From the Guidelines
Tinnitus diagnosis and treatment should prioritize a targeted history and physical examination to identify underlying conditions that may relieve tinnitus, as well as recommending cognitive-behavioral therapy (CBT) to patients with persistent, bothersome tinnitus. Management of tinnitus typically involves identifying and treating underlying causes when possible. For most cases, there is no specific medication that cures tinnitus, but several approaches can help.
Key Management Strategies
- Sound therapy using white noise machines, fans, or smartphone apps can mask the tinnitus sounds.
- Hearing aids may help if hearing loss is contributing to tinnitus.
- Cognitive behavioral therapy (CBT) can reduce tinnitus-related distress by changing how you respond to the sounds, as recommended by clinicians for patients with persistent, bothersome tinnitus 1.
- For sleep disturbances, short-term use of medications like melatonin (3-5mg before bedtime) may help.
- Avoiding triggers such as loud noises, caffeine, alcohol, and certain medications (like high-dose aspirin or some antibiotics) can prevent worsening symptoms.
- Stress management techniques including meditation, yoga, or regular exercise often reduce tinnitus perception.
Education and Counseling
Clinicians should educate patients with persistent, bothersome tinnitus about management strategies, as this has been shown to have a preponderance of benefit over harm 1.
Diagnostic Approach
A targeted history and physical examination should be performed at the initial evaluation of a patient with presumed primary tinnitus to identify conditions that if promptly identified and managed may relieve tinnitus, based on observational studies with a preponderance of benefit over harm 1.
Treatment to Avoid
Transcranial magnetic stimulation (TMS) should not be recommended for the routine treatment of patients with persistent, bothersome tinnitus, due to inconclusive RCTs 1.
From the Research
Diagnosis of Tinnitus
- Tinnitus is defined as the perception of noise in the absence of an acoustic stimulus outside of the body 2
- The underlying cause of tinnitus must be determined to best help patients, as it is a symptom and not a disease 2
- Common causes of tinnitus include sensorineural hearing loss, otologic, vascular, neoplastic, neurologic, pharmacologic, dental, and psychological factors 2, 3
- A standard workup for tinnitus begins with a targeted history and physical examination to identify treatable causes and associated symptoms 3
- Audiometry with tympanometry should be performed for almost all patients with tinnitus, and some patients may require neuroimaging or assessment of vestibular function with electronystagmography 2
Treatment of Tinnitus
- Cognitive behavior therapy is the only treatment that has been shown to improve quality of life in patients with tinnitus 3
- Sound therapy and tinnitus retraining therapy are treatment options, but evidence is inconclusive 3
- Melatonin, antidepressants, and cognitive training may help with sleep disturbance, mood disorders, and cognitive impairments, respectively 3
- Transcranial direct current stimulation (tDCS) has shown promising therapeutic outcomes for tinnitus, with moderate to significant treatment effects on tinnitus symptoms 4
- Antidepressant drugs have been used to treat tinnitus, but there is insufficient evidence to say that they improve tinnitus 5
- Avoidance of noise exposure may help prevent the development or progression of tinnitus 3
- Patient education and preventive measures, as well as reassurance and assistance with the psychologic aftereffects of tinnitus, can be valuable to patients 6