What medications are used to treat tinnitus?

Medication for Tinnitus

No medications are recommended for the primary treatment of tinnitus—the American Academy of Otolaryngology-Head and Neck Surgery explicitly advises against using antidepressants, anticonvulsants, anxiolytics, or intratympanic medications due to insufficient evidence and potential side effects. 1, 2

What Does NOT Work

• Antidepressants, anticonvulsants, and anxiolytics should not be routinely prescribed for persistent, bothersome tinnitus, as they lack evidence of benefit and may cause adverse effects or worsen tinnitus 1, 2

• Dietary supplements including Ginkgo biloba, melatonin, and zinc are not recommended due to lack of consistent benefit and should be avoided 1, 2

• Intratympanic medications have no role in primary tinnitus treatment 1, 2

• No causative pharmacologic treatment exists for established ototoxicity from platinum-based chemotherapy 1

What Actually Works Instead

Cognitive Behavioral Therapy (CBT) is the only treatment with the strongest evidence for improving quality of life in patients with persistent, bothersome tinnitus 1, 2, 3

• Hearing aids are recommended for any degree of hearing loss associated with tinnitus, even if the hearing loss is mild or unilateral 1, 2, 3

• Education and counseling about tinnitus management strategies should be provided to all patients with persistent, bothersome tinnitus 1, 2

• Sound therapy may provide symptomatic relief as a management option 1

Clinical Algorithm for Tinnitus Management

1. Classify the tinnitus: Determine if it is pulsatile versus non-pulsatile, unilateral versus bilateral, and bothersome versus non-bothersome 1, 2

2. Obtain comprehensive audiologic examination for unilateral tinnitus, persistent tinnitus (≥6 months), or tinnitus associated with hearing difficulties 1, 2

3. If hearing loss is present: Recommend hearing aid evaluation regardless of severity 1, 2, 3

4. For persistent, bothersome tinnitus: Offer CBT as the primary evidence-based intervention 1, 2, 3

5. Provide education and counseling to all patients about realistic expectations and management strategies 1, 2

Critical Pitfalls to Avoid

• Do not prescribe medications without clear evidence that may cause side effects or worsen the condition 1

• Do not overlook mild hearing loss that could benefit from hearing aid intervention 1

• Do not recommend supplements that lack efficacy evidence 1, 2

• Identify patients with severe anxiety or depression promptly, as tinnitus patients with psychiatric comorbidities have increased suicide risk 1, 3

Special Considerations

• Pulsatile tinnitus almost always requires imaging evaluation (CTA or MRA) to identify potentially treatable vascular causes 1, 2

• For chemotherapy-induced tinnitus, while no treatment reverses established ototoxicity, hearing aids and CBT remain beneficial 1, 3

• Imaging studies should only be obtained for unilateral tinnitus, pulsatile tinnitus, focal neurological abnormalities, or asymmetric hearing loss 1, 2