Lorazepam Should Not Be Used for Tinnitus Treatment
Lorazepam and other benzodiazepines (including anxiolytics) are explicitly not recommended for the primary treatment of persistent, bothersome tinnitus according to current evidence-based guidelines. 1, 2
Guideline-Based Recommendations
The American Academy of Otolaryngology-Head and Neck Surgery specifically advises against routinely recommending anxiolytics (which includes lorazepam) for treating persistent, bothersome tinnitus due to insufficient evidence of benefit and potential for harm. 1, 2 This recommendation applies to primary tinnitus treatment, not to situations where lorazepam might be indicated for other conditions like alcohol withdrawal syndrome. 3
Why Benzodiazepines Are Not Recommended
Lack of meaningful clinical benefit: While some research on alprazolam (a different benzodiazepine) showed improvement in visual analog scale scores, it failed to demonstrate significant improvement in the Tinnitus Handicap Inventory or actual tinnitus loudness—the outcomes that matter most for patient quality of life. 4
Risk-benefit profile: Benzodiazepines carry risks of dependence, tolerance, cognitive impairment, and withdrawal symptoms that outweigh any modest subjective improvements. 1, 2
Better alternatives exist: Evidence-based treatments with proven efficacy are available and should be used instead. 1, 5, 2
What Should Be Done Instead
For patients with persistent, bothersome tinnitus, the treatment algorithm is:
Comprehensive audiologic examination to identify hearing loss, which commonly accompanies tinnitus. 1, 2
Hearing aid evaluation if any degree of hearing loss is present, even if mild or unilateral—this addresses both the auditory deficit and can significantly reduce tinnitus burden. 1, 5, 2
Cognitive Behavioral Therapy (CBT) as the primary evidence-based psychological intervention, delivered over approximately 8 weekly sessions of 120 minutes each, incorporating cognitive restructuring, applied relaxation, and behavioral activation. 1, 5, 2
Education and counseling about tinnitus management strategies for all patients with persistent symptoms. 1, 2
Sound therapy may be offered as an adjunctive management option for symptomatic relief. 1
Critical Pitfall to Avoid
Do not prescribe lorazepam or other benzodiazepines simply because a patient requests medication or appears anxious about their tinnitus. 1, 2 If severe anxiety or depression is present as a comorbid psychiatric condition (not just distress from tinnitus itself), psychiatric consultation is warranted for appropriate mental health treatment—but this is separate from tinnitus management. 3, 1
Special Circumstances
The only context where lorazepam appears in tinnitus-related literature is when it's used for its established indication of alcohol withdrawal syndrome in patients who happen to also have tinnitus—not as a tinnitus treatment. 3 In alcohol withdrawal, lorazepam is recommended at 1-4 mg every 4-8 hours for patients with severe symptoms, advanced age, liver failure, or other serious comorbidities. 3