Tinnitus is usually a symptom of a deeper problem. The cause may lie in the ear, brain or other organs.

If the problem is not severe and the sufferer tends to have tinnitus off and on treatment may not be sought.

The condition however needs to be evaluated by an ear, nose, and throat surgeon or an otolaryngologist.

Two specific approaches to Tinnitus treatment

Tinnitus therapy includes two specific approaches (1) –

1. Those that reduce the cause and intensity of the tinnitus – This includes medication and electrical suppression.
2. Those that reduce the annoyance caused by tinnitus – This includes behavioural therapy etc.

Treatment to reduce the cause and intensity of Tinnitus

Treatment of tinnitus that reduces the cause and intensity include (1-6) :–

• If there is impaction of wax or foreign body that is causing tinnitus, it needs to be removed.
• White noise sometimes helps in blocking out the sound of tinnitus. Some hearing aids and devices help patients with tinnitus with making a constant humming noise in the background called white noise.
• Stress, alcohol, caffeine etc. may increase tinnitus. Relaxation techniques and avoidance of drugs that cause tinnitus like aspirin, loop diuretics etc. may relieve the condition. Loud noises are triggers for tinnitus and need to be avoided.
• If tinnitus is caused due to other problems like high blood pressure, anemia, or rare problems like tumors or aneurysms, the underlying problem is treated.
• Sometimes drugs like Niacin are recommended for treatment of tinnitus. However it may not always be effective.

  Antiepileptic medication Gabapentin or another drug Acamprosate may also be prescribed.

  Other alternatives like Ginkgo biloma has also been tried in tinnitus.

  The only beneficial agents in tinnitus are antidepressants like nortriptyline, amitriptyline and anti anxiety agents like alprazolam, clonazepam, and oxazepam.

  If there is associated depression or anxiety, antidepressants or antianxiety drugs are also prescribed.

• Electrical suppression of tinnitus may be attempted. The cochlea is stimulated with trains of pulses at 5,000 pulses per second. This may suppress the tinnitus in some.

  Similarly Transcutaneous electrical nerve stimulation may be attempted around the ear to reduce tinnitus.

Treatment to reduce the annoyance caused by Tinnitus

Treatment that reduces the annoyance caused by tinnitus include (1-6) –

• Cognitive behavioral therapy (CBT) has been found to be effective in patients with idiopathic tinnitus where no cause for the condition is detected.

  It is done by a psychotherapist who has had special training in CBT.

  Patients are informed that it is unlikely that their condition will improve dramatically.

  They are informed about the usefulness of tinnitus groups and helped to reduce activities that may aggravate their condition.

• Sound therapy - Sounds found in natural settings like waterfalls, streams, rain, or wind are used to reduce the intensity of the tinnitus.
• Habituation and music therapy - Tinnitus retraining therapy or TRT. These are forms of habituation therapy.

  A repeated heard stimulus is given to habituate to the tinnitus and reduce discomfort.

• Massage and stretching of the neck and jaw muscles may also help.
• Hearing aids
• Alternative techniques like biofeedback, acupuncture, hypnosis, yoga etc. may help some patients of tinnitus.

  Electromagnetic stimulation or ear magnets are small electrical devices that send electromagnetic pulses through the ear and may help tinnitus.

• Hyperbaric oxygen therapy involves putting the patient in a pressurized chamber with pure oxygen to breathe.

  The aim is to increase the flow of oxygen to the ears and brain. It may help a person with hearing loss as well as tinnitus