Is physiotherapy a treatment option for tinnitus?

Physiotherapy for Tinnitus Management

Physiotherapy is not a recommended treatment option for tinnitus based on current clinical practice guidelines. Instead, evidence-based management strategies include cognitive behavioral therapy (CBT), sound therapy, hearing aids for those with hearing loss, and patient education 1.

Evidence-Based Treatment Options for Tinnitus

First-Line Interventions

• Cognitive Behavioral Therapy (CBT) should be recommended for patients with persistent, bothersome tinnitus, based on randomized controlled trials showing a preponderance of benefit over harm 1, 2
• Hearing Aid Evaluation should be recommended for patients with hearing loss and persistent, bothersome tinnitus, even if the hearing loss is mild or unilateral 1
• Sound Therapy may be recommended for patients with persistent, bothersome tinnitus, using various sound types (environmental sounds, music, or speech) to provide relief, reduce contrast between tinnitus and the acoustic environment, or divert attention 3, 4, 5
• Education and Counseling should be provided to all patients with persistent, bothersome tinnitus about management strategies 1

Treatments Not Recommended

• Medical Therapy including antidepressants, anticonvulsants, anxiolytics, or intratympanic medications should not be routinely recommended for treating persistent, bothersome tinnitus 1
• Dietary Supplements such as Ginkgo biloba, melatonin, zinc, or other supplements should not be recommended 1
• Transcranial Magnetic Stimulation (TMS) should not be recommended for routine treatment 1
• Acupuncture has insufficient evidence to make a recommendation either way 1

Sound Therapy Options

Sound therapy, while not physiotherapy, is an evidence-supported approach that can be used in tinnitus management:

• Types of therapeutic sound 3, 4:

  • Soothing sounds - to provide relief from tinnitus-associated stress
  • Background sounds - to passively reduce contrast between tinnitus and environment
  • Interesting sounds - to actively divert attention away from tinnitus

• Sound delivery methods 4, 6, 5:

  • Hearing aids (especially for those with hearing loss)
  • Sound generators/maskers
  • Combination devices (hearing aid + sound generator)
  • Smartphone apps
  • Tabletop sound machines

Clinical Approach to Tinnitus Management

1. Assessment and Differentiation:

   • Distinguish bothersome from non-bothersome tinnitus 1
   • Determine if tinnitus is recent onset or persistent (≥6 months) 1
   • Conduct comprehensive audiologic examination, especially for unilateral, persistent tinnitus, or tinnitus associated with hearing difficulties 1

2. Treatment Algorithm:

   • For patients with hearing loss: recommend hearing aid evaluation 1
   • For all patients with persistent, bothersome tinnitus: recommend CBT 1
   • Consider sound therapy as an adjunctive treatment 3, 4, 6
   • Provide education and counseling about tinnitus management strategies 1

Important Caveats

• The evidence for sound therapy is limited, with significant heterogeneity in evaluation methods and outcome measures across studies 6, 5
• Combined approaches (e.g., sound therapy plus counseling) are commonly used in clinical practice but make it difficult to isolate the specific effects of individual components 2, 6
• No single treatment approach provides complete remission for all patients with tinnitus 5
• Optimal management often requires addressing any underlying hearing loss, which is frequently associated with tinnitus 1, 2