You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Coping and marital support as correlates of tinnitus disability.
Abstract 1:
Although there is increasing awareness that depression can add significantly to the disability associated with chronic medical illness , it is not clear whether all of the impact of psychosocial factors upon medical disability are mediated by or moderated by depression . It has not been determined whether treating depression alone is an adequate strategy for addressing psychosocial magnification of medical disability . We analyzed data collected at initiation of a treatment trial from 92 subjects with chronic severe tinnitus to assess the role of coping , and 49 subject-spouse pairs to assess the role of marital interaction  in  tinnitus-related role dysfunction . Three multiple regression models were developed . After accounting for gender , tinnitus loudness , and depressive severity among the 92 subjects , greater role dysfunction was associated appraisal of tinnitus as salient , and less role dysfunction with coping through avoidance or seeking social support . Marital interaction was assessed from patient and spouse perspectives . In the patient-rated set , less marital cohesion was associated with greater tinnitus-related role dysfunction . In the spouse-rated set , more punishing responses to subject illness behavior were associated with greater tinnitus-related role dysfunction . In each case the disabling effect was greater in the face of high levels of subject depression . This study provides evidence for the oft-stated analogy between chronic tinnitus and chronic pain , and provides justification for a similar multimodal treatment strategy . Reducing depression is an important means to reduce medical disability but should be supplemented by clinical attention to appraisal of the illness , modes of coping with the illness , and spousal response to the illness


Title 2:
Treatment of Depressed Tinnitus Patients with Nortriptyline
Abstract 2:
Patients disabled by tinnitus show a high prevalence of major depression . Furthermore , tinnitus produces patterns of disability similar to those produced by major depression . To explore further this link between tinnitus and depression , and to investigate the efficacy of treating depression in the treatment of tinnitus , a single-blind , placebo-washout , nonr and omized pilot study of the tricyclic antidepressant nortriptyline ( hydrochloride ) was undertaken in disabled tinnitus patients who also met diagnostic criteria for major depression . Nineteen patients began the study , two responded to placebo  , and two dropped out prior to completion . Fourteen considered their tinnitus improved , and 12 chose to continue taking nortriptyline after the study . Depression severity decreased , on the average , by 65 % ( p<.0001 ) . Tinnitus loudness measured by audiometric matching decreased by a mean of 10 dB or 50 % ( p<.02 ) . Self-reports of tinnitus loudness and severity , somatic and psychologic symptoms , and psychosocial dysfunction all showed significant improvement with treatment . These results suggest that what initially appears to be an irreversible otologic disability in these patients may be in large part a reversible psychiatric disability


Title 3:
A randomized trial of nortriptyline for severe chronic tinnitus. Effects on depression, disability, and tinnitus symptoms.
Abstract 3:
OBJECTIVE To determine whether the antidepressant , nortriptyline , is effective for treatment of depression , tinnitus-related disability , and tinnitus symptoms in patients with severe chronic tinnitus . DESIGN A 12-week , double-blind , r and omized controlled trial . SETTING A university otolaryngology clinic . PATIENTS Ninety-two subjects with severe chronic tinnitus : 38 with current major depression and 54 with depressive symptoms and significant tinnitus-related disability . INTERVENTION Nortriptyline ( maintained at 50 to 150 mg/mL for 6 weeks ) or placebo . MAIN OUTCOME MEASURES Hamilton Depression Rating Scale , Tinnitus Disability Measures , and Audiometric Measures . RESULTS Nortriptyline was superior to placebo by multivariate analysis of covariance for depression ( 10.6 vs 14.3 final Hamilton Depression score ) , for tinnitus-related disability ( 1.8 vs 2.4 final MPI Tinnitus Interference ) , and tinnitus loudness ( 13.6 vs 20.0 dB final loudness match [ in worst ear at tinnitus frequency ] ) . When major depression and depressive symptoms groups were considered separately , nortriptyline was superior to placebo on these same measures but differences did not achieve statistical significance . CONCLUSIONS The antidepressant nortriptyline decreases depression , functional disability , and tinnitus loudness associated with severe chronic tinnitus . What appears to be irreversible disability of otologic origin may , in part , be reversible disability of psychiatric origin
There was no evidence that Gingko biloba was effective in patients with a primary complaint of tinnitus .
The practical clinical significance of this is unclear .
The incidence of side effects was low .
The limited evidence does not demonstrate that Ginkgo biloba is effective for tinnitus when this is the primary complaint