clinical trial: The main aim of this study is to compare the effectiveness of Cognitive Behavioral Therapy (CBT) and Sound Therapy, both individually and in combination, in the management of patients with chronic subjective tinnitus and to evaluate their impact on decreasing tinnitus severity, psychological wellbeing and quality of life.

Patients will be randomly divided into three groups:

• Group A: patients will receive Sound Therapy.
• Group B: patients will receive Cognitive Behavioral Therapy (CBT).
• Group C: patients will receive Combined CBT + Sound Therapy.

Because of the multifactorial nature of tinnitus, its effective management requires a multidisciplinary approach. While there is no single pullet mechanism of cure, current treatment strategies primary focus on reducing tinnitus related perception and minimizing its associated distress through auditory and psychological interventions.

Among these approaches, is the Sound Therapy which aims to decrease the contrast between tinnitus and related neural activity by introducing external sounds, which facilitates habituation and reducing tinnitus perception .

In contrast, Cognitive Behavioral Therapy (CBT) targets the patient's cognitive and emotional reaction to tinnitus by modifying maladaptive thoughts and behaviors, there by improving coping strategies and reducing tinnitus-related distress (Andersson, 2011). Recent evidence suggests that combining both modalities may provide superior outcomes compared to either approach alone, highlighting the potential value for integrated treatment strategies in tinnitus management (Hall et

Inclusion Criteria:

• o Age: 18-65 years.

  • Hearing level: Patients with normal hearing or mild to moderate sensorineural hearing loss (to ensure homogeneity of the sample) (National Institute for Health and Care Excellence, 2020)
  • Complaint: patients with chronic subjective tinnitus (> 3 months).
  • Psychological state: Patients with stable general and psychological condition.

Exclusion Criteria:

• o Age: <18, >65 years

  • Hearing level: Patients with severe hearing loss not suitable for sound therapy
  • Complaint: Objective tinnitus (vascular or muscular origin)
  • Psychological state: Patients with active psychiatric disorders requiring immediate intervention.
  • Active middle or external ear disease

No decision has been made regarding the sharing of individual participant data at this time

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