What is the recommended treatment for patients with tinnitus using sound therapy?

Sound Therapy for Tinnitus Management

Sound therapy may be recommended as part of a management strategy for patients with persistent, bothersome tinnitus, though it has less robust evidence than cognitive behavioral therapy (CBT). 1, 2

Assessment and Classification of Tinnitus

Before initiating sound therapy, proper assessment is essential:

1. Distinguish between types of tinnitus:

   • Recent onset vs. persistent (≥6 months)
   • Bothersome vs. non-bothersome
   • Unilateral vs. bilateral
   • Pulsatile vs. non-pulsatile 1, 2

2. Comprehensive audiologic examination is recommended for:

   • Unilateral tinnitus
   • Persistent tinnitus (≥6 months)
   • Tinnitus associated with hearing difficulties 1, 2

Sound Therapy Options

Sound therapy should be considered after addressing any underlying causes and can include:

1. Hearing aids - Recommended for patients with hearing loss and persistent, bothersome tinnitus

   • Benefits patients even with mild or unilateral sensorineural hearing loss
   • Improves auditory input and reduces contrast between tinnitus and background sound 1, 2

2. Sound generators - Tabletop or ear-level devices that produce various sounds

   • Provide passive distraction from tinnitus
   • May help reduce tinnitus-associated stress 3

3. Combination devices - Incorporate both amplification and sound generation

   • Evidence shows no significant superiority over hearing aids alone 4

4. Binaural sound therapy (BST) - Uses specific sound patterns presented to both ears

   • May help reduce stress in some patients
   • Limited evidence suggests it may reduce tinnitus perception in approximately 15% of patients 5

Evidence and Effectiveness

The evidence supporting sound therapy is limited:

• Low-quality evidence shows no difference between hearing aids and sound generators in reducing tinnitus symptom severity 4
• Low-quality evidence shows no difference between combination devices and hearing aids alone 4
• Both hearing aids and sound generators are associated with clinically significant reductions in tinnitus symptom severity in some patients 4

Implementation of Sound Therapy

When implementing sound therapy:

1. Patient education is essential:

   • Explain realistic expectations about treatment outcomes
   • Discuss the role sound therapy plays in the management plan 3

2. Consider patient preferences:

   • Patient motivation and expectations
   • Acceptability of sound stimuli
   • Willingness to use sound extensively or intermittently 3

Comprehensive Management Approach

Sound therapy should be part of a broader management strategy:

1. Cognitive Behavioral Therapy (CBT) has the strongest evidence base among all interventions for tinnitus and should be recommended 1, 2

2. Education and counseling about tinnitus mechanisms and management strategies should be provided 1, 2

3. Avoid medications specifically for tinnitus:

   • Antidepressants, anticonvulsants, anxiolytics, and intratympanic medications should not be routinely prescribed for tinnitus
   • These may worsen tinnitus in some cases and carry significant side effect risks 1, 2

Cautions and Considerations

• Music therapy may increase tinnitus perception in some patients (up to 30%) and increase anxiety and stress in others 5
• Sound therapy should be tailored based on hearing loss and tinnitus characteristics 5
• Avoid recommending unproven supplements that may be costly and ineffective 2
• Address psychological aspects of tinnitus management, particularly when symptoms are bothersome 2

Sound therapy remains an option for tinnitus management, but clinicians should be guided by patient preferences and ensure patients understand its role within the overall treatment plan.