Tinnitus treatment [Neurosurgery Wiki]

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====== Tinnitus treatment ======

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===== Identifying Underlying Cause =====
Before initiating treatment, rule out reversible or treatable causes:

  * Hearing loss (age-related or noise-induced)
  * Earwax impaction
  * Ototoxic medications (NSAIDs, aminoglycosides, chemotherapy)
  * Temporomandibular joint (TMJ) dysfunction
  * Vascular anomalies (especially in pulsatile tinnitus)
  * Vestibular schwannoma (consider in unilateral tinnitus)

===== Treatment Options =====

==== Sound Therapy ====
Uses external sounds to reduce tinnitus perception.
  * White noise machines
  * Hearing aids with built-in masking features
  * Custom tinnitus maskers
  * Sound pillows or mobile apps

==== Cognitive Behavioral Therapy (CBT) ====
Psychological approach with strong evidence of benefit.
  * Reduces distress, improves coping
  * Typically delivered in structured sessions

==== Hearing Aids ====
For patients with coexisting hearing loss.
  * Amplifies environmental sounds
  * May reduce tinnitus awareness

==== Tinnitus Retraining Therapy (TRT) ====
Combines low-level sound stimulation with counseling.
  * Goal: habituation to tinnitus
  * Long-term process (6–24 months)

==== Medications ====

[[Tinnitus medical treatment]]


===== Experimental / Emerging Therapies =====
  * **Repetitive transcranial magnetic stimulation (rTMS)**
  * **Bimodal neuromodulation (e.g., Lenire® system)**
  * **Supplements** (e.g., Ginkgo biloba, melatonin) — low evidence

===== Lifestyle and Coping Strategies =====
  * Avoid complete silence — use background sounds
  * Limit caffeine, nicotine, and alcohol
  * Practice stress-reduction techniques (e.g., mindfulness, yoga)
  * Improve sleep hygiene

===== When to Refer =====
Refer to ENT or neurology if:
  * Unilateral tinnitus
  * Pulsatile tinnitus
  * Neurological symptoms
  * Severe impact on quality of life despite initial management


===== Deep brain stimulation for tinnitus =====
[[Deep brain stimulation for tinnitus]]