From the Guidelines
Treatment for tinnitus should prioritize cognitive-behavioral therapy (CBT) as it has shown a preponderance of benefit over harm in reducing distress for patients with persistent, bothersome tinnitus, as recommended by the 2014 clinical practice guideline 1. When considering treatment options for tinnitus, it's essential to understand that there is no single cure, and a multifaceted approach is often necessary.
Treatment Options
- Sound therapy, utilizing white noise machines, fans, or smartphone apps, can help mask tinnitus sounds, making them less noticeable.
- Hearing aids are beneficial for patients with hearing loss, as they amplify external sounds that help distract from tinnitus.
- Cognitive behavioral therapy (CBT) is recommended for patients with persistent, bothersome tinnitus, as it changes how patients react to tinnitus, reducing distress even when the sound remains 1.
- Education and counseling about management strategies are also crucial, as they have a preponderance of benefit over harm for patients with persistent, bothersome tinnitus 1.
- Medication options, such as antidepressants (amitriptyline 10-100 mg daily or nortriptyline 25-100 mg daily) or anti-anxiety medications (alprazolam 0.25-0.5 mg as needed), can help manage emotional reactions to tinnitus, although no drugs are FDA-approved specifically for tinnitus.
- Lifestyle modifications, including stress management techniques, avoiding loud noises, limiting caffeine and alcohol consumption, and getting adequate sleep, can also help alleviate tinnitus symptoms.
- Tinnitus retraining therapy, which combines sound masking with educational counseling, can help the brain reclassify tinnitus as an unimportant sound that can be tuned out over time, typically requiring 12-18 months of treatment for maximum benefit.
Avoiding Ineffective Treatments
- Transcranial magnetic stimulation (TMS) should not be recommended for the routine treatment of patients with persistent, bothersome tinnitus, as the evidence from RCTs is inconclusive 1.
From the Research
Treatment Options for Tinnitus
- Counseling: used as a strategy to manage tinnitus symptoms 2
- Psychotherapy: utilized to help patients cope with the emotional and psychological aspects of tinnitus 2
- Pharmacological approaches: various medications have been used to treat tinnitus, although their effectiveness can vary 2, 3
- Masking devices: devices that produce a constant, soothing sound to help mask the tinnitus perception 2
- Individualized sound stimulation: customized sound therapy tailored to the individual's specific tinnitus characteristics 4
- Cognitive behavioral therapy (CBT): a type of therapy that has been shown to have a definite improvement effect on tinnitus symptoms in a large randomized controlled trial 2
- Repetitive transcranial magnetic stimulation (rTMS): a noninvasive method of applying electromagnetic fields to the brain that can induce alterations of neuronal activity 3
- Transcranial direct current stimulation (tDCS): a noninvasive method of applying direct current to the brain that has shown promise in reducing tinnitus symptoms 3, 5
- Sound therapy: various forms of sound therapy have been developed, including customized sound therapy, which has been shown to be effective in suppressing tinnitus symptoms 4, 6
Mechanisms of Action
- Abnormal activities in the central nervous system: elevated spontaneous neuronal firing rate and increased neuronal synchronization caused by auditory deprivation 2
- Changes in the tonotopic map: reorganization of the auditory cortex in response to tinnitus 2
- Dysregulation of the limbic system: involvement of nonauditory brain areas in the perception and distress associated with tinnitus 3
- Central auditory cortex: target of stimulation for tDCS and rTMS treatments 3, 5
Efficacy of Treatment Options
- CBT: has been shown to have a definite improvement effect on tinnitus symptoms in a large randomized controlled trial 2
- Sound therapy: has been shown to be effective in suppressing tinnitus symptoms, although further research is needed to identify the most effective form of sound therapy 4, 6
- rTMS and tDCS: have shown promise in reducing tinnitus symptoms, although further research is needed to fully understand their efficacy and optimal treatment protocols 3, 5