DMSO Should Not Be Used for Tinnitus Treatment
There is no evidence supporting the use of DMSO (Dimethyl Sulfoxide) for tinnitus, and it is not mentioned in any established clinical practice guidelines for this condition. The American Academy of Otolaryngology-Head and Neck Surgery explicitly recommends against using medications without clear evidence of benefit, particularly given the potential for side effects and the availability of proven alternatives 1, 2.
Evidence-Based Treatment Framework
The absence of DMSO from tinnitus treatment guidelines is notable, especially when considering that extensively studied medications have been systematically rejected:
Medications Explicitly Not Recommended
Antidepressants, anticonvulsants, anxiolytics, and intratympanic medications should not be routinely prescribed for persistent, bothersome tinnitus due to insufficient evidence and potential for harm, including the possibility of worsening tinnitus 1, 2, 3.
Dietary supplements including Ginkgo biloba, melatonin, and zinc are not recommended despite being commonly available, as they show no consistent benefit in randomized controlled trials 1, 4.
Even intravenous lidocaine, which showed some efficacy, is not recommended due to short duration of effect and adverse reactions 5.
What Actually Works
Cognitive Behavioral Therapy (CBT) is the only treatment with strong evidence from randomized controlled trials demonstrating improved quality of life and should be recommended as first-line therapy for persistent, bothersome tinnitus 4, 2, 3.
Hearing aids should be evaluated for all patients with any degree of hearing loss and tinnitus, even if hearing loss is mild or unilateral, as they provide significant relief by addressing auditory deprivation 4, 2, 3.
Education and counseling are essential foundational interventions for all patients with persistent tinnitus to help them understand the natural history and set realistic management expectations 4, 2, 3.
Clinical Reasoning Against DMSO
The systematic review of pharmacological treatments for tinnitus found that even well-studied medications lack sufficient evidence 5, 6. DMSO has not undergone rigorous evaluation in tinnitus trials, and the methodological standards for tinnitus research are already challenging 7.
Common Pitfall to Avoid
Do not prescribe unproven medications that may cause side effects or worsen tinnitus when evidence-based alternatives exist 1, 2. The guideline development group for tinnitus management found a clear predominance of harm over benefit for unproven therapies 1.
Recommended Treatment Algorithm
Perform comprehensive audiologic examination for unilateral, persistent (≥6 months), or hearing-associated tinnitus 4, 3
Evaluate for hearing aids immediately if any degree of hearing loss is present 2, 3
Initiate CBT for all patients with persistent, bothersome tinnitus 4, 2, 3
Provide education and counseling about management strategies 4, 2, 3
Screen for anxiety and depression as psychiatric comorbidities increase suicide risk and require prompt intervention 4, 2
Obtain imaging only if tinnitus is unilateral, pulsatile, or associated with focal neurological abnormalities 4, 3