From the Guidelines
The most effective treatment for chronic tinnitus is cognitive-behavioral therapy (CBT), which should be recommended to patients with persistent, bothersome tinnitus, as it has a preponderance of benefit over harm, according to the clinical practice guideline 1. This approach is supported by the guideline's recommendation to use CBT to help patients develop coping mechanisms and change negative thought patterns about their tinnitus. Some key points to consider when treating chronic tinnitus include:
- Sound therapy, which uses external noise to mask or distract from tinnitus sounds, can be effective in combination with CBT.
- Tinnitus retraining therapy (TRT) combines sound therapy with educational counseling to help the brain habituate to tinnitus sounds.
- Lifestyle modifications, such as stress management techniques, avoiding loud noise exposure, limiting caffeine and alcohol consumption, and maintaining good sleep hygiene, can also help alleviate symptoms.
- Medications, including antidepressants like nortriptyline, may be used for short-term relief, but their effectiveness is not well-established, and they may have significant side effects, as noted in the guideline 1. It's essential to note that the guideline recommends against using transcranial magnetic stimulation (TMS) for the routine treatment of patients with persistent, bothersome tinnitus, due to inconclusive RCTs 1. The guideline's purpose is to provide evidence-based recommendations for clinicians managing patients with tinnitus, with a focus on improving patient care and mitigating the personal and social impact of persistent, bothersome tinnitus 1.
From the Research
Effective Treatments for Chronic Tinnitus
The following are some of the most effective treatments for chronic tinnitus:
- Cognitive Behavioral Therapy (CBT): CBT is a strongly recommended treatment for chronic tinnitus, as it has been shown to be effective in reducing tinnitus-related distress and improving quality of life 2, 3, 4, 5, 6.
- Auditory Therapeutic Measures: Auditory therapeutic measures, such as sound therapy, can be effective in reducing tinnitus symptoms and improving hearing loss 2, 6.
- Repetitive Transcranial Magnetic Stimulation (rTMS): rTMS has been shown to be effective in reducing tinnitus symptoms and improving quality of life, especially when combined with CBT 3.
- Notched Sound Therapy (NST): NST has been shown to be effective in reducing tinnitus loudness and improving quality of life, although it may not be as effective as CBT in reducing tinnitus-related distress 4.
- Refined Sound Therapy: Refined sound therapy combined with CBT has been shown to be more effective than post-auricular injection of lidocaine and methylprednisolone sodium succinate in treating tinnitus and improving psychological symptoms 6.
Treatment Considerations
When considering treatment for chronic tinnitus, the following factors should be taken into account:
- Severity of tinnitus: Treatment options should be based on the severity of the tinnitus and any associated problems 5.
- Underlying or accompanying conditions: Treatment of underlying or accompanying conditions, such as anxiety disorders, can help to reduce the distress associated with tinnitus 2, 5.
- Hearing loss: Treatment of hearing loss can also be effective in reducing tinnitus symptoms 2, 6.
- Patient counseling: Patient counseling is an essential part of tinnitus treatment, and specific tinnitus counseling should be performed 2.