From the Guidelines
Tinnitus treatment should prioritize a combination of sound therapy, hearing aids for those with related hearing loss, and cognitive behavioral therapy (CBT) to manage symptoms and improve quality of life. According to the clinical practice guideline for tinnitus 1, a targeted history and physical examination should be performed to identify underlying conditions that may relieve tinnitus. The guideline also recommends a prompt, comprehensive audiologic examination for patients with unilateral, persistent, or hearing-related tinnitus 1.
Key treatment options include:
- Sound therapy to mask the ringing sensation, as recommended by clinicians for patients with persistent, bothersome tinnitus 1
- Hearing aids for patients with hearing loss and persistent, bothersome tinnitus, based on observational studies with a preponderance of benefit over harm 1
- Cognitive behavioral therapy (CBT) to change how patients respond to tinnitus, reducing distress even when the sound remains, with a recommendation based on RCTs and a preponderance of benefit over harm 1
It is essential to note that:
- Clinicians should not routinely recommend antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for a primary indication of treating persistent, bothersome tinnitus 1
- Dietary supplements like Ginkgo biloba, melatonin, zinc, or other supplements should not be recommended for treating patients with persistent, bothersome tinnitus 1
- Transcranial magnetic stimulation (TMS) should not be recommended for the routine treatment of patients with persistent, bothersome tinnitus, based on inconclusive RCTs 1
Lifestyle modifications can also provide relief, including avoiding loud noises, limiting caffeine and alcohol, managing stress through meditation or yoga, and maintaining good cardiovascular health through regular exercise. Tinnitus often improves with time as the brain adapts to the sound through a process called habituation, where the nervous system gradually filters out the persistent noise.
From the Research
Treatment Options for Tinnitus
- Cognitive Behavioral Therapy (CBT): CBT is a recommended treatment for tinnitus, as it helps reduce the psychological distress associated with the condition 2, 3, 4, 5.
- Mindfulness-Based Cognitive Therapy (MBCT): MBCT has been shown to be effective in reducing tinnitus severity and psychological distress in patients with chronic tinnitus 2.
- Sound Therapy: Sound therapy is a treatment option for tinnitus, although the evidence is inconclusive 4.
- Tinnitus Retraining Therapy: Tinnitus retraining therapy is another treatment option, but the evidence is limited 4.
- Nutritional Supplements: Nutritional supplements such as Ginkgo biloba and B-complex vitamins may have an impact on selected patients with mild-to-moderate tinnitus 3.
- Surgical Treatment Options: Surgical treatment options, such as cochlear implant, have been shown to be effective in reducing tinnitus in patients with sudden unilateral hearing loss as the cause of tinnitus 3.
- Repetitive Transcranial Magnetic Stimulation and Vagal Stimulator: These surgical approaches have had some limited benefits in reducing tinnitus 3.
- Melatonin, Antidepressants, and Cognitive Training: These may help with sleep disturbance, mood disorders, and cognitive impairments associated with tinnitus 4.
Approach to Treatment
- A standard workup begins with a targeted history and physical examination to identify treatable causes and associated symptoms that may improve with treatment 6, 4.
- 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 4.
- 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 4.
- 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 4.