What is the treatment for tinnitus characterized by cricket sounds?

Treatment for Tinnitus with Cricket Sounds

For tinnitus described as cricket sounds (a form of nonpulsatile, subjective tinnitus), cognitive behavioral therapy (CBT) is the only treatment proven to improve quality of life, and should be your primary therapeutic intervention for persistent, bothersome cases. 1, 2

Initial Classification and Risk Stratification

Cricket-like sounds represent nonpulsatile, subjective tinnitus—the most common variant affecting 70-80% of tinnitus patients. 3 This classification is critical because it determines whether imaging is needed:

• No imaging is indicated if the tinnitus is bilateral, nonpulsatile, without focal neurologic deficits, and without asymmetric hearing loss. 3, 2
• Imaging is required only if the tinnitus is unilateral, pulsatile, associated with focal neurologic abnormalities, or accompanied by asymmetric hearing loss. 3, 2

Mandatory Initial Evaluation Steps

Obtain a comprehensive audiologic examination for any patient with:

• Unilateral tinnitus 2
• Tinnitus persisting ≥6 months 2
• Any associated hearing difficulties 2

This is essential because hearing loss is one of the two major causes of tinnitus, and even mild or unilateral hearing loss warrants intervention. 4, 5

Evidence-Based Treatment Algorithm

First-Line Interventions

1. Hearing Aids (if any hearing loss detected)

• Recommend hearing aid evaluation even for mild or unilateral hearing loss. 1, 2
• Hearing aids provide significant relief by compensating for auditory deficits that contribute to tinnitus perception. 4, 6

2. Cognitive Behavioral Therapy

• CBT has the strongest evidence for improving quality of life in tinnitus patients. 1, 2
• CBT reshapes negative thought patterns and behaviors associated with tinnitus-induced distress. 6
• This should be recommended for all patients with persistent, bothersome tinnitus. 2

3. Education and Counseling

• Provide education about tinnitus management strategies to all patients with persistent, bothersome symptoms. 1, 2
• Discuss natural progression and set realistic expectations. 7

Second-Line Options

Sound Therapy

• May be offered as a management option for symptomatic relief, though evidence is less conclusive than for CBT. 1, 2
• Wide-band sound therapy combined with CBT-based counseling has the strongest evidence base. 4

Treatments to Avoid

Do NOT routinely prescribe:

• Antidepressants, anticonvulsants, or anxiolytics for primary tinnitus treatment (insufficient evidence, potential side effects). 1, 2
• Dietary supplements including Ginkgo biloba, melatonin, or zinc (lack of consistent benefit). 1, 2
• Intratympanic medications (not indicated for primary tinnitus). 2

Critical Psychiatric Screening

Screen for severe anxiety or depression at every visit, as patients with tinnitus and psychiatric comorbidities have increased suicide risk and require prompt intervention. 3, 1 While antidepressants aren't recommended for tinnitus itself, treating co-existing psychiatric illness is essential. 3

Common Pitfalls

• Dismissing mild hearing loss: Even mild or unilateral hearing loss benefits from hearing aid intervention. 1, 4
• Prescribing unproven supplements: Avoid recommending supplements that lack efficacy evidence and may give false hope. 1, 2
• Ordering unnecessary imaging: Bilateral, nonpulsatile tinnitus without localizing features does not require imaging. 3, 2
• Overlooking CBT availability: CBT is the gold standard but availability may be limited; refer early to ensure access. 4