From the Guidelines
Management options for tinnitus in adults should prioritize non-pharmacological approaches, including education, reassurance, sound therapy, and cognitive behavioral therapy (CBT), as these interventions have been shown to improve symptoms and quality of life 1. The first-line treatments for tinnitus in adults focus on education, reassurance, and sound therapy. Patients should be educated about tinnitus, its causes, and the importance of avoiding silence through background noise or sound generators.
- Cognitive behavioral therapy (CBT) is highly effective for reducing tinnitus distress by changing negative thought patterns, as recommended by the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) 1.
- Hearing aids are recommended for patients with hearing loss, as they can mask tinnitus by amplifying environmental sounds.
- Sound therapy using white noise machines, smartphone apps, or tabletop sound generators can provide relief by reducing the contrast between tinnitus and background silence.
- Tinnitus retraining therapy combines sound therapy with counseling to help patients habituate to the noise. For pharmacological management, no medications are FDA-approved specifically for tinnitus, but antidepressants like amitriptyline (10-150 mg daily) or nortriptyline (25-100 mg daily) may help manage associated depression, anxiety, or insomnia 1.
- Benzodiazepines should be avoided due to addiction potential. Lifestyle modifications including stress reduction, adequate sleep, limiting caffeine and alcohol, and avoiding loud noise exposure are important complementary approaches.
- These interventions work by either masking the tinnitus perception, reducing the brain's attention to tinnitus signals, or addressing underlying psychological distress that can amplify tinnitus perception. It is essential to note that the American Academy of Otolaryngology and Head and Neck Surgery Foundation (AAO-HNS) guidelines recommend targeted history and clinical examination as the initial evaluation and determination as to whether the tinnitus is bothersome or not, before any imaging 1.
- The guidelines also recommend a prompt and comprehensive audiological examination in patients with hearing problems or with unilateral persistent tinnitus.
- Some patients with severe anxiety, depression, or psychological disturbances may need prompt identification and intervention 1.
From the Research
Management Options for Tinnitus in Adults
- Tinnitus is a common disorder that can greatly affect a patient's physical and psychological quality of life 2
- Management strategies for tinnitus include:
- Sound therapy (masking) using sound-creating devices, including hearing aids 3
- Therapeutic sound with progressive audiologic tinnitus management, which can involve environmental sound, music, and speech 4
- Acoustic therapy, including hearing aids and other types of environmental sound enrichment 5
- Cognitive-behavioral therapy, psychological counseling, hypnosis, biofeedback, and relaxation training 5
- Superficial brain stimulation, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) 6
Approach to Tinnitus Management
- Clinical history taking is directed at eliciting the quality and characteristics of the tinnitus symptoms 2
- Referral to an otolaryngologist is recommended for pulsatile or unilateral tinnitus, as these qualities might be associated with more serious underlying conditions 2
- Most patients with tinnitus can be managed with reassurance, conservative measures, and hearing aids if substantial hearing loss exists 2
- Family physicians play the primary role in managing patients with tinnitus and are well situated to address both the physiologic and the psychological manifestations 2
Effectiveness of Management Options
- The limited data from included studies failed to show strong evidence of the efficacy of sound therapy in tinnitus management 3
- Effective and noninvasive treatments for tinnitus are available, but a true cure for tinnitus has not yet been found 5
- Brain stimulation approaches, such as rTMS and tDCS, have shown potential for the treatment of tinnitus, but further research is needed before these techniques can be recommended for routine clinical use 6