From the Guidelines
Tinnitus treatment should prioritize cognitive-behavioral therapy (CBT) to reduce distress associated with the condition, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1.
Treatment Approaches
Tinnitus treatment focuses on managing symptoms since there is no universal cure. The most effective approach is sound therapy, which involves using background noise like white noise machines, fans, or smartphone apps to mask the ringing sensation.
- Hearing aids can help if tinnitus is related to hearing loss.
- CBT is recommended to reduce the distress associated with tinnitus by changing how patients respond to the sound 1.
- For medication options, no drugs are FDA-approved specifically for tinnitus, but antidepressants like amitriptyline (10-100 mg daily) or nortriptyline (25-75 mg daily) may help manage associated anxiety or depression.
- Some patients find relief with melatonin (3 mg before bedtime) for sleep disturbances.
Lifestyle Modifications
Avoiding triggers like loud noise exposure, caffeine, alcohol, and high-sodium foods can prevent worsening symptoms.
- Stress management techniques including meditation, yoga, and regular exercise often reduce tinnitus perception.
- Tinnitus typically results from damage to inner ear hair cells that transmit sound signals to the brain, causing the brain to generate phantom sounds when receiving incomplete signals.
Personalized Approach
Treatment success varies widely among individuals, so a personalized approach combining multiple strategies typically works best.
- Clinicians should educate patients with persistent, bothersome tinnitus about management strategies, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1.
- A targeted history and physical examination at the initial evaluation of a patient with presumed primary tinnitus can help identify conditions that if promptly identified and managed may relieve tinnitus 1.
- Avoid using medications that are not approved for use in the geriatric population, as they may have significant potential side effects and no proven benefit 1.
From the Research
Treatment Options for Tinnitus
- Cognitive Behavioral Therapy (CBT): CBT has been shown to be an effective treatment for tinnitus, with studies demonstrating its ability to improve quality of life and reduce tinnitus-related distress 2, 3, 4, 5.
- Sound Therapy: Sound therapy, including notched sound therapy, has been found to be effective in reducing tinnitus symptoms, although the evidence is not as strong as it is for CBT 6, 4.
- Pharmacological Approaches: Medications such as melatonin, antidepressants, and cognitive training may help with sleep disturbance, mood disorders, and cognitive impairments associated with tinnitus 5.
- Masking Devices: Masking devices can be used to help reduce the perception of tinnitus, although the evidence for their effectiveness is limited 2.
- Individualized Sound Stimulation: Individualized sound stimulation has been found to be effective in reducing tinnitus symptoms, although more research is needed to fully understand its effects 2.
Non-Invasive Brain Stimulation
- Repetitive Transcranial Magnetic Stimulation (rTMS): rTMS has been found to be effective in reducing tinnitus perception, although the effects are typically short-term and may not be suitable for all patients 6.
- Transcranial Direct Current Stimulation (tDCS): tDCS has been found to be effective in reducing tinnitus symptoms, although more research is needed to fully understand its effects 6.
Diagnosis and Management
- Comprehensive Audiologic Evaluation: A comprehensive audiologic evaluation should be performed for patients who experience unilateral tinnitus, tinnitus that has been present for six months or longer, or that is accompanied by hearing problems 5.
- Neuroimaging: Neuroimaging is not part of the standard workup unless the tinnitus is asymmetric or unilateral, pulsatile, associated with focal neurologic abnormalities, or associated with asymmetric hearing loss 5.
- Counseling and Psychotherapy: Counseling and psychotherapy can be effective in helping patients cope with the emotional and psychological impacts of tinnitus 2, 3.