From the Guidelines
Tinnitus is a persistent ringing, buzzing, or other sound in the ears that isn't caused by an external source, and while there's no cure, several strategies can help manage symptoms, with the most recent guidelines from 2023 suggesting a comprehensive approach to diagnosis and treatment 1. The diagnosis of tinnitus involves a targeted history and physical examination to identify conditions that may relieve tinnitus, as well as a prompt and comprehensive audiological examination in patients with hearing problems or unilateral persistent tinnitus 1. Some key points to consider in the diagnosis and treatment of tinnitus include:
- Protecting hearing from loud noises and reducing caffeine and alcohol intake
- Trying sound therapy using white noise machines, fans, or smartphone apps to mask the tinnitus
- Relaxation techniques like deep breathing or meditation to help manage stress, which can worsen symptoms
- Consulting an ENT doctor or audiologist if tinnitus is significantly impacting daily life, who may recommend cognitive behavioral therapy, hearing aids, or sound-masking devices
- Certain medications like antidepressants or anti-anxiety drugs may be suggested for severe cases, but these require a doctor's evaluation 1
- Addressing underlying conditions like high blood pressure or ear infections may help alleviate tinnitus symptoms
- Understanding that tinnitus is typically not harmful can help reduce anxiety about the condition and improve overall management 1 It's essential to note that the American Academy of Otolaryngology and Head and Neck Surgery Foundation (AAO-HNS) guidelines recommend against imaging studies of the head and neck for patients with nonpulsatile tinnitus that does not localize to one ear and is not associated with focal neurological abnormalities or asymmetric hearing loss 1. The most effective treatment approach for tinnitus is a multidisciplinary one, incorporating education, counseling, and cognitive behavioral therapy, as recommended by the 2023 guidelines 1.
From the Research
Diagnosis of Tinnitus
- Tinnitus is the sensation of hearing a sound in the absence of an internal or external source, and 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.
- The evaluation of patients with tinnitus includes selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology 3.
Treatment of Tinnitus
- 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.
- Acceptance and commitment therapy, tailor-made notched music therapy, hearing aids, and cochlear implants are also potential treatment options 4.
- The role of pharmacotherapy and dietary supplements remains uncertain, and further research is warranted to confirm their effectiveness and long-term effects 4.
- Clinicians should recommend cognitive behavioral therapy to patients with persistent, bothersome tinnitus, and may recommend sound therapy to patients with persistent, bothersome tinnitus 3.
Management Strategies
- Avoidance of noise exposure may help prevent the development or progression of tinnitus 2.
- 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.
- Clinicians should distinguish patients with bothersome tinnitus from patients with nonbothersome tinnitus, and should perform a targeted history and physical examination at the initial evaluation of a patient with presumed primary tinnitus 3.
- Clinicians may obtain an initial comprehensive audiologic examination in patients who present with tinnitus, regardless of laterality, duration, or perceived hearing status 3.