Chronic tinnitus: What helps – and what doesn’t?

Although a wide range of treatments for chronic tinnitus are available, none of them have been proven to reduce the symptoms. Cognitive behavioral therapy can help people cope better with the tinnitus sounds and improve their quality of life.

If tinnitus lasts longer than three months, it is considered to be chronic. In many cases the cause remains unknown. This makes it harder to treat effectively. A lot of treatments have been tried out and some have been tested in scientific studies. Most of the research so far hasn't been able to say whether there are any treatments that can effectively reduce tinnitus.

This doesn't mean that you just have to put up with it. Because all treatments can have side effects, it isn't a good idea to try out every last one of them. Many people find it more important to try to accept the sounds and find a way to keep them from becoming too distressing in everyday life.

What can help you cope better with tinnitus?

Cognitive behavioral therapy (CBT) is an option for treating tinnitus if the cause is unknown. CBT is a psychological treatment approach. It teaches people strategies to help them cope better with a problem.

In the treatment of tinnitus, CBT is based on the assumption that the amount of distress caused by the tinnitus depends more on how you deal with it than how loud the sounds actually are. Studies have in fact shown that there is only a weak link between the severity of tinnitus and the distress caused by it.

The CBT therapist will first help identify thought patterns or behavioral patterns that are making it harder to live with tinnitus. The next step is to try to change those patterns.

Studies suggest that cognitive behavioral therapy (CBT) can improve the quality of life of people who have tinnitus during the time they are having the treatment. It can help you cope better with tinnitus and it can probably also help relieve depression. But CBT doesn't actually reduce the tinnitus sounds. It is not clear whether the positive effect lasts after the end of treatment. CBT can help some people sleep better, too.

In Germany, CBT is covered by statutory health insurers if the tinnitus is causing considerable psychological distress or if the patient has another medical condition too, such as depression. If you would like to try out CBT, it is best to find a psychotherapist who has had special training in CBT.

When does it make sense to get a hearing aid?

A hearing aid may be considered if tinnitus is accompanied by hearing loss too. Hearing aids amplify the sound waves that reach the ear, making it easier to hear and join in conversations again. Some specialists believe that the improved hearing can help mask out tinnitus sounds to make them less bothersome.

Which treatments have not been proven to work?

Treatments that use medication

There is no scientific evidence that mecfication is effective in the treatment of chronic tinnitus. Some of the medications may have severe side effects as well. These medications include:

Antidepressants: for example, tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs). SSRIs can cause side effects such as a dry mouth, feeling faint and a decreased libido.
Epilepsy drugs, including the medication gabapentin. The possible side effects include sleepiness, dizziness and – in the long term – weight gain.
Ginkgo biloba can cause side effects such as gastrointestinal (stomach and bowel) problems or allergic reactions. Ginkgo can also interact with other medications. For instance, it can increase the effect of anticoagulant (blood-thinning) medication, which can cause bleeding.
Other medications: betahistine, melatonin, benzodiazepine, cannabis, oxytocin and steroids.

Treatments that do not use medication

A number of treatments that do not involve the use of medication are also available. There is no proof that they are effective either:

Acupuncture
Electromagnetic stimulation: This involves the use of electromagnets to try to influence the nerve signals that are responsible for tinnitus. One example is known as repetitive transcranial magnetic stimulation (rTMS). This procedure involves placing a special coil on the scalp, where it generates a magnetic field.
Relaxation techniques like progressive muscle relaxation, autogenic training or yoga.
Hyperbaric oxygen therapy: This involves sitting in a special high-pressure chamber and breathing in pure oxygen. The aim is to increase the transport of oxygen to the ears and brain. Hyperbaric oxygen therapy is most commonly used in people who have hearing loss as well as tinnitus.
Hypnosis: This involves getting people into a deep state of relaxation where they are at a different level of consciousness. The therapist then uses hypnotic suggestion to try to change how they perceive the tinnitus sounds.
Dietary supplements such as certain vitamin or zinc supplements.
Sound therapy: In this treatment, special noise generators produce a sound (usually a shushing sound). Some noise generators, known as “noise maskers,” distract patients from the tinnitus sounds by drowning them out. Others integrate the tinnitus sounds into other sounds in order to make them less noticeable. They are worn like hearing aids. You can also play recordings of the sounds of ocean waves or install a tabletop fountain to produce a sound background that make the tinnitus less bothersome.
Filtered music: Certain smartphone apps alter the frequency of music you play on your phone on the basis of your individual frequency of tinnitus. Listening to music using the app for one to two hours per day is claimed to reduce the volume of tinnitus sounds.

Sources

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IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

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