What medications are used to treat tinnitus?

Medication Treatment for Tinnitus

Medications are NOT recommended for treating tinnitus—the American Academy of Otolaryngology-Head and Neck Surgery explicitly advises against using antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for persistent, bothersome tinnitus due to insufficient evidence of benefit and potential for harm. 1, 2

What NOT to Prescribe

The evidence is clear and consistent across multiple guidelines:

• No antidepressants (e.g., SSRIs, tricyclics like amitriptyline) should be prescribed specifically for tinnitus treatment 1, 2, 3
• No anticonvulsants (e.g., gabapentin, pregabalin) are recommended for primary tinnitus management 1, 2, 3
• No anxiolytics including benzodiazepines should be used for tinnitus treatment 1, 2, 3
• No intratympanic medications (such as intratympanic steroids or gentamicin) are recommended 1, 2
• No dietary supplements including Ginkgo biloba, melatonin, or zinc have consistent evidence of benefit 1, 2, 3

Important Caveats About Psychiatric Medications

While medications are not recommended for tinnitus itself, there is a critical distinction: 4

• Antidepressants may be appropriate if the patient has comorbid depression requiring treatment (treat the depression, not the tinnitus) 4
• Melatonin may help with sleep disturbance associated with tinnitus, but not the tinnitus perception itself 4
• Screen all patients with bothersome tinnitus for anxiety and depression, as psychiatric comorbidities increase suicide risk and require prompt intervention 2, 3

What DOES Work: Evidence-Based Alternatives

Instead of medications, the treatment algorithm should follow this hierarchy:

First-line interventions:

• Cognitive Behavioral Therapy (CBT) is the ONLY treatment with strong evidence for improving quality of life in tinnitus patients 1, 2, 3, 5
• Hearing aids for any patient with hearing loss and tinnitus, even if hearing loss is mild or unilateral 1, 2, 3, 5
• Education and counseling about tinnitus management strategies for all patients with persistent, bothersome tinnitus 1, 2

Supportive interventions:

• Sound therapy and tinnitus retraining therapy may provide symptomatic relief, though evidence is less robust 2, 4
• CBT-based counseling combined with sound therapy has the strongest evidence base 5

Common Pitfalls to Avoid

• Do not dismiss patients with statements like "nothing can be done"—this is inappropriate and harmful 6
• Do not prescribe medications without clear evidence of benefit that may cause side effects or potentially worsen tinnitus 2
• Do not overlook mild hearing loss that could benefit from hearing aid intervention 3
• Do not skip comprehensive audiologic examination for unilateral, persistent (≥6 months), or hearing-associated tinnitus 2, 3

Special Context: Chemotherapy-Induced Tinnitus

For patients with tinnitus secondary to platinum-based chemotherapy, the approach differs slightly:

• No causative treatment exists for established ototoxicity 7
• Hearing aids remain beneficial 7
• CBT strategies can be offered for chemotherapy-induced tinnitus 7
• Sodium thiosulfate for prevention in children receiving cisplatin shows promise but cannot be recommended as standard treatment in adults due to uncertainty about tumor protection 7