Chronic tinnitus: What helps – and what doesn’t?
Although a wide range of treatments for chronic tinnitus are offered and used, 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?
Several studies have indicated that cognitive behavioral therapy (CBT) can improve the quality of life of people who have tinnitus. It can help you cope better with tinnitus and it can also help relieve depression. But CBT doesn't actually reduce the tinnitus sounds. It is not known how long the positive effect lasts: most studies only lasted a year or less.
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 for the patient to live with tinnitus. The next step is to try to change those patterns.
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 so they are perceived to be less bothersome.
Treatments that haven't been proven to work
Treatments for tinnitus that have not yet been proven to help include the following:
- 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.
- 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. But rTMS has not yet been shown to work in good-quality studies.
- Relaxation techniques like progressive muscle relaxation, autogenic training or yoga.
- Epilepsy drugs such as the medication gabapentin. The possible side effects include sleepiness, dizziness and – in the long term – weight gain.
- Ginkgo biloba: Several studies involving a total of more than 1,000 participants didn’t provide any proof that ginkgo products effectively relieve tinnitus symptoms. But they 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.
- 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: Dietary supplements such as certain vitamin or zinc supplements haven’t been proven to relieve tinnitus symptoms.
- 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 can mask the tinnitus.
- 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.
Baldo P, Doree C, Molin P, McFerran D, Cecco S. Antidepressants for patients with tinnitus. Cochrane Database Syst Rev 2012; (9): CD003853.
Bennett MH, Kertesz T, Perleth M, Yeung P, Lehm JP. Hyperbaric oxygen for idiopathic sudden sensorineural hearing loss and tinnitus. Cochrane Database Syst Rev 2012; (10): CD004739.
Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie (DGHNOKHC). Chronischer Tinnitus (S3-Leitlinie). AWMF-Registernr.: 017-064. February 2015.
Hilton MP, Zimmermann EF, Hunt WT. Ginkgo biloba for tinnitus. Cochrane Database Syst Rev 2013; (3): CD003852.
Hoare DJ, Edmondson-Jones M, Sereda M, Akeroyd MA, Hall D. Amplification with hearing aids for patients with tinnitus and co-existing hearing loss. Cochrane Database Syst Rev 2014; (1): CD010151.
Hobson J, Chisholm E, El Refaie A. Sound therapy (masking) in the management of tinnitus in adults. Cochrane Database Syst Rev 2012; (11): CD006371.
Hoekstra CE, Rynja SP, van Zanten GA, Rovers MM. Anticonvulsants for tinnitus. Cochrane Database Syst Rev 2011; (7): CD007960.
Kreuzer PM, Vielsmeier V, Langguth B. Chronic tinnitus: an interdisciplinary challenge. Dtsch Arztebl Int 2013; 110(16): 278-284.
Martinez-Devesa P, Perera R, Theodoulou M, Waddell A. Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev 2010; (9): CD005233.
Mehta S, Peynenburg VA, Hadjistavropoulos HD. Internet-delivered cognitive behaviour therapy for chronic health conditions: a systematic review and meta-analysis. J Behav Med 2018 [Epub ahead of print].
Meng Z, Liu S, Zheng Y, Phillips JS. Repetitive transcranial magnetic stimulation for tinnitus. Cochrane Database Syst Rev 2011; (10): CD007946.
Person OC, Puga ME, da Silva EM, Torloni MR. Zinc supplementation for tinnitus. Cochrane Database Syst Rev 2016; (11): CD009832.
Phillips JS, McFerran DJ, Hall DA, Hoare DJ. The natural history of subjective tinnitus in adults: A systematic review and meta-analysis of no-intervention periods in controlled trials. Laryngoscope 2018; 128(1): 217-227.
Pichora-Fuller MK, Santaguida P, Hammill A, Oremus M, Westerberg B, Ali U et al. Evaluation and Treatment of Tinnitus: Comparative Effectiveness. 08.2013. (AHRQ Comparative Effectiveness Reviews; Band 122).
Savage J, Waddell A. Tinnitus. BMJ Clin Evid 2014: pii: 0506.
Soleimani R, Jalali MM, Hasandokht T. Therapeutic impact of repetitive transcranial magnetic stimulation (rTMS) on tinnitus: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2016; 273(7): 1663-1675.
Zenner HP, Delb W, Kröner-Herwig B, Jäger B, Peroz I, Hesse G et al. Zur interdisziplinären S3-Leitlinie für die Therapie des chronischen-idiopathischen Tinnitus. HNO 2015; 63(6): 419-427.
IQWiG health information is written with the aim of helping
people understand the advantages and disadvantages of the main treatment options and health
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.
Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.