From the Guidelines
Tinnitus treatment should prioritize cognitive behavioral therapy (CBT) and sound therapy, as these approaches have shown to be effective in reducing distress and improving quality of life, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery Foundation guidelines 1.
Treatment Options
- Sound therapy: using white noise machines, fans, or smartphone apps to mask the tinnitus sounds and provide relief
- Hearing aids: to help if tinnitus is associated with hearing loss by amplifying external sounds
- Cognitive behavioral therapy (CBT): to change how patients react to tinnitus, reducing distress without altering the actual sound
- Lifestyle modifications: including stress management techniques, avoiding loud noise exposure, limiting caffeine and alcohol consumption, and maintaining good sleep hygiene
Medical Therapy
- No drugs are FDA-approved specifically for tinnitus, but antidepressants like amitriptyline or nortriptyline (10-100 mg daily) may help manage associated anxiety or depression 1
- Anti-anxiety medications like alprazolam (0.25-0.5 mg as needed) may provide relief, though they carry addiction risks and are not for long-term use
Imaging Studies
- Should not be obtained unless the patient has pulsatile tinnitus, focal neurological abnormalities, or asymmetric hearing loss, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery Foundation guidelines 1
Recent Guidelines
- The 2023 ACR Appropriateness Criteria® Tinnitus update recommends a 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 American College of Radiology recommends against imaging studies for patients with subjective, nonpulsatile tinnitus that does not localize to one ear and is not associated with a focal neurologic abnormality or asymmetric hearing loss 1
From the Research
Treatment Options for Tinnitus
The treatment options for tinnitus are varied and depend on the underlying cause of the condition. Some of the treatment options include:
- Cognitive behavior therapy (CBT) which has been shown to improve quality of life in patients with tinnitus 2
- Sound therapy and tinnitus retraining therapy, although the evidence for these treatments is inconclusive 2
- Melatonin, antidepressants, and cognitive training may help with sleep disturbance, mood disorders, and cognitive impairments, respectively 2
- Repetitive transcranial magnetic stimulation (rTMS) which has been shown to be effective in combination with CBT for treating tinnitus and insomnia 3
- Hearing aids, masking devices, and retraining methods can provide relief for some patients 4
- Management of underlying pathologies such as carotid artery atherosclerosis, skull base tumors, intracranial hypertension, and AVMs/AVFs can also provide relief for some patients 4
Supportive Counseling and Therapy
Supportive counseling should begin during the initial evaluation to help patients cope with tinnitus 5. Providing information to the patient is the first step for a sensible treatment of the symptoms 6. Supportive therapy includes a psychosomatic therapy and the use of medication or instrumentation 6.
Avoidance of Noise Exposure
Avoidance of noise exposure may help prevent the development or progression of tinnitus 2.
Comprehensive Audiologic Evaluation
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
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.