From the Guidelines
The most effective treatment for tinnitus is cognitive-behavioral therapy (CBT), which should be recommended to patients with persistent, bothersome tinnitus, as it has been shown to have a preponderance of benefit over harm 1.
Treatment Options for Tinnitus
Tinnitus is a complex condition with various underlying causes, and treatment should be tailored to the individual. The following options may be considered:
- Cognitive-behavioral therapy (CBT): As mentioned, CBT is a highly effective treatment for tinnitus, and clinicians should recommend it to patients with persistent, bothersome tinnitus 1.
- Sound therapy: This approach involves exposing the patient to soothing sounds to help manage tinnitus symptoms.
- Lifestyle modifications: Patients can try to manage their tinnitus by making lifestyle changes, such as reducing stress, getting regular exercise, and avoiding loud noises.
- Medications: While there is no single medication specifically approved to treat tinnitus, some medications may help manage tinnitus symptoms or underlying conditions, such as:
- Antidepressants like sertraline or paroxetine for tinnitus-related anxiety or depression.
- Anti-anxiety medications like alprazolam for anxiety.
- Melatonin for sleep disturbances.
- Off-label use of anticonvulsants like gabapentin for reducing tinnitus perception.
- Betahistine for Ménière's disease-related tinnitus. However, clinicians should not routinely recommend antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for a primary indication of treating persistent, bothersome tinnitus, as the evidence is insufficient to justify routine use 1. It is essential to note that transcranial magnetic stimulation (TMS) should not be recommended for the routine treatment of patients with persistent, bothersome tinnitus, as the evidence is inconclusive 1. Always consult a doctor before starting any medication or treatment. Treatment should be tailored to the individual and underlying cause, and combining medication with other approaches like sound therapy, CBT, and lifestyle modifications often yields better results. Be patient, as it may take several weeks to notice improvements. Regular follow-ups with your healthcare provider are important to monitor progress and adjust treatment as needed.
From the Research
Treatment Options for Tinnitus
The treatment options for tinnitus, a common hearing disorder characterized by the perception of sound without an external source, vary depending on the severity of the condition and associated symptoms.
- Counseling and psychotherapy are commonly used strategies to manage tinnitus, as they can help patients cope with the emotional and psychological aspects of the condition 2.
- Pharmacological approaches, such as antidepressants and anticonvulsants, have been used to treat tinnitus, but their effectiveness is limited and they are not recommended for routine treatment 3.
- Masking devices and individualized sound stimulation are also used to manage tinnitus, with sound stimulation alone performing better than medication alone, educational consultation alone, and no treatment 4.
- Cognitive behavioral therapy (CBT) is a widely used treatment for tinnitus, and it has been shown to have a definite improvement effect on the condition in a large randomized controlled trial 2, 3.
- Surgical treatment options, such as cochlear implant, have been shown to be effective in reducing tinnitus in patients with sudden unilateral hearing loss as the cause of tinnitus 5.
- Combination therapy, such as sound stimulation plus educational consultation and sound stimulation plus drug therapy, has been found to yield significantly better outcomes than individual treatments 4.
Non-Recommended Treatments
Some treatments are not recommended for tinnitus management, including:
- Antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for the routine treatment of patients with persistent, bothersome tinnitus 3.
- Ginkgo biloba, melatonin, zinc, or other dietary supplements for treating patients with persistent, bothersome tinnitus 3.
- Transcranial magnetic stimulation for the routine treatment of patients with persistent, bothersome tinnitus 3.
Additional Considerations
- 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.
- A prompt, comprehensive audiologic examination is recommended for patients with tinnitus that is unilateral, persistent (≥ 6 months), or associated with hearing difficulties 3.
- Educating patients with persistent, bothersome tinnitus about management strategies is crucial, and recommending a hearing aid evaluation for patients with documented hearing loss is also important 3.