Last edited 03/2020
- principles of management of tinnitus includes:
- history and examination
- referral if appropriate
- explanation - The British Tinnitus Association may help
- If the history and examination
do not reveal a condition which should be referred, and the audiogram is normal,
then the condition should be managed in general practice
treatments are available to help people cope with tinnitus (1)
- give positive encouragement such as “Spontaneous disappearance is possible”, “Improvement is usual”, “There are means of helping such as learning relaxation techniques”
- avoid telling negative words such as ‘incurable’, ‘permanent’ or ‘you’ve got to live with it’ which will result in worsening of the perception on tinnitus
- inform patients to take their attention away from tinnitus (2)
- hearing aids
- sometimes tinnitus is also associated with hearing loss and these patients may benefit from a hearing aid
- hearing aids may emphasise beneficial sounds in the environment and decrease the attention the patient gives to hearing problems.
- hearing aids also amplify background noise, and helps patients feel better
- patients may feel comfortable when there is background noise or music
- sound therapy is used in many ways to reduce the effects of tinnitus
- by masking
- by reducing its loudness
- by distracting the patient
- several types of sounds are used in sound
therapy. These include:
- broadband noise
- music (soft, light, and background music)
- sound produced specifically for relaxation (e.g., waves lapping against the shore, raindrops falling on leaves)
- several different devices produce these sounds:
- wearable devices simillar to hearing aids
- wearable devices with earphones
- non-wearable devices (radios, tape players, compact disc players)
- cognitive behaviour modification
- relaxation therapy
- sedatives or antidepressants help secondary agitation or depression but do not eliminate tinnitus.
- surgery is limited to a few remediable otological causes (3)
- intravenous lidocaine seems to be effective, but the short duration of the effect and the adverse reactions prevent its use (4)
- these include:
NICE state (5):
- offer amplification devices to people with tinnitus who have a hearing loss that affects their ability to communicate
- consider amplification devices for people with tinnitus who have a hearing loss but do not have difficulties communicating
- do not offer amplification devices to people with tinnitus but no hearing loss.
Psychological therapies for people with tinnitus-related distress
- consider a stepped approach to treat tinnitus-related distress in adults whose tinnitus is still causing an impact on their emotional and social wellbeing, and day-to-day activities, despite having received tinnitus support. If a person does not benefit from the first psychological intervention they try or declines an intervention, offer an intervention from the next step in the following order:
- digital tinnitus-related cognitive behavioural therapy (CBT) provided by psychologists
- group-based tinnitus-related psychological interventions including mindfulness-based cognitive therapy (delivered by appropriately trained and supervised practitioners), acceptance and commitment therapy or CBT (delivered by psychologists)
- individual tinnitus-related CBT (delivered by psychologists).
Betahistine - do not offer betahistine to treat tinnitus.
- (1) treatment options for tinnitus, Department of Otolaryngology at University of Iowa Hospitals and Clinics,USA.
- (2) British Tinnitus Association 2009. Tinnitus guidelines for primary care
- (3) Hanna A et al. BMJ, 2005;330(7485):237
- (4) Espinosa-Sánchez JM et al. Pharmacotherapy for tinnitus: much ado about nothing. Rev Neurol 2014 Aug 16;59(4):164-74.
- (5) NICE (March 2020). Tinnitus:assessment and management