Trial of Management of Chronic Tinnitus by Sound Therapy and Cognitive Behavioral Therapy

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.

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: \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