management

Last edited 03/2020

  • 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 simillar to hearing aids
          • wearable devices with earphones
          • non-wearable devices (radios, tape players, compact disc players)
      • psychological therapy
        • cognitive behaviour modification
        • relaxation therapy
      • 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:

Related pages:

audiometry

tinnitus maskers

drug treatments

counselling

referral criteria from primary care - tinnitus