What are the treatments for tinnitus?

Anyone whose tinnitus becomes persistent or who suspects their hearing is not as good as it used to be should make an appointment to see their family doctor.

Usually, the doctor will refer the patient to an audiologist or Ear, Nose and Throat (ENT) unit at the hospital. Here a specialist will be able to rule out more serious middle ear problems and conduct a hearing test to determine whether the problem is linked to a hearing loss. Although tinnitus has no simple ‘cure’, there are strategies for reducing its impact.

Sound generators

For most people, tinnitus is no more than a slight annoyance while there is sufficient background noise. For those with mild tinnitus, everyday sounds may mask the tinnitus during the daytime, making it either easier to deal with or completely inaudible. However, tinnitus can become a real problem during quiet times of day, such as before sleep. Many people find relief by adding an external competing sound at a constant low level. Radio static, the television or the hum of a fan might all help to distract from the internal sounds of the tinnitus.

Products are also available which will generate white noise specifically to mask the sound of tinnitus, including small speakers which can be placed under the pillow, or bedside models. Behind-the-ear wearable sound generators (similar to hearing aids in appearance) which produce a low-level hissing noise, adjustable specifically to your tinnitus, are also widely used and are available through the NHS.

There is little evidence to suggest that sound generators can actually reduce the perceived level of the tinnitus when they are not in use.

Psychological treatments

Modern imaging techniques have shown that areas of the brain that process information from the ears are more active in tinnitus sufferers than people without the condition.

Research indicates that many people can be helped to reduce the perceived level of their tinnitus sound by retraining the brain to pay less attention to it. Where a person achieves a lower awareness of their tinnitus, it is known as habituation. Treatment based on habituation is possible and available in NHS audiology departments and uses a mix of counselling, sound therapy and relaxation therapy.

Tinnitus Retraining Therapy (TRT) is a specific form of habituation based on structured counselling sessions using specially designed counselling sessions combined with sound therapy. It does not offer a ‘cure’ as such, and results will vary from one person to the next. However, research evidence does show that counselling sessions with an expert trained in tinnitus management can have a positive effect for many people. Although many experts maintain that the use of a sound generator is an integral part of the process, there is evidence to indicate that it is the counselling element of the programme which is the most important.

Hearing aids

Tinnitus is more common in deaf and hard of hearing people than in hearing people, partly due to the damage to the hearing system which is associated with its onset. For those with a hearing impairment, a hearing aid may not only help to make external sounds more audible but may, in some cases, reduce the level of the tinnitus. It is important that hearing aid levels are not set too loud as this can actually worsen the tinnitus in some cases.

Cochlear implants

A cochlear implant is a device fitted surgically which can improve the hearing ability of many profoundly or totally deaf people. Tiny electrodes connect directly into the hearing nerve bypassing the non-functioning hair cells in the inner ear. They electrically stimulate the hearing nerve in response to sounds which are then interpreted by the brain.
Many people fitted with a cochlear implant, find their tinnitus symptoms improve or even disappear. However, in rare cases, tinnitus can actually be worsened as a result of implantation.

Drug treatments

Although several drugs have been tested in controlled trials, no single drug treatment has yet been developed which can benefit all people with tinnitus.

Tricyclic or SSRI-type anti-depressant medication can form an integral part of a treatment programme for some tinnitus patients. However, whilst such drugs may reduce the anxiety caused by tinnitus (so reducing its perceived level), they do not offer a cure.

Diet and Lifestyle

Improving blood circulation through exercise and a good diet can help reduce tinnitus symptoms for some people. Salt can impair circulation and raise blood pressure so avoid processed food with high salt levels, and adding it to food yourself.

Some people notice a change in their tinnitus according to what they eat or drink. It can help to keep a food diary for a while to see whether an increase in symptoms coincides with the intake of any particular food or drink. Most commonly named aggravators are red wine and other alcoholic drinks, cheese, coffee and tobacco. However, everyone's sensitivity is different and so there is no reason to avoid something without good reason.

Relaxation therapy is a useful approach to breaking the cycle of tinnitus, reducing stress levels and helping to restore a regular sleep pattern. Books and CDs on relaxation are widely available. You could also ask your GP for advice or contact a local college or health centre about courses in your area.

Complementary treatments

A substantial number of people use a variety of complementary treatments to control their tinnitus. The commonest treatments tried include acupuncture, homeopathy and dietary supplements. There is no hard evidence that these treatments are effective, although for some patients they may help to lower anxiety levels and encourage them to feel more in control, thus reducing the perceived level of their tinnitus.

Until recently, the popular herbal supplement, ginkgo biloba was being widely used as a complementary treatment for tinnitus, particularly in cases linked to poor circulation. However, a double blind, placebo controlled trial carried out by the University of Birmingham concluded that ginkgo biloba is not an effective treatment for tinnitus. Despite this, some individuals report that this supplement does reduce their tinnitus.

Some complementary therapies are available through GP surgeries. Alternatively, you should check that your intended therapist has a recognised qualification through the appropriate professional body. Guidance is also available from the Complementary Medical Association: www.the-cma.org.uk