From the Guidelines
The best course of treatment for tinnitus after a motor vehicle collision should begin with a thorough medical evaluation to determine the underlying cause, as recommended by the American Academy of Otolaryngology and Head and Neck Surgery Foundation guidelines 1.
Initial Evaluation
The initial evaluation should include a targeted history and physical examination to identify conditions that may relieve tinnitus, such as traumatic brain injury, temporal bone fractures, or inner ear damage 1.
- A prompt and comprehensive audiological examination is recommended for patients with unilateral, persistent, or hearing-related tinnitus 1.
- Imaging studies of the head and neck should not be obtained unless the patient has tinnitus that localizes to one ear, pulsatile tinnitus, focal neurological abnormalities, or asymmetric hearing loss 1.
Treatment Approaches
Treatment typically includes a combination of approaches, such as:
- Sound therapy to mask the tinnitus, particularly at night 1.
- Cognitive behavioral therapy (CBT) to help patients develop coping strategies for the psychological distress associated with persistent tinnitus 1.
- Hearing aid evaluation for patients with hearing loss and persistent, bothersome tinnitus 1.
- Avoiding potential tinnitus aggravators such as loud noises, caffeine, alcohol, and nicotine.
Management and Follow-up
Regular follow-up with healthcare providers is essential to monitor progress and adjust treatment as needed. It's important to understand that tinnitus following trauma often improves gradually over time as the body heals, though some patients may experience persistent symptoms requiring ongoing management.
- Clinicians should educate patients with persistent, bothersome tinnitus about management strategies and recommend CBT to patients with persistent, bothersome tinnitus 1.
- Medical therapy, such as antidepressants, anticonvulsants, anxiolytics, or intratympanic medications, should not be routinely recommended for a primary indication of treating persistent, bothersome tinnitus 1.
From the Research
Tinnitus after MVC
- Tinnitus is a common disorder that can occur after a Motor Vehicle Collision (MVC) and is characterized by the sensation of hearing a sound in the absence of an internal or external source 2.
- The treatment of tinnitus is difficult, and traditional approaches such as medication, sound enhancement, and cognitive behavioral therapy have limited efficacy 3.
Diagnosis and Management
- A standard workup for tinnitus begins with a targeted history and physical examination to identify treatable causes and associated symptoms that may improve with treatment 2.
- 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.
- Cognitive behavior therapy is the only treatment that has been shown to improve quality of life in patients with tinnitus 2, 4.
Treatment Options
- Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive method of applying electromagnetic fields to the brain that can induce alterations of neuronal activity that outlast the stimulation period, and has been successful in transiently reducing tinnitus perception 3.
- Transcranial direct current stimulation (tDCS) has also shown potential for the treatment of tinnitus, with both auditory and frontal tDCS showing tinnitus reduction in a subgroup of patients 3.
- Sound therapy and tinnitus retraining therapy are treatment options, but evidence is inconclusive 2, 5.
- Melatonin, antidepressants, and cognitive training may help with sleep disturbance, mood disorders, and cognitive impairments, respectively 2.
Specific Considerations
- Avoidance of noise exposure may help prevent the development or progression of tinnitus 2.
- Providing information about the natural progression of tinnitus and being familiar with the causes that warrant additional evaluation, imaging, and specialist involvement are essential to comprehensive care 2.
- The therapeutic aim is the compensation of tinnitus, and if possible, the therapy should be causally orientated 6.