Tinnitus that is perceived as a tone on sound is commonly referred to as tonal tinnitus. However most patients do not perceive a particular frequency and rather here a wide band noise resembling sound of his seashell, water, or crickets. Others here a particular frequency that could be identified and its intensity measured. In rare cases patients here at tone of music repeated over and over which is referred to as musical tinnitus. This has to be distinguished from auditory hallucinations perceived by patients with schizophrenia.
Diagnosis of tinnitus is purely clinical and based on patient’s complaint. If the perceived sound is not a pulse, is present in both ears or in the center of the head, and not associated with any neurologic symptoms no imaging studies are usually obtained. An audiogram, also known as a hearing test, and is required to objectively evaluate patient’s hearing in all frequencies. Many patients are not aware of subtle hearing loss in higher frequencies.
Patients who have tinnitus only in one ear, may have associated progressive hearing loss and possibly other neurologic symptoms are strongly recommended to seek counsel of a competent physician.
Of the 10% of the population who experienced constant tinnitus, great majority do not require any treatment. Over a span of a few weeks to a few months either the sound disappears or becomes only noticeable in a very quiet environment. Masking noise such as soft music, sound of a fan, or noise making machines could be used to help the patient cope with tinnitus. For patient’s that are bothered by this sound constantly other treatments were offered.
The research in the area of tinnitus treatment continues to be not optimal. This is due to the fact that on one hand the natural history of tinnitus is very favorable in majority of patients, and on the other, tinnitus could be manifestation of different disorders in the group of patients who have been studied together. Most research studies also don’t have stringent inclusion criteria and many times including patient’s with tinnitus of different duration and level of annoyance in the same group. Here is a summary of data so far available on different treatment modalities based on data available at the time of writing of this text. Please refer to your physician for individualized treatment.
Counseling: This should be the first step in treatment of a patient with tinnitus. Many patients would not be bothered and affected by tinnitus as long as they are evaluated and dangerous pathology ruled out. Counseling also helps to introduce patients to different treatment modalities available to them. Many of the studies and tinnitus always include counseling for both the control and the experimental group.
Hearing aids: Although there have been no randomized trials on the subject, there is enough tympanic evidence to suggest that patients who suffer from tinnitus and hearing loss would benefit from hearing amplification. This is particularly true for patient whose tinnitus frequency is within the range of hearing loss.
Noisemakers and masking: This is a common and successful treatment for select group of patients. If this sound is only perceived in a quiet environment, any device that makes wideband frequency sound could be used. Some patients actually record sound of shower and use that for masking. For patients who are bothered by tinnitus even during daytime, ear level masking sound could be produced by special hearing devices. These could be combined within a hearing aid for patients who also have hearing loss.
Cognitive behavior therapy and tinnitus retraining therapy: These two treatments are based on the theory that bothersome chronic tinnitus is a signal not generated by the ears necessarily but rather by the emotional centers of the brain also known as the limbic system. In this therapy the patient is assisted to dissociate the sound of a tinnitus from an unpleasant feeling. Many patients respond very well to this therapy particularly the ones that are incredibly bothered by their tinnitus.
Ginkgo biloba, zinc, garlic and other supplements: Despite numerous randomized trials none of these supplements have been proven to have better efficacy than placebo in treatment of tinnitus over time. One has to consider that the rate of tinnitus improvement with placebo is a time over 50%. Our recommendation is that if patients would like to try supplements and alternative therapy they are encouraged to do so as long as they’re cautious about possible side effects, cost, and unsubstantiated claims by people who generate great profit from these supplements.
Acupuncture: Randomized trials on acupuncture, including sham studies using random placement of needles by a person with no background in acupuncture have demonstrated no better efficacy than placebo as well. Again one needs to consider that tinnitus in one patient might be generated by temperament blurred joint disorder and may have good response to acupuncture and in other by a gun blast loud noise injury which may not respond to acupuncture.
Medication: Numerous medications, from antidepressants to seizure medication, have been used to treat bothersome tinnitus. Data of this treatment modality is also not very clear. Select antidepressants have shown efficacy beyond placebo effect in patients with tinnitus. One can argue that antidepressants aren’t treating patients depression so they are not as bothered by this sound, however some of these studies excluded patients with diagnosed depression.