From the Guidelines
Tinnitus treatment should prioritize a comprehensive approach, focusing on managing symptoms and improving quality of life, as there is no universal cure, and the most recent guidelines recommend a targeted history and physical examination to identify underlying causes 1. The treatment of tinnitus involves a multifaceted strategy, including:
- Identifying and addressing any underlying causes, such as ear infections, medication side effects, or hearing loss
- Utilizing sound therapy, such as white noise machines, fans, or smartphone apps, to mask the ringing sensation
- Employing cognitive behavioral therapy (CBT) to reduce distress associated with tinnitus, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery Foundation 1
- Considering the use of hearing aids if tinnitus is related to hearing loss
- Implementing lifestyle modifications, such as limiting caffeine, alcohol, and nicotine, using ear protection in loud environments, managing stress through meditation or yoga, and maintaining good cardiovascular health through regular exercise
- Educating patients about management strategies, as recommended by clinical practice guidelines 1 It is essential to note that while some medications, such as low doses of antidepressants like amitriptyline or nortriptyline, may be helpful, they are not FDA-approved specifically for tinnitus, and their use should be carefully considered on a case-by-case basis 1. Additionally, the effectiveness of supplements like ginkgo biloba, zinc, or melatonin is limited, and their use should be approached with caution. By prioritizing a comprehensive and patient-centered approach, healthcare providers can help individuals with tinnitus manage their symptoms and improve their quality of life.
From the Research
Tinnitus Treatment Options
- Cognitive behavior therapy is the only treatment that has been shown to improve quality of life in patients with tinnitus 2
- Sound therapy and tinnitus retraining therapy are treatment options, but evidence is inconclusive 2
- Melatonin, antidepressants, and cognitive training may help with sleep disturbance, mood disorders, and cognitive impairments, respectively 2
- Avoidance of noise exposure may help prevent the development or progression of tinnitus 2
Diagnostic Evaluation
- A standard workup begins with a targeted history and physical examination to identify treatable causes and associated symptoms that may improve with treatment 2
- 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 2
- 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 2
Clinical Practice Guidelines
- Clinicians should perform a targeted history and physical examination at the initial evaluation of a patient with presumed primary tinnitus to identify conditions that if promptly identified and managed may relieve tinnitus 3
- Clinicians should obtain a prompt, comprehensive audiologic examination in patients with tinnitus that is unilateral, persistent (≥ 6 months), or associated with hearing difficulties 3
- Clinicians should recommend cognitive behavioral therapy to patients with persistent, bothersome tinnitus 3
Treatment Effectiveness
- The evidence for the effectiveness of the various treatment interventions varies considerably 4
- Counselling, cognitive-behavioral therapy (CBT), hearing aids and cochlear implants for patients with a relevant hearing loss, sound generators, novel auditory stimulation approaches, tinnitus retraining therapy (TRT), pharmacological treatment, neurofeedback, brain stimulation, bimodal stimulation, Internet- and app-based digital approaches, and alternative treatment approaches are available treatment options 4
Pharmacotherapy
- Various medications are currently used in the treatment of tinnitus, including anesthetics, antiarrhythmics, anticonvulsants, antidepressants, antihistamines, antipsychotics, anxiolytics, calcium channel blockers, cholinergic antagonists, NMDA antagonists, muscle relaxants, vasodilators, and vitamins 5
- No medications have been specifically approved to treat tinnitus by the US Food and Drug Administration (FDA) 5