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Management

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Principles of management of tinnitus includes:
- history and examination
- audiogram
- 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
several treatments are available to help people cope with tinnitus (1)
- these include:
  - counselling
    - 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
  - sound therapy
    - 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 similar to hearing aids
      - wearable devices with earphones
      - non-wearable devices (radios, tape players, compact disc players)
  - psychological therapy
    - cognitive behaviour modification
    - relaxation therapy (there is a strong association between tinnitus and stress)
  - medical management
    - 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)

NICE state (5):

Amplification devices

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.

Reference:

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Management

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