First-Line Treatment for Tinnitus in Patients with Diabetes Mellitus
For patients with diabetes mellitus and tinnitus, the first-line treatment should be education, counseling, and sound therapy, with consideration for hearing aid evaluation if hearing loss is present. 1
Initial Assessment and Diagnosis
- Perform a targeted history and physical examination to identify any underlying conditions that could be causing or exacerbating tinnitus 1
- Obtain a comprehensive audiologic examination, which is particularly important for patients with diabetes who have higher prevalence of hearing impairment 1, 2
- Distinguish between bothersome and non-bothersome tinnitus, as this will guide treatment decisions 1
- Avoid unnecessary imaging studies unless the patient has unilateral tinnitus, pulsatile tinnitus, focal neurological abnormalities, or asymmetric hearing loss 1
Treatment Approach for Tinnitus in Diabetic Patients
1. Education and Counseling (First-line)
- Provide education about the relationship between diabetes and tinnitus, as diabetes can affect the auditory system through neuropathy and microvascular complications 3, 4
- Counsel patients on the importance of glycemic control, as poorly controlled diabetes is associated with worse hearing outcomes and potentially more severe tinnitus 4
- Explain that tinnitus in diabetes may be an indicator of developing neuropathy or microangiopathy of the inner ear 3
2. Sound Therapy (First-line)
- Recommend sound therapy to mask or provide relief from tinnitus perception 1
- Options include white noise machines, environmental sound generators, or smartphone applications that produce soothing sounds 1
3. Hearing Aid Evaluation
- Recommend hearing aid evaluation for patients with hearing loss and persistent, bothersome tinnitus 1
- Hearing aids can both address hearing loss and provide relief from tinnitus by amplifying environmental sounds 1
4. Glycemic Control
- Emphasize strict glycemic control as part of tinnitus management in diabetic patients 4
- Poor glycemic control is associated with more severe hearing loss, particularly at higher frequencies, which may worsen tinnitus perception 4
- Target HbA1c levels according to individualized diabetes management goals to potentially improve or prevent worsening of tinnitus 1
5. Cognitive Behavioral Therapy (CBT)
- Recommend CBT for patients with persistent, bothersome tinnitus 1
- CBT helps patients develop coping strategies and reduce the psychological impact of tinnitus 1
What to Avoid
- Do not routinely recommend antidepressants, anticonvulsants, anxiolytics, or intratympanic medications specifically for treating tinnitus 1
- Avoid recommending dietary supplements such as Ginkgo biloba, melatonin, or zinc for tinnitus treatment 1
- Do not recommend transcranial magnetic stimulation (TMS) for routine treatment of tinnitus 1
Special Considerations for Diabetic Patients
- Patients with diabetes are more susceptible to noise-induced hearing loss and have impaired recovery from noise exposure, so advise protection from loud noises 5
- Longer duration of diabetes (>10 years) is associated with more severe tinnitus, warranting closer monitoring in these patients 3, 4
- Consider the ototoxic potential of medications when prescribing for diabetic patients with tinnitus 2
- Be aware that tinnitus may be an early warning sign of diabetic neuropathy affecting the auditory system 3, 6
Follow-up and Monitoring
- Regular audiologic follow-up is recommended for diabetic patients with tinnitus, especially those with poor glycemic control, diabetes duration >10 years, or diabetic complications 4
- Monitor for changes in tinnitus severity or character, which may indicate changes in diabetic control or progression of complications 3
By following this approach, clinicians can effectively manage tinnitus in patients with diabetes mellitus while addressing the underlying metabolic condition that may be contributing to or exacerbating their symptoms.