Medications for Tinnitus
Direct Answer
No medications should be routinely prescribed for the primary treatment of tinnitus, as there is insufficient evidence supporting their efficacy and they carry risks of adverse effects including potentially worsening tinnitus. 1, 2, 3
Evidence-Based Treatment Recommendations
What NOT to Prescribe
Antidepressants, anticonvulsants, and anxiolytics should not be used for treating persistent, bothersome tinnitus due to insufficient evidence of benefit, known harms, cost, and potential for some medications (particularly antidepressants) to actually worsen tinnitus. 1, 2, 3
Dietary supplements including Ginkgo biloba, melatonin, and zinc should not be recommended as they have no demonstrated benefit in randomized controlled trials and systematic reviews. 1, 2, 3
Intratympanic medications (steroids, gentamicin) should not be routinely used for tinnitus treatment, with insufficient evidence of clinically meaningful benefit. 1, 3
Transcranial Magnetic Stimulation (TMS) should not be recommended for routine tinnitus treatment due to inconclusive efficacy data and potential financial and physical harm. 1, 3
What SHOULD Be Offered Instead
Cognitive Behavioral Therapy (CBT) has the strongest evidence for improving quality of life in patients with persistent, bothersome tinnitus and should be the primary treatment recommendation. 2, 3, 4
Hearing aids should be recommended for any patient with tinnitus and hearing loss, even if the hearing loss is mild or unilateral, as this addresses a frequently associated underlying condition. 2, 3
Education and counseling about tinnitus management strategies should be provided to all patients with persistent, bothersome tinnitus as an essential component of care. 2, 3
Sound therapy may be offered as a management option for symptomatic relief in persistent tinnitus. 2
Clinical Algorithm
Step 1: Comprehensive Audiologic Evaluation
- Obtain pure tone audiometry covering 500-8000 Hz to detect any degree of hearing loss. 5
- Perform comprehensive otologic examination to identify treatable underlying conditions. 2
Step 2: If Hearing Loss Present
- Recommend hearing aid evaluation immediately, regardless of severity (mild, unilateral, or bilateral). 2, 3
Step 3: For All Patients with Persistent, Bothersome Tinnitus
- Refer for Cognitive Behavioral Therapy as the primary evidence-based intervention. 2, 3
- Provide education and counseling about management strategies. 2, 3
- Consider sound therapy for symptomatic relief. 2
Step 4: Screen for Psychiatric Comorbidities
- Identify severe anxiety or depression promptly due to increased suicide risk in tinnitus patients with psychiatric comorbidities. 2
- Treat psychiatric conditions independently, but not with the expectation of reducing tinnitus severity. 1
Important Caveats
The Medication Evidence Gap
No FDA or European Medicines Agency approved drugs exist for tinnitus treatment, despite widespread off-label prescribing in clinical practice. 6, 7
Available clinical trials show that no investigated drugs have demonstrated replicable long-term reduction of tinnitus impact exceeding placebo effects. 6
The pharmaceutical evidence base is characterized by methodological heterogeneity, small sample sizes, and inconsistent results. 8
Special Consideration: Chemotherapy-Induced Tinnitus
For patients with cisplatin-induced tinnitus, no causative treatment exists for established ototoxicity. 2, 5
- Hearing aids remain beneficial if hearing loss is present. 2, 5
- CBT strategies can be offered with moderate supporting evidence. 2
- Sodium thiosulfate may prevent ototoxicity in children receiving cisplatin, but evidence in adults is uncertain. 2
Common Prescribing Pitfalls to Avoid
Do not prescribe medications without clear evidence simply because patients request pharmacological solutions, even though this is their preference. 7
Do not overlook mild or unilateral hearing loss that could benefit from hearing aid intervention—this is a treatable component frequently missed. 2, 3
Do not recommend acupuncture as there is insufficient evidence to support its use, though serious harm is rare. 1, 3
Avoid giving false hope about dietary supplements or unproven therapies that waste patient resources and delay effective treatment. 1
Why Medications Don't Work
The lack of effective pharmacotherapy stems from multiple factors: incomplete understanding of tinnitus pathophysiology, heterogeneity of tinnitus subtypes potentially requiring different treatments, lack of objective biomarkers, very large placebo effects in treatment trials, and poor correlation between animal models and human studies. 7
The bottom line: Focus clinical efforts on CBT, hearing aids when indicated, and patient education rather than pharmacological interventions. 2, 3