What medications are used to treat tinnitus in an adult patient with no significant medical history?

Medications for Tinnitus

No medications are recommended for the routine treatment of persistent, bothersome tinnitus—the American Academy of Otolaryngology-Head and Neck Surgery explicitly advises against antidepressants, anticonvulsants, anxiolytics, or intratympanic medications due to insufficient evidence of benefit and potential for harm. 1, 2, 3

What NOT to Prescribe

The evidence is clear on what to avoid:

• Antidepressants, anticonvulsants, and anxiolytics (including lorazepam) should not be used as primary tinnitus treatments, as they lack evidence of efficacy and carry risk of side effects or dependency 1, 2, 3
• Dietary supplements including Ginkgo biloba, melatonin, and zinc are not recommended due to lack of consistent benefit across clinical trials 1, 3
• Intratympanic medications have no role in routine tinnitus management 1, 3

Evidence-Based Treatment Algorithm

Instead of medications, the following stepwise approach is recommended:

Step 1: Initial Evaluation

• Perform comprehensive audiologic examination to identify any degree of hearing loss, which commonly accompanies tinnitus 1, 3
• Distinguish pulsatile from non-pulsatile tinnitus and unilateral from bilateral presentation to identify potentially treatable underlying conditions 1

Step 2: First-Line Interventions

For patients with any degree of hearing loss (even mild or unilateral):

• Recommend hearing aid evaluation and fitting, as this addresses both auditory deficit and reduces tinnitus burden 1, 4, 3, 5

For all patients with persistent, bothersome tinnitus:

• Provide education and counseling about tinnitus management strategies as a foundational element 1, 2, 3
• Recommend Cognitive Behavioral Therapy (CBT), which has the strongest evidence for improving quality of life—typically delivered over 8 weekly sessions of approximately 120 minutes each 1, 4, 3, 5
• Consider sound therapy as an adjunctive management option for symptomatic relief 1, 2, 3

Step 3: Special Considerations

When psychiatric comorbidity is present:

• Promptly identify and treat severe anxiety or depression through psychiatric consultation, as suicide risk is increased in tinnitus patients with coexisting psychiatric illness 6, 1
• Medications may be appropriate for treating the psychiatric condition itself, but not as primary tinnitus treatment 2

Key Clinical Pitfalls to Avoid

• Do not prescribe medications "to try something" when evidence shows no benefit and potential harm 1, 2, 3
• Do not overlook mild or unilateral hearing loss that could benefit from hearing aid intervention 1, 2
• Do not dismiss patients by saying "nothing can be done"—multiple evidence-based non-pharmacologic interventions exist 7
• Do not order imaging studies unless tinnitus is unilateral, pulsatile, associated with focal neurologic abnormalities, or accompanied by asymmetric hearing loss 1, 3

Why This Approach Works

CBT works equally well regardless of initial tinnitus severity, duration, or presence of hearing loss, making it the most universally applicable evidence-based intervention 4. When combined with hearing aids for those with hearing loss, this addresses both the auditory deficit and psychological distress 4. The combination of sound therapy and CBT-based counseling has the strongest evidence base, though clinical trials are constrained by patient heterogeneity 5.