From the Guidelines
Treatment options for tinnitus should prioritize cognitive behavioral therapy (CBT) as the first line of treatment, as it has shown effectiveness in reducing distress and improving quality of life for patients with persistent, bothersome tinnitus, as recommended by the American Academy of Otolaryngology—Head and Neck Surgery Foundation 1.
Overview of Tinnitus Treatment
Tinnitus is a symptom that can be associated with multiple causes, and its treatment should be tailored to the individual patient's needs. The effects of tinnitus on health-related quality of life (QOL) vary widely, with most patients less severely affected but some experiencing anxiety, depression, and extreme life changes.
Recommended Treatment Approaches
- Cognitive Behavioral Therapy (CBT): CBT has shown effectiveness in changing how patients react to tinnitus, reducing distress even when the sound remains 1.
- Sound Therapy: Sound therapy, using white noise machines, fans, or smartphone apps, can help mask the tinnitus sounds and provide relief.
- Hearing Aids: Hearing aids can be beneficial for those with hearing loss, as they amplify external sounds that help distract from tinnitus.
- Lifestyle Modifications: Lifestyle modifications, including stress management techniques, avoiding loud noises, limiting caffeine and alcohol consumption, and maintaining good sleep habits, can also help.
Medications and Other Interventions
- Medications, such as tricyclic antidepressants like amitriptyline (10-100 mg daily), or anti-anxiety medications such as alprazolam (0.25-0.5 mg as needed), may help some patients, though they treat the emotional response rather than the tinnitus itself.
- Tinnitus retraining therapy combines sound therapy with educational counseling to help the brain habituate to tinnitus sounds over time, typically requiring 12-18 months of treatment.
Guideline Recommendations
The American Academy of Otolaryngology—Head and Neck Surgery Foundation recommends that clinicians distinguish patients with bothersome tinnitus from patients with nonbothersome tinnitus, and prioritize intervention and facilitate discussions about natural history and follow-up care 1. Clinicians should also educate patients with persistent, bothersome tinnitus about management strategies, and recommend a hearing aid evaluation for patients with hearing loss and persistent, bothersome tinnitus.
From the Research
Treatment Options for Tinnitus
- Cognitive behavioral therapy (CBT) is the only treatment that has been shown to improve quality of life in patients with tinnitus 2, 3, 4
- Sound therapy and tinnitus retraining therapy are treatment options, but evidence is inconclusive 2, 3, 5, 4
- Melatonin, antidepressants, and cognitive training may help with sleep disturbance, mood disorders, and cognitive impairments, respectively 2
- Avoidance of noise exposure may help prevent the development or progression of tinnitus 2
- Hearing aids can be effective when hearing loss is identified, even if it is mild or unilateral 3
- Wide-band sound therapy and counseling are also available treatments 3
- Experimental, controversial, and futuristic treatments for chronic tinnitus include acoustic therapy, psychological counseling, hypnosis, biofeedback, and relaxation training 5
Non-Invasive Treatments
- Acoustic therapy, including hearing aids and environmental sound enrichment, is a non-invasive treatment option 5
- Cognitive-behavioral therapy, psychological counseling, hypnosis, biofeedback, and relaxation training are also non-invasive treatments 5
- Over-the-counter or prescription medications may be used as needed to facilitate sleep and to reduce anxiety, depression, or obsessive-compulsiveness 5
Important Considerations
- There is no universal medical or surgical treatment for tinnitus 6
- Invasive treatments for tinnitus should be avoided due to the risk of harm and lack of evidence for effectiveness 5
- Patients and clinicians should be cautious when considering invasive treatments for tinnitus and should rely on evidence-based treatments 5