From the Guidelines
Tinnitus treatment should prioritize cognitive-behavioral therapy (CBT) as the primary approach for managing symptoms, as it has been shown to have a preponderance of benefit over harm in reducing tinnitus-related distress 1.
Key Considerations
- Tinnitus is a symptom defined by the perception of sound in the absence of external stimuli, affecting over 50 million Americans, with significant negative impacts on psychosocial well-being and quality of life 1.
- The American Academy of Otolaryngology and Head and Neck Surgery Foundation (AAO-HNS) guidelines recommend targeted history and clinical examination as the initial evaluation, followed by a prompt and comprehensive audiological examination in patients with hearing problems or unilateral persistent tinnitus 1.
- CBT is effective in reducing tinnitus-related distress by changing how patients respond to the sound, and clinicians should recommend it to patients with persistent, bothersome tinnitus 1.
Treatment Approaches
- Sound therapy using white noise machines, fans, or smartphone apps can help mask the ringing sensation.
- Hearing aids can be beneficial if tinnitus is related to hearing loss.
- Lifestyle modifications, such as limiting caffeine, alcohol, and nicotine, using ear protection in loud environments, managing stress through meditation or yoga, and maintaining good cardiovascular health through regular exercise, can also help alleviate symptoms.
- Tinnitus retraining therapy, which combines counseling with sound therapy over 12-18 months, can help the brain habituate to the tinnitus sound.
Important Considerations
- The type of tinnitus and associated symptoms often determine the choice of imaging studies and their appropriateness 1.
- Patients with severe anxiety, depression, or psychological disturbances may need prompt identification and intervention 1.
- Education and counseling are essential in managing tinnitus, and clinicians should educate patients about management strategies, as it has been shown to have a preponderance of benefit over harm 1.
From the Research
Tinnitus Treatment Options
- Cognitive Behavioral Therapy (CBT) has been shown to be effective in reducing tinnitus severity and improving quality of life in patients with chronic subjective tinnitus 2, 3, 4.
- Notched Sound Therapy (NST) has also been found to be effective in reducing tinnitus loudness, although CBT may be more effective in decreasing tinnitus-related distress 2.
- Mindfulness-Based Cognitive Therapy (MBCT) has been shown to be effective in reducing tinnitus severity and psychological distress in patients with chronic tinnitus 5.
- Sound therapy and tinnitus retraining therapy are also treatment options, although the evidence for their effectiveness is inconclusive 6.
Comparison of Treatment Options
- CBT has been compared to audiological care, tinnitus retraining therapy, and other active controls, and has been found to be effective in reducing the impact of tinnitus on quality of life 4.
- MBCT has been compared to intensive relaxation training and has been found to be more effective in reducing tinnitus severity 5.
- The effectiveness of CBT and other treatments may depend on the individual patient and the specific characteristics of their tinnitus 2, 4.
Treatment Outcomes
- CBT has been shown to result in significant reductions in tinnitus severity, psychological distress, anxiety, and depression 2, 3, 4.
- MBCT has been shown to result in significant reductions in tinnitus severity, psychological distress, anxiety, and depression, and to have a lasting effect at 6 months follow-up 5.
- The evidence for the effectiveness of CBT and other treatments in improving health-related quality of life and reducing negatively biased interpretations of tinnitus is limited and inconclusive 4.