Tinnitus Treatment Options
Cognitive Behavioral Therapy (CBT) is the strongest evidence-based treatment for improving quality of life in patients with persistent, bothersome tinnitus and should be recommended as first-line therapy. 1
Initial Evaluation
- Perform a targeted history and physical examination to identify potentially treatable underlying causes of tinnitus 2
- Classify tinnitus as pulsatile or non-pulsatile, and primary or secondary, to guide treatment approach 1
- Complete audiologic evaluation is essential for patients with unilateral tinnitus or tinnitus persisting ≥6 months 1, 3
- Pulsatile tinnitus almost always requires imaging evaluation to identify potential vascular abnormalities 1, 4
- Patients with tinnitus accompanied by severe anxiety or depression require prompt identification and intervention due to increased suicide risk 2, 5
Evidence-Based Treatment Options
First-Line Treatments
- Cognitive Behavioral Therapy (CBT) has the strongest evidence for improving quality of life in tinnitus patients 1
- Hearing aids are recommended for patients with hearing loss and tinnitus, even if hearing loss is mild or unilateral 1, 5
- Education and counseling are essential components for all patients with persistent tinnitus 1, 3
- Sound therapy may provide symptomatic relief for persistent tinnitus 1
Second-Line Treatments
- Tinnitus retraining therapy combines sound therapy with directed counseling, though evidence is less conclusive than for CBT 3, 6
- Melatonin may help with sleep disturbances associated with tinnitus 3
- Antidepressants may help manage mood disorders related to tinnitus but are not recommended as primary treatment for tinnitus itself 1, 3
Treatments Not Recommended
- Antidepressants, anticonvulsants, and anxiolytics are not recommended for primary treatment of persistent tinnitus due to insufficient evidence and potential side effects 1
- Dietary supplements including Ginkgo biloba, melatonin, zinc, or other supplements should not be recommended due to lack of consistent benefit 1
- Intratympanic medications are not recommended for routine treatment of primary tinnitus 1
Special Considerations
- For pulsatile tinnitus, imaging studies should include CT of temporal bone and/or CT angiography of head and neck with contrast 4
- MRI and MR angiography with contrast are useful for evaluating cerebellopontine angle lesions and vascular malformations 4
- Underlying treatable conditions such as cerumen impaction, otosclerosis, or vascular abnormalities should be addressed before symptomatic tinnitus management 5, 7
- Noise exposure avoidance may help prevent development or progression of tinnitus 3
Common Pitfalls to Avoid
- Prescribing medications without clear evidence of benefit that may cause side effects or worsen tinnitus 1
- Recommending dietary supplements that lack evidence of efficacy 1
- Overlooking mild hearing loss that could benefit from hearing aid intervention 1, 5
- Failing to evaluate pulsatile tinnitus with appropriate imaging studies 4
- Neglecting to assess for anxiety and depression in patients with bothersome tinnitus 2, 5