What are the latest treatment approaches for tinnitus?

Latest Treatment Approaches for Tinnitus

Cognitive Behavioral Therapy (CBT) is the most evidence-based first-line treatment for tinnitus management, with Acceptance and Commitment Therapy (ACT) showing particular effectiveness among CBT variations. 1

Diagnostic Evaluation

Before initiating treatment, a proper diagnostic evaluation is essential:

• Audiologic examination is recommended if tinnitus:

  • Persists beyond medication discontinuation
  • Is unilateral
  • Is associated with hearing difficulties 1

• Imaging studies should be considered only if tinnitus:

  • Localizes to one ear
  • Is pulsatile
  • Is associated with focal neurological abnormalities
  • Presents with asymmetric hearing loss 1

Recommended imaging based on tinnitus type:

Type of Tinnitus	Recommended Imaging Study
Unilateral	CT scan or MRI with internal auditory canal protocol
Pulsatile	Temporal bone CT scan or CT angiography (CTA)
Focal neurological abnormalities	CT scan or MRI
Asymmetric hearing loss	CT scan or MRI

Treatment Algorithm

First-Line Treatments:

1. Cognitive Behavioral Therapy (CBT)

   • Most evidence-based treatment option 1, 2
   • ACT appears particularly effective, focusing on accepting tinnitus while pursuing valued life activities 1
   • CBT has been shown to improve quality of life in patients with tinnitus 3

2. Education and counseling

   • Providing information about tinnitus mechanisms
   • Teaching management strategies 1

Second-Line Treatments:

1. Hearing aids

   • Recommended for patients with hearing loss, even if mild or unilateral 1, 4
   • Can help reduce tinnitus perception by amplifying external sounds

2. Sound therapy

   • Used as a complement to other treatments
   • Aims to reduce tinnitus perception 1
   • Options include wide-band sound therapy 4

Combined Treatment Approach:

• The combination of sound therapy and CBT-based counseling shows the strongest evidence for tinnitus management 1, 4

Treatment Contraindications

The following treatments are not recommended due to lack of evidence or inconclusive results:

• Dietary supplements (Ginkgo biloba, melatonin, zinc)
• Medications (antidepressants, anticonvulsants, anxiolytics) except in acute phase
• Transcranial Magnetic Stimulation (TMS)
• Acupuncture 1

Special Considerations

Medication-Induced Tinnitus

• Discontinue causative medication if tinnitus occurs
• Medication-induced tinnitus typically resolves upon discontinuation of the offending agent 1

Comorbidities

• Depression should be treated, with pharmacological support if necessary
• Psychiatric treatment should be provided on a case-by-case basis 1
• Melatonin may help with sleep disturbance, antidepressants for mood disorders 3

Red Flags Requiring Immediate Attention

• Worsening headache
• Focal neurological deficits
• Confusion or memory problems
• Increased sleepiness 1

Emerging Treatments

While promising, current evidence is insufficient to recommend:

• Transcranial magnetic or direct current stimulation
• Specific forms of acoustic stimulation (noiser/masker, retraining therapy, music, and coordinated reset) 5

Prevention

• Avoidance of noise exposure may help prevent the development or progression of tinnitus 3

For severe cases, a multidisciplinary approach involving audiologists, otolaryngologists, and mental health professionals may be necessary to provide comprehensive care and address all aspects of tinnitus impact.