From the Guidelines
Tinnitus treatment should prioritize cognitive behavioral therapy (CBT) as recommended by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, due to its proven effectiveness in changing how patients respond to tinnitus mentally, as supported by studies such as 1. The treatment of tinnitus, a symptom characterized by the perception of sound in the absence of external stimuli, involves a multifaceted approach since there is no single cure.
Initial Steps
When addressing tinnitus, it is essential to start by consulting a healthcare provider to identify any underlying causes, such as ear infections, medication side effects, or hearing loss.
Therapeutic Options
- Sound Therapy: Often recommended, using white noise machines, fans, or smartphone apps to mask the ringing sensation.
- Hearing Aids: Can help if tinnitus is related to hearing loss.
- Cognitive Behavioral Therapy (CBT): Proven effective by changing how you respond to tinnitus mentally, as recommended by studies like 1 and 1.
- Medications: While no medications are FDA-approved specifically for tinnitus, some antidepressants like nortriptyline (10-75 mg daily) or antianxiety medications may help manage associated distress.
Lifestyle Modifications
Lifestyle changes can also reduce symptoms, including:
- Limiting caffeine, alcohol, and nicotine
- Managing stress through meditation or yoga
- Protecting ears from loud noises
- Maintaining good cardiovascular health through regular exercise
Disease Management
Tinnitus often improves with time as the brain adapts to the sound through a process called habituation, where the brain learns to filter out the noise and reduce awareness of it. According to the most recent guidelines, such as 1, the type of tinnitus and associated symptoms determine the choice of imaging studies and their appropriateness, emphasizing the importance of targeted history, clinical examination, and audiological examination in the initial evaluation.
From the Research
Treatment Options for Tinnitus
- Traditional treatment approaches for tinnitus include medication, active or passive sound enhancement, and cognitive behavioral therapy, but these have limited efficacy 2
- Noninvasive brain stimulation methods such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) have shown potential in reducing tinnitus perception 2
- Sound therapy is a commonly used method for tinnitus management, with various forms showing positive therapeutic effects 3
- Cognitive behavioral therapy is the only treatment that has been shown to improve quality of life in patients with tinnitus 4
- Other treatment options include tinnitus retraining therapy, melatonin, antidepressants, and cognitive training, but evidence for these is inconclusive 4
Sound Therapy for Tinnitus
- Sound therapy can effectively suppress tinnitus in some patients, but there is a lack of randomized controlled trials to identify effective management strategies 3
- Customized sound therapy may be more effective than non-customized sound therapy, and patients with more severe initial tinnitus may respond better to sound therapy 3
- Combination therapy, such as sound stimulation plus educational consultation and sound stimulation plus drug therapy, may yield better outcomes than individual treatments 5
- Network meta-analysis has shown that sound stimulation alone performs better than medication alone, educational consultation alone, and no treatment 5
Brain Stimulation for Tinnitus
- rTMS has been successful in transiently reducing tinnitus perception, and repeated sessions have resulted in tinnitus relief in a subgroup of patients 2
- tDCS has also shown potential for the treatment of tinnitus, with both auditory and frontal tDCS showing tinnitus reduction in a subgroup of patients 2
- Larger and longer lasting effects have been observed with direct electrical stimulation of the auditory cortex via implanted epidural electrodes 2