Can hearing aids help alleviate tinnitus symptoms?

Can Hearing Aids Help Tinnitus?

Yes, hearing aids should be recommended for patients with hearing loss and persistent, bothersome tinnitus (≥6 months duration), as they improve quality of life and reduce tinnitus-related distress through amplification of external sounds. 1

Clinical Algorithm for Hearing Aid Recommendation in Tinnitus

Step 1: Establish Candidacy

• Confirm persistent tinnitus: Symptoms must be present for ≥6 months to distinguish patients most likely to benefit from intervention 1
• Verify bothersome nature: Tinnitus must be subjectively bothersome to the patient, warranting active management 1
• Document hearing loss: Any degree of hearing loss qualifies, including mild unilateral sensorineural hearing loss, as even minimal hearing loss-associated tinnitus may benefit from amplification 1

Step 2: Recommend Hearing Aid Evaluation

The American Academy of Otolaryngology-Head and Neck Surgery provides a formal recommendation (Grade C evidence, high confidence) that clinicians should recommend hearing aid evaluation for all patients meeting the above criteria. 1 This is considered a first-line audiologic intervention even for marginal hearing aid candidates who might not otherwise pursue amplification 1

Step 3: Expected Benefits and Mechanism

• Tinnitus distress reduction: Recent multicenter European data (2025) demonstrates significant reductions in Tinnitus Handicap Inventory scores (mean decrease of 11.64 points) and Tinnitus Functional Index scores (mean decrease of 12.80 points) after just 6 weeks of hearing aid use 2
• Quality of life improvement: Hearing aids improve function and QOL by alleviating both hearing loss and tinnitus perception 1
• Dual mechanism: Amplification makes patients less aware of tinnitus by increasing external sound stimulation and improves communication by reducing the masking sensation tinnitus creates 3
• Neuroplastic effects: External sound activation may reprogram the auditory nervous system through neural plasticity, potentially providing long-term beneficial effects beyond simple masking 3

Step 4: Fitting Specifications

• Bilateral fitting preferred: Hearing aids should be fitted to both ears when bilateral hearing loss exists 3
• Open ear aids recommended: Use the widest amplification band available 3
• Disable noise reduction: Noise-reducing controls should be disabled to maximize external sound input 3
• Verification required: Real-ear measures must confirm prescriptive targets are met to avoid under-amplification 4

Step 5: Timeline and Monitoring

• Initial benefit window: Maximum tinnitus distress reduction occurs within the first 6 weeks of hearing aid use, with no further statistically significant improvement between 6-12 weeks 2
• Usage requirements: Average daily use of 4-5 hours is typical for achieving benefit 2
• Ongoing assessment: Annual monitoring is required for adults, with self-assessment tools (Hearing Handicap Inventory for Adults or Elderly) to determine impact on quality of life 1, 4

Evidence Quality and Nuances

The guideline recommendation is based on observational studies (Grade C evidence) but carries high confidence from the American Academy of Otolaryngology-Head and Neck Surgery 1. A critical caveat: a 2014 Cochrane systematic review found insufficient evidence to support or refute routine hearing aid use for tinnitus, noting that while one RCT showed hearing aids were as effective as sound generators, no difference was found between the two interventions. 5 However, more recent research (2025) from a large European multicenter trial demonstrates clear benefits 2.

Importantly, the predictors of success remain unclear: tinnitus frequency, degree of hearing loss, hearing aid use time, and fitting accuracy do not predict treatment response 2. This means hearing aids should be offered regardless of these characteristics, as benefit cannot be predicted in advance.

Comparative Effectiveness

• Superior to counseling alone: Patients with hearing loss and tinnitus who receive hearing aids plus counseling show statistically significant THQ score reductions (p<0.0001), while counseling alone does not reach statistical significance 6
• Equivalent to sound generators: Hearing aids perform comparably to dedicated sound generators for tinnitus management 5
• Design considerations: Hearing aids with in-built maskers provide the greatest benefit, followed by tinnitus-specific programming, then basic programming 7

What Hearing Aids Do NOT Do

• No effect on subjective tinnitus loudness: Hearing aids reduce tinnitus-related distress but do not change the perceived loudness of tinnitus itself 2
• Not a cure: Hearing aids are a management strategy, not curative treatment 1

Alternative Considerations

If hearing aids provide insufficient benefit or hearing loss is too severe for effective amplification, consider:

• CROS/BiCROS systems for unilateral severe hearing loss 1
• Bone-anchored devices for patients with severe-to-profound unilateral loss and normal contralateral hearing 1
• Cochlear implants when appropriately fit amplification fails and the "60/60" guideline is met (pure tone average ≥60 dB and word recognition ≤60%) 4
• Cognitive-behavioral therapy should be recommended as it has RCT-level evidence for persistent, bothersome tinnitus 1

What to Avoid

• Do not recommend medications: Antidepressants, anticonvulsants, anxiolytics, or intratympanic medications should not be routinely used for primary tinnitus treatment (Grade B evidence against) 1
• Do not delay intervention: Waiting beyond 6 months provides no additional benefit and may defer helpful treatment 1
• Do not skip verification: Real-ear measurements are essential to identify under-amplification as a cause of treatment failure 4