What are the management options for tinnitus due to sensory neural (sensorineural) hearing loss?

Management of Tinnitus Due to Sensorineural Hearing Loss

For patients with tinnitus and sensorineural hearing loss, clinicians should recommend hearing aids as the primary intervention, supplemented by cognitive-behavioral therapy for persistent, bothersome symptoms, while avoiding routine use of medications or dietary supplements. 1

Initial Diagnostic Evaluation

Obtain comprehensive audiologic examination promptly (within 4 weeks) to confirm sensorineural hearing loss and characterize the pattern (unilateral vs. bilateral, degree of loss). 1 This assessment is critical because:

• 86% of patients with unilateral sensorineural hearing loss report hearing handicap on validated instruments 1
• Audiometric testing identifies candidates for amplification and sound therapy 1
• Prompt evaluation facilitates early intervention, which may improve quality of life outcomes 1

Primary Treatment: Hearing Aids

Hearing aids are the cornerstone of management for tinnitus with co-existing hearing loss. 1, 2

• Amplification provides dual benefit: improves communication function while reducing tinnitus perception through external sound enrichment 1, 2
• For bilateral moderate sensorineural hearing loss, bilateral hearing aids significantly reduce psychosocial burden and improve quality of life 2
• Evidence shows clinically significant reduction in tinnitus symptom severity with hearing aid use, though direct comparison studies show no superiority over sound generators 3, 4

Amplification Options by Clinical Scenario

For unilateral hearing loss:

• CROS (contralateral routing of signal) hearing aids transmit sound from the affected ear to the better ear 1
• BICROS devices for patients with pre-existing hearing loss in the better ear 1
• Monaural hearing aids if the affected ear can benefit from direct amplification 1
• Osseointegrated bone conduction devices as surgical alternative 1

For bilateral hearing loss:

• Standard bilateral hearing aids as first-line 2
• Combination devices (amplification plus sound generation) show no superiority over hearing aids alone but remain an option 4

Adjunctive Sound Therapy

Clinicians may recommend sound therapy for persistent, bothersome tinnitus. 1 However:

• Low-quality evidence shows no difference between hearing aids and dedicated sound generators for tinnitus symptom severity 3, 4
• Combination devices (hearing aid plus sound generator) show no advantage over hearing aids alone 4
• Sound enrichment through hearing aids provides adequate therapeutic benefit for most patients 1, 2

Cognitive-Behavioral Therapy

Clinicians should recommend CBT to patients with persistent, bothersome tinnitus. 1 This represents a strong recommendation from the American Academy of Otolaryngology-Head and Neck Surgery for addressing the psychological impact of tinnitus beyond amplification alone. 1

What NOT to Do

Avoid these interventions that lack evidence or carry unnecessary risk:

• Do not routinely prescribe antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for primary tinnitus treatment 1
• Do not recommend Ginkgo biloba, melatonin, zinc, or other dietary supplements 1
• Do not recommend transcranial magnetic stimulation for routine treatment 1
• Medications may be used selectively for co-morbid conditions (insomnia, anxiety, depression) but not as primary tinnitus therapy 5

Counseling and Rehabilitation

Clinicians should counsel patients about audiologic rehabilitation and supportive measures. 1 This is a strong recommendation that includes:

• Realistic expectations: hearing aids improve both hearing and tinnitus, but complete resolution may not occur 2
• Natural history: many patients experience habituation over time 6
• Communication strategies: face-to-face positioning, minimizing background noise, speech-to-text applications 7
• Referral to support groups (e.g., Hearing Loss Association of America) for adjustment counseling 2

Outcome Assessment

Use validated instruments to quantify baseline severity and monitor treatment response:

• Tinnitus Handicap Inventory (THI) for tinnitus-specific impact 1, 2, 3
• Hearing Handicap Inventory for Adults (HHIA) or Elderly (HHIE) for hearing-related quality of life 1, 2
• Visual Analog Scale (VAS) for tinnitus loudness 8

Schedule formal evaluation at 3-6 months to determine if communication goals are met and quality of life has improved. 2

Follow-Up Protocol

• Audiometry at treatment conclusion and within 6 months 1
• Annual audiometry to monitor for progression 2
• Adjust amplification as hearing status changes 7

Escalation for Inadequate Response

If standard hearing aids provide insufficient benefit:

• Upgrade to hearing aids with built-in maskers or hearing assistive technology systems 2
• For severe-to-profound hearing loss with persistent tinnitus, consider cochlear implantation (96% report tinnitus improvement post-implantation) 2

Common Pitfalls to Avoid

• Waiting for "bothersome" criteria before obtaining audiometry—obtain testing promptly for any patient presenting with tinnitus 1
• Prescribing medications or supplements as first-line therapy—these lack evidence and delay effective interventions 1
• Failing to address the psychological impact—tinnitus significantly affects quality of life even when unilateral 1
• Pursuing invasive treatments without evidence—risk exceeds benefit for most surgical or experimental interventions 5