What medication is given for tinnitus (ringing in the ear)?

Treatment Options for Tinnitus (Ringing in the Ear)

There is no FDA-approved medication specifically for treating tinnitus, and the strongest evidence supports cognitive behavioral therapy (CBT) as the most effective intervention for improving quality of life in patients with persistent, bothersome tinnitus. 1, 2

Understanding Tinnitus

• Tinnitus is the perception of sound (ringing, buzzing, clicking, pulsations) in the absence of an external source, affecting approximately 10-15% of adults in the United States 3, 4
• Most tinnitus is subjective (perceived only by the patient) and often occurs with concomitant sensorineural hearing loss 3
• Around 20% of adults who experience tinnitus will require clinical intervention due to significant impact on quality of life 3, 4

First-Line Treatment Approaches

Non-Pharmacological Interventions (Recommended)

• Cognitive Behavioral Therapy (CBT): Has the strongest evidence for improving quality of life in tinnitus patients 1, 2
• Hearing aids: Recommended for patients with tinnitus associated with hearing loss, even if the hearing loss is mild or unilateral 1, 5
• Sound therapy: May provide symptomatic relief for persistent tinnitus 1, 2
• Education and counseling: Essential components for all patients with persistent tinnitus 1, 2

Pharmacological Treatments

Not Recommended Due to Insufficient Evidence

• Antidepressants: Not recommended for routine treatment of persistent, bothersome tinnitus 1, 2
• Anticonvulsants: Lack sufficient evidence for routine use 1, 2
• Anxiolytics: Not recommended despite sometimes being prescribed 1, 2
• Intratympanic medications: Not recommended for routine treatment 1, 2
• Dietary supplements: Ginkgo biloba, melatonin, zinc, or other supplements are not recommended due to lack of consistent benefit 1, 2

Treatment Algorithm

1. Determine tinnitus characteristics:

   • Pulsatile vs. non-pulsatile 1
   • Unilateral vs. bilateral 3
   • Duration and severity 3

2. For patients with hearing loss:

   • Recommend hearing aid evaluation 1, 5

3. For persistent, bothersome tinnitus:

   • Offer CBT as primary intervention 1, 2
   • Consider sound therapy as adjunctive treatment 1, 2
   • Provide education and counseling 1

4. For tinnitus with psychiatric comorbidities:

   • Prompt identification and intervention for patients with severe anxiety or depression due to increased suicide risk 3, 1

Common Pitfalls to Avoid

• Prescribing medications without clear evidence of benefit that may cause side effects or worsen tinnitus 1, 2
• Recommending dietary supplements that lack evidence of efficacy 1, 2
• Overlooking mild hearing loss that could benefit from hearing aid intervention 1, 5
• Failing to identify potentially serious underlying causes such as vascular abnormalities or vestibular schwannoma 6
• Neglecting the psychological impact of tinnitus, which can lead to anxiety, depression, and sleep disturbances 4

Special Considerations

• Pulsatile tinnitus almost always requires imaging evaluation to rule out vascular abnormalities 1
• Patients with unilateral tinnitus or asymmetric hearing loss should undergo comprehensive audiological examination and possibly imaging 6, 2
• Tinnitus can sometimes be associated with medication use or withdrawal, particularly from benzodiazepines like clonazepam or lorazepam 7, 8