counseling versus groupbased (1:n) formats. Suh, et al. [27] compared group counseling with one-on-one counseling provided via an interactive smart pad application; in this study, each of the three group sessions was delivered by a different provider, which the authors suggested helped sustain attention and reduced habituation to a single speaker’s tone and communication style. Lee, et al. [29] compared synchronous group counseling via Zoom with a self-directed learning format in which participants viewed a sequence of 108 self-help tips. Schlee, et al. [28] delivered the same video content through a mobile application designed for individual use.

The included studies demonstrated notable variation in delivery formats, ranging from traditional face-to-face individual counseling to group-based and technology-assisted models. These differences appear to be shaped by clinical needs as well as practical factors such as provider availability, clinical resources, and the need to improve accessibility for individuals with geographic or mobility limitations [30,31]. Delivery format may also influence patient engagement, interaction quality, and perceived therapeutic benefit. For example, technology-assisted or internet-based programs can offer flexible, self-paced learning environments, but may provide less immediate interpersonal feedback than face-to-face counseling [32]. Therefore, understanding how different delivery methods affect patient participation and clinical outcomes is essential for determining when individualized, group-based, or digital counseling approaches may be most appropriate.

Protocol compliance monitoring

Seven of the included studies implemented monitoring methods to assess participant compliance with counseling protocols. Four studies used questionnaires or brief self-report checklists to evaluate engagement [22,27-29], whereas three assessed adherence through follow-up sessions involving Q&A interactions [24-26]. Liu, et al. [22] reported that participants who adhered to sleep hygiene recommendations showed greater improvements in tinnitus-related distress and sleep quality than those who did not. Similarly, Schlee, et al. [28] found that participants who engaged more frequently and attentively with a mobile application experienced greater reductions in tinnitus symptoms.

A clear understanding of the counseling content and the consistent application of tinnitus management strategies in daily life are crucial for achieving successful outcomes. Consequently, establishing robust mechanisms to monitor and enhance protocol adherence is essential, particularly in selfguided formats where external reinforcement is limited [33].

Theoretical rationale and content development

A strong theoretical or empirical rationale is essential for ensuring the validity and clinical relevance of educational counseling content. However, many studies provided limited explanation regarding how their counseling materials were conceptualized or which theoretical models informed their structure. Two studies [16,24] referenced Jastreboff’s neurophysiological model, which attributes tinnitus to interactions among the auditory, limbic, and autonomic nervous systems, resulting in heightened physiological and emotional responses [34,35]. Rocha, et al. [21] based their counseling on Tyler’s model, which expands Jastreboff’s framework by incorporating psychological and cognitive dimensions [36]. Although these theoretical distinctions may shape counseling focus and messaging, it remains difficult to attribute clinical outcomes directly to such differences due to the frequent use of concurrent interventions such as hearing aids, sound generators, medication, and variations in the number of sessions and delivery formats. As a result, the independent contribution of counseling content alone is often challenging to determine.

For example, studies referencing Jastreboff’s neurophysiological model [16,24] emphasized reducing threat perception and promoting habituation; however, Park, et al. [16] combined counseling with alprazolam and Ginkgo biloba extract, and Scherer, et al. [24] incorporated conventional or placebo sound generators alongside counseling, making it difficult to isolate counseling-specific effects. In contrast, the Standard of Care counseling group in Scherer, et al. [24], which followed the American Speech-Language-Hearing Association (ASHA) guidelines and a patient-centered interaction style without device-based sound therapy, emphasized reassurance regarding the benign nature of tinnitus, the use of environmental sounds, attention-diversion and relaxation strategies, and personalized coping planning. Reductions in tinnitus-related distress at 18-month follow-up were reported, suggesting possible improvements in perceived control and daily adjustment.

In studies utilizing self-directed formats, the content was generally adapted from previously validated sources. Schlee, et al. [28] developed a set of 108 self-help tips derived from established tinnitus self-management resources. Similarly, Lee, et al. [29] created 100 counseling prompts in a Q&A format based on survey responses from individuals with tinnitus, aiming to address frequently asked questions and patientspecific concerns.

When counseling is delivered as a stand-alone intervention, the clarity of its theoretical basis and development process becomes particularly critical. In this context, specifying the underlying conceptual model, the evidence informing the selection of counseling components, and the principles guiding individual tailoring is essential for ensuring reproducibility and maintaining consistency across clinicians. Clear documentation of these elements also supports intervention fidelity and provides a foundation for developing standardized, evidence-based clinical protocols for tinnitus educational counseling.

Counseling topics

Most studies included educational content covering basic auditory anatomy and physiology, such as the structure of the ear, auditory pathways, and sound processing mechanisms, as well as tinnitus pathophysiology, including definitions, causes, and clinical presentations. In studies with shorter session durations, auditory anatomy and physiology were often excluded [28,29], and in some cases, even basic explanations of tinnitus pathophysiology were omitted [28]. All studies, except one that focused solely on hearing aid fitting [21], included practical strategies for daily tinnitus management. These topics included sound therapy, habituation, relaxation techniques, attention redirection, sleep hygiene, and coping strategies. In five studies, counseling was individualized based on patients’ hearing and tinnitus evaluation results [21,23-26]. Six studies incorporated Q&A sessions to encourage active discussion, clarify misunderstandings, and address participants’ additional questions [16,23,24,26,27,29].

Effective management of tinnitus requires not only a comprehensive understanding of the condition but also familiarity with the range of available intervention strategies. This foundational knowledge supports treatment adherence and increases the likelihood of positive outcomes [37]. However, comprehension of counseling content may vary considerably among individuals, and the information patients seek may not always align with the knowledge considered clinically essential.

Supplementary materials

Only two studies provided supplementary materials to support the counseling sessions. Scherer, et al. [24] offered different materials for each intervention group. The Standard of Care group received a leaflet containing general tinnitus information and tips on sleep, relaxation, and concentration, along with links to relevant websites. Participants in the TRT and partial TRT groups were provided with a summary of the TRT counseling content and instructions for using a sound generator. Kam [23] distributed a booklet that included answers to common questions about tinnitus, as well as information on sleep hygiene, attention diversion techniques, auditory physiology, and self-help strategies.

These supplementary materials serve as valuable tools for post-session review and reinforcement, representing a costeffective method to enhance the continuity and overall impact of tinnitus management.

Intervention outcomes

Intervention outcomes can be evaluated using both objective perceptual measures, such as pitch, loudness, and minimum masking level, and subjective self-reported instruments, including the Tinnitus Handicap Inventory (THI), Tinnitus Functional Index, Tinnitus Questionnaire (TQ), Tinnitus Primary Function Questionnaire (TPFQ), and Visual Analog Scales (VAS) for loudness, annoyance, and awareness. Only two studies employed perceptual assessments both before and after treatment. Rocha, et al. [21] collected baseline perceptual data but did not perform a post-treatment evaluation, thereby limiting conclusions regarding efficacy. In contrast, all studies used subjective outcome measures, with the THI being the most commonly applied, followed by the VAS for loudness and annoyance.

Across the four studies in which educational counseling was provided in conjunction with hearing aids, reductions in tinnitus-related outcome measures were reported [21,23,25,26]. In eight longitudinal studies with follow-up periods ranging from 2 to 18 months, these changes were reported to be maintained over time (p<0.05) [16,21-27]. Three studies compared educational counseling alone with counseling combined with other interventions, such as hearing aids or TRT [23,24,26]. In two of these studies, the combined interventions were reported to show earlier or greater changes, whereas one study reported no substantial difference between intervention types, indicating variation in outcome patterns across studies.

In the original RCT by Scherer, et al. [24], improvements were observed across treatment conditions. In a subsequent secondary analysis of these data, Formby, et al. [38] applied an exponential recovery model and identified group differences in the time constant (τ), which represents the point at which approximately 63% of the total predicted improvement is achieved. The TRT group reached this point at approximately 1.2 months, the partial TRT group at 2.2 months, and the counseling only group at 2.7 months, indicating variation in the rate of improvement across intervention conditions rather than in the magnitude of change. In Wang, et al. [26], the proportion of participants achieving the minimal clinically important difference (MCID) did not differ significantly between the counseling only and counseling with hearing aid groups (p=0.35). In contrast, Kam [23] observed different MCID achievement rates across groups: 46% in the counseling with hearing aid group, 23% in the counseling with sound therapy group, and 8% in the counseling only group.

Three studies compared individual versus group-based counseling [16,27,29], and reductions in tinnitus-related measures were reported in both formats, with no consistent differences in the magnitude of change between formats. Two studies evaluated self-directed, internet-based interventions. Schlee, et al. [28] reported effect size of d=0.408 for VAS annoyance and d=0.168 for THI, indicating that small-to-moderate changes were observed. Lee, et al. [29] reported statistically significant reductions in total Korean version of the TPFQ scores and in the emotional and sleep subscales (p<0.05).

Future directions

Educational counseling remains a central component of tinnitus management, functioning both as a standalone intervention and as part of multimodal therapeutic strategies. Its clinical effectiveness depends on multiple dimensions—what information is conveyed, to whom, how, and by whom—with treatment success largely determined by the patients’ ability to understand and apply this information in daily life. The five key factors are illustrated in Fig. 2.

A major limitation identified in this review is the lack of diversity and standardization in counseling content. Future research should prioritize the development of evidence-based, structured protocols grounded in established theoretical and clinical frameworks, such as the Jastreboff neurophysiological model [35], multidisciplinary European guidelines [9], and ASHA-preferred practice patterns [36]. These protocols should then undergo rigorous clinical validation to ensure their effectiveness across diverse patient populations.

Determining appropriate target groups is essential, given the heterogeneous nature of tinnitus symptoms and their variable impact on quality of life. Notably, the information patients seek often differs from clinicians’ priorities, highlighting the importance of personalized counseling. In this context, Tyler and Baker’s classification [39], which classifies tinnitus-related difficulties into five domains—emotional distress, sleep disruption, hearing difficulties, concentration problems, and interference with daily activities—may provide a useful framework for designing patient-centered interventions.

Another critical area is the mode of counseling delivery. While face-to-face counseling remains the conventional standard, recent trends have emphasized digital health solutions, including mobile applications, videoconferencing, and webbased platforms [40,41]. Although digital and self-directed formats pose limitations, such as reduced personalization, technology reliance, and potential loss of therapeutic interaction, their scalability, accessibility, and cost-effectiveness make them compelling alternatives. Hybrid models that combine in-person and remote elements may offer a balanced solution, leveraging the advantages of both approaches [42].

Clarifying the qualifications and responsibilities of counseling providers remains a pressing need. In studies involving multiple providers, robust quality assurance mechanisms are essential to maintain consistency and fidelity.

To optimize the effectiveness of educational counseling, future efforts should prioritize developing valid tools for assessing patient comprehension, incorporating interactive delivery methods, and implementing continuous feedback systems to support protocol adherence and long-term engagement [43].

Conclusion

This scoping review systematically analyzed the role of educational counseling in tinnitus management by mapping current evidence on intervention structure, content, and outcomes. The analysis of ten studies revealed substantial heterogeneity across multiple dimensions: the number and duration of counseling sessions varied widely, delivery formats ranged from traditional face-to-face individual counseling to group-based and technology-assisted models, and counseling content differed in theoretical grounding, topic coverage, and degree of individualization. While several studies reported improvements following counseling alone, others observed variation in outcome patterns depending on whether counseling was combined with other interventions such as hearing aids or sound therapy, or delivered through different formats.

These research findings highlight several important limitations and opportunities for future research and clinical practice. First, the lack of standardized protocols complicates crossstudy comparisons and limits the consistency of clinical implementation. Future efforts should prioritize the development of evidence-based counseling frameworks grounded in established theoretical models and rigorously validated across diverse patient populations. Second, given the heterogeneous characteristics of tinnitus symptoms and their variable impact on quality of life, determining appropriate target groups and tailoring counseling content to individual needs remain essential. Third, while digital and technology-assisted delivery formats offer scalability and accessibility, their effectiveness relative to traditional face-to-face counseling requires further investigation, particularly regarding patient engagement, comprehension, and long-term adherence.

By synthesizing the available evidence on structural design, content characteristics, and clinical outcomes, this review provides a foundation for developing standardized, patientcentered counseling protocols that can inform future clinical guidelines and enhance the effectiveness and consistency of tinnitus care. Further research is needed to clarify optimal counseling content, delivery methods, provider qualifications, and mechanisms for monitoring patient comprehension and protocol adherence.

Notes

Conflicts of Interest

The authors have no financial conflicts of interest.

Author Contributions

Conceptualization: In-Ki Jin. Data curation: Jung Suk Yang. Methodology: Jung Suk Yang, In-Ki Jin. Project administration: In-Ki Jin. Supervision: In-Ki Jin. Validation: Jung Suk Yang. Writing—original draft: Jung Suk Yang, In-Ki Jin. Writing—review & editing: Jung Suk Yang, In-Ki Jin. Approval of final manuscript: Jung Suk Yang, In-Ki Jin.

Funding Statement

This work was supported by the National Research Foundation of Korea grant funded by the Korea government (MSIT; RS-2023-NR076371 & RS-2025-00554694).

Acknowledgments

None

Fig. 1.

PRISMA-ScR flow diagram for the scoping review. PCC, Population, Concept, and Context; PRISMA-ScR, Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.

Fig. 2.

Key factors, current issues, and recommended strategies for effective structuring of tinnitus educational counseling.

Table 1.

Database search strategy

Database	Search strategy
PubMed (n=1,162)	(“Tinnitus”[MeSH] OR tinnitus[Title/Abstract]) AND ((“Patient Education as Topic”[MeSH] OR education[Title/Abstract]) OR (“Counseling”[MeSH] OR counsel[Title/Abstract]) OR (“Information Dissemination”[MeSH] OR information*[Title/Abstract]))
Google Scholar (n=23,500)	tinnitus AND (education* OR information* OR counsel*)

Table 2.

Eligibility criteria (Population-Concept-Context Framework)

Inclusion	Exclusion
• Original research involving individuals with tinnitus	• Review articles, systematic reviews, or meta-analyses
• Studies in which educational counseling was delivered as a primary or adjunctive component of tinnitus management	• Editorials, opinion papers, dissertations, or book chapters
• Any empirical study design (quantitative, qualitative, or mixed-methods) including randomized or non-randomized studies	• Conference abstracts, case reports, or single-case studies
• Outcomes reported on tinnitus severity, psychological distress, coping/self-management, or quality of life	• Articles not available in English
• Published between 2010 and 2024	• Full text not available or restricted-access articles

Table 3.

Structure of counseling sessions and study outcomes in included studies

Study	Design	Intervention & number of participants (n)	Structure of counseling						Outcomes
Study	Design	Intervention & number of participants (n)	Number of sessions (n)	Duration per session (min)	Delivery format	Tailoring	Protocol compliance	Counseling provider	Perception	Reaction
Park, et al. (2013) [16]	Longitudinal	Counseling + Oral medication (n=55)	1	30	• 1:4 in-person	-	-	A TRT specialist	N/A	THI, VAS loudness/ annoyance/awareness: Both groups showed significant improvement (p < 0.01).
Park, et al. (2013) [16]	Retrospective	Counseling + Oral medication (n=55)	1	30	• 1:1 in-person	-	-	A TRT specialist	N/A
Rocha, et al. (2017) [21]	Longitudinal	• SG (n=15)	1	N/A	1:1 in-person	√	-	N/A	N/A	THI, VAS annoyance: Both groups showed significant improvement (p < 0.05).
Rocha, et al. (2017) [21]	Prospective	• SG + amplification (n=15)	1	N/A	1:1 in-person	√	-	N/A	N/A
Liu, et al. (2018) [22]	Longitudinal	Educational counseling + Sleep/lifestyle advice (n=159)	1	70-140	1:1 in-person	-	√	• An audiology technician	N/A	THI, TEQ, VAS loudness: Significant improvement (p < 0.01)
Liu, et al. (2018) [22]	Longitudinal	Educational counseling + Sleep/lifestyle advice (n=159)	1	70-140	1:1 in-person	-	√	• A physician	N/A	THI, TEQ, VAS loudness: Significant improvement (p < 0.01)
Scherer, et al. (2019) [24]	RCT	• SOC (n=49)	5	15-150	1:1 in-person	√	√	Audiologists	N/A	TQ, TFI, THI, VAS annoyance: Significant improvement (p < 0.05)
	Longitudinal	• pTRT (n=51)
	Longitudinal	• TRT (n=51)
Schlee, et al. (2022) [28]	RCT	Self-help tip (n=36)	108	1-2	Self-viewing	-	√	108 self-help tips	N/A	VAS annoyance: Both groups showed significant improvement (p < 0.001).
Simonetti, et al. (2022) [25]	Longitudinal	• Individual counseling + HA (n=19)	≥1	N/A	1:1 in-person	√	√	An audiologist	MML: Significant improvement (p < 0.05)	THI, VAS annoyance: Significant improvement (p < 0.001)
Wang, et al. (2023) [26]	Longitudinal	• EC only (n=51)	≥3	20-60	1:1 in-person	√	√	Auditory technicians	N/A	THI, TEQ, VAS loudness: Both groups showed significant improvement (p < 0.001).
Wang, et al. (2023) [26]	Longitudinal	• EC + HA (n=21)	≥3	20-60	1:1 in-person	√	√	Auditory technicians	N/A
Suh, et al. (2023) [27]	Longitudinal	• Conv-TRT (n=42)	3	10-60	• 1:4 in-person	-	√	• An audiologist	N/A	THI, VAS loudness/ annoyance/awareness/effect: Both groups showed significant improvement (p < 0.05).
Suh, et al. (2023) [27]	Prospective	• Smart-TRT (n=42)	3	10-60	• 1:1 in-person via interactive smart pad app	-	√	• 3 audiologists	N/A
Kam (2024) [23]	RCT	• IC only (n=8)	1	90	1:1 in-person	√	-	Audiologists	Pitch, Loudness: No significant change	TFI: The IC + HA group showed significant improvement compared with the IC group (p < 0.05).
	Longitudinal	• IC + CS (n=7)
	Longitudinal	• IC + HA (n=7)
Lee, et al. (2024) [29]	RCT	• Online (n=15)	• 6	• 30-40	• 1:5 via Zoom	-	√	• An audiologist	N/A	TPFQ emotional aspect, VAS annoyance: Both groups showed significant improvement (p < 0.05).
Lee, et al. (2024) [29]	RCT	• Video (n=21)	• 100	• 2-3	• Self-viewing	-	√	• 100 videos	N/A

TRT, tinnitus retraining therapy; THI, Tinnitus Handicap Inventory; VAS, Visual Analog Scale; SG, sound generator; TEQ, Tinnitus Evaluation Questionnaire; RCT, randomized controlled trial; SOC, standard of care; pTRT, partial tinnitus retraining therapy; TQ, Tinnitus Questionnaire; TFI, Tinnitus Functional Index; HA, hearing aids; MML, minimum masking level; EC, educational counseling; Conv, conventional; IC, informational counseling; CS, customized sound therapy; TPFQ, Tinnitus Primary Function Questionnaire; min, minute; N/A, not available; √, included; -, not included.

Table 4.

Content of educational counseling

Item	Description
Rationale for the content	• Jastreboff’s neurophysiological models of tinnitus [16,24]
	• Tyler’s neurophysiological models of tinnitus [21]
	• ASHA’s preferred practice patterns [24]
	• Findings from previous studies [28,29]
	• Expert consensus [22,23,25-27]
Counseling topics covered	• Explanation of participant’s hearing or tinnitus test results [21,23-26]
	• Auditory anatomy and physiology [16,21-27]
	• Pathophysiology of tinnitus [16,21-27,29]
	• Treatment of tinnitus: sound therapy, habituation, management strategies, relaxation, attention, and sleep advice [16,22-29]
	• Q&A [16,23,24,26,27,29]
Supplementary materials	• Tinnitus handouts – Key points about tinnitus [24]
Supplementary materials	• Booklet covering tinnitus information and self-help strategies [23]

ASHA, American Speech-Language-Hearing Association.

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