In Reference to “A Cure for Tinnitus After Tinnitus Retraining Therapy: Insights From a Large Case Series”

Dear Editor, We read with great interest the article by Velasco et al1, entitled “A Cure for Tinnitus After Tinnitus Retraining Therapy: Insights from a Large Case Series.” This retrospective analysis of 1027 patients provides one of the largest datasets to date examining factors associated with successful symptom resolution. The authors did great work in sensorineural tinnitus treatment, but still, several aspects of the study merit further consideration to enhance the clinical applicability. First, there is potential selection bias due to the inclusion of only patients who achieved “cure,” which overlooks patients with partial improvement or treatment failure. In clinical practice, response to tinnitus retraining therapy (TRT) is highly heterogeneous, with many patients experiencing varying degrees of benefit rather than complete resolution. Given the authors’ access to a large retrospective cohort, analyzing patients across the full spectrum of outcomes—including non-responders—would allow for the identification of predictors of differential response, which is of considerable importance to clinicians when selecting treatment strategies. Currently, there is no guideline to help clinicians determine which subgroups are most likely to benefit from TRT. A comparative analysis of patient characteristics between cure, partial response, and non-response groups could provide critical evidence to inform patient selection and counseling. Besides, the absence of long-term follow-up data may limit the ability to assess the durability of tinnitus resolution. In clinical practice, some patients experience recurrence years or months even weeks after initial improvement, particularly when underlying auditory dysfunction or psychosocial disorders2. Incorporating structured longitudinal follow-up beyond the point of symptom resolution could provide valuable insights into the stability of habituation and offer clinically relevant prognostic information regarding sustained benefit. Last, while the use of Spearman correlation analysis provides useful preliminary insights, it may not fully account for the multifactorial nature of tinnitus outcomes. The reported moderate correlations suggest meaningful associations, but confounding variables like audiological, and psychological variables, which are common in patients with sudden sensorineural hearing loss have not been controlled. From the clinical perspective, these factors are critical in making treatment decisions and providing patient education3. Incorporating multivariable regression models could better delineate the independent contribution of each predictor and provide a more robust basis for clinical interpretation. Given the large sample size in this cohort, such analyses appear feasible and we are curious about the possible results. In conclusion, the work by Velasco and colleagues represents a valuable contribution to understanding successful TRT outcomes in a large clinical population. Expanding future analyses to larger patients spectrum and applying multivariable modeling to control for confounding variables would greatly enhance the study’s clinical relevance and methodological rigor. Such approaches would not only refine prognostic models but also inform personalized TRT strategies, helping clinicians identify patients most likely to benefit and provide more accurate prognostic counseling.