Psychotherapy. Cognitive behavioral therapy (CBT) is the most studied nonpharmacological treatment. It is the treatment of choice as it targets anxiety and improves patients’ quality of life.14 Mindfulness and meditation reduce the stress response state and in turn decrease the distress associated with tinnitus.
Other interventions. Patients who received acupuncture treatments reported benefit compared with the control group that received sham treatment with fake needles.15 When the tinnitus is associated with sensorineural hearing loss, especially if unilateral, cochlear implantation may be indicated.
Brain stimulation. Both low frequency and high frequency repetitive trans-cranial magnetic stimulation to the auditory cortex was studied in patients with tinnitus and showed promising results. Other areas studied are the frontal and parietal regions, as well as the dorsal cochlear nucleus, the inferior colliculus, and the medial geniculate body of the thalamus.16
Epidural stimulation has been shown to be safe and effective in small trials.17 Deep brain stimulation, although not used specifically for tinnitus but rather for other approved indications (eg, movement disorders) has shown benefit in patients who have comorbid tinnitus.18
We currently know that tinnitus is an aberrant brain-ear circuitry. The work-up consists of a thorough history and physical exam including a cognitive assessment. Urgent referrals should be made when tinnitus is pulsatile or associated with neural deficits (facial weakness or paralysis), unexplained sudden hearing loss, vestibular symptoms, or otalgia and drainage.
In the case of tinnitus without the symptoms described above, other comorbidities such as psychiatric symptoms, stress, sleep, and trauma should be assessed and treated. There is no single treatment for tinnitus, and the goal is to target associated distress with CBT to decrease the perception of tinnitus and improve the patient’s quality of life.
Dr Chemali is Director, Neuropsychiatry Clinics; Director, Behavioral Neurology-Neuropsychiatry Fellowship; Director, Global Implementation Program in Neuropsychiatry, Behavioral and Social Sciences; Associate Professor, Harvard Medical School, Massachusetts General Hospital, Boston, MA. Dr Nehme is Psychiatry Fellow, Consult-Liaison Psychiatry, Cambridge Health Alliance, Cambridge, MA. The authors report no conflicts of interest concerning the subject matter of this article.
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