From the Guidelines
Tinnitus treatment should prioritize cognitive behavioral therapy (CBT) as the primary approach, as it has been shown to have a preponderance of benefit over harm in managing persistent, bothersome tinnitus, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery Foundation guidelines 1.
Treatment Options
The following treatment options can help manage tinnitus symptoms:
- Sound therapy: Use white noise machines, fans, or smartphone apps to play background sounds that mask the tinnitus, starting with 30-60 minutes daily, especially when trying to sleep.
- Cognitive behavioral therapy (CBT): Seek a therapist specializing in tinnitus, typically involving 8-12 weekly sessions to develop coping strategies and reduce stress associated with tinnitus.
- Hearing aids: If hearing loss is present, hearing aids can improve overall hearing and potentially reduce tinnitus perception.
- Lifestyle changes:
- Limit caffeine, alcohol, and nicotine intake
- Practice stress reduction techniques like meditation or yoga for 15-20 minutes daily
- Maintain consistent sleep patterns with 7-9 hours of sleep per night
- Medications: While no drugs are FDA-approved specifically for tinnitus, some options may help, such as low-dose antidepressants like nortriptyline (10-50 mg daily) or sertraline (25-200 mg daily), and anti-anxiety medications like alprazolam (0.25-0.5 mg as needed) for short-term use.
Importance of Recent Guidelines
The most recent guidelines from the American College of Radiology (2023) emphasize the importance of a comprehensive otologic examination, audiometric examination, and review of medical history and medications before imaging 1. These guidelines also highlight the need for prompt identification and intervention in patients with severe anxiety or depression, as they are at higher risk of suicide.
Avoiding Ineffective Treatments
It is essential to note that some treatments, such as transcranial magnetic stimulation (TMS), are not recommended for the routine treatment of patients with persistent, bothersome tinnitus due to inconclusive RCTs 1. By prioritizing CBT and other evidence-based treatments, patients can better manage their tinnitus symptoms and improve their quality of life.
From the Research
Treatment Options for Tinnitus
The treatment options for tinnitus can be categorized into several approaches, including:
- Cognitive behavior therapy, which has been shown to improve quality of life in patients with tinnitus 2
- Sound therapy and tinnitus retraining therapy, although evidence for their effectiveness is inconclusive 2
- Medications such as melatonin, antidepressants, and cognitive training, which may help with sleep disturbance, mood disorders, and cognitive impairments, respectively 2
- Avoidance of noise exposure, which may help prevent the development or progression of tinnitus 2
Pharmacological and Surgical Interventions
Other treatment options include:
- Nutritional supplements, such as Ginkgo biloba and B-complex vitamins, which may have an impact on selected patients with mild-to-moderate tinnitus 3
- Surgical treatment options, such as cochlear implant, which have been shown to be effective in reducing tinnitus in patients with sudden unilateral hearing loss as the cause of tinnitus 3
- Repetitive transcranial magnetic stimulation and vagal stimulator, which have had some limited benefits 3
Counseling and Support
Supportive counseling should begin during the initial evaluation to help patients cope with tinnitus, and may also improve the chances of successful subsequent treatment 4 Cognitive behavior therapy can help to reduce the distress associated with tinnitus, especially in patients with underlying or accompanying anxiety disorders 3
Comprehensive Care
Providing information about the natural progression of tinnitus and being familiar with the causes that warrant additional evaluation, imaging, and specialist involvement are essential to comprehensive care 2