Otology
Tinnitus
Causes of tinnitus, diagnostic algorithm, sound enrichment and TRT therapy.
Can tinnitus be treated, and which approaches work?
Tinnitus is the perception of sound in the ear or head without an external source. It affects 15–20% of adults; in 2–3% it impacts quality of life. Most tinnitus accompanies underlying hearing loss (noise-induced, age-related, otosclerosis, acoustic neuroma). There is no "definitive cure", but habituation-focused therapies work: TRT (Tinnitus Retraining Therapy), sound enrichment (background sound, white noise), cognitive-behavioural therapy, acoustic devices. A hearing aid (if hearing loss is present) improves both hearing and tinnitus perception. Stress, sleep hygiene, and caffeine intake affect perception.
Diagnostic algorithm
Step one: history (onset, duration, unilateral or bilateral, accompanying hearing loss / vertigo / headache). Unilateral tinnitus + unilateral sensorineural hearing loss = MRI indication (rule out acoustic neuroma). Pulsatile tinnitus = workup for vascular malformation, glomus tumour, intracranial hypertension.
Standard additional tests: audiometry, tympanometry, OAE (otoacoustic emissions), and ABR (auditory brainstem response) if needed. History and exam are 80% sufficient for diagnosis; advanced testing is for selected cases.
Treatment options
TRT (Tinnitus Retraining Therapy): directive counselling + neutral background sound. Reduces conscious awareness; most patients achieve habituation by 12–24 months.
CBT (Cognitive Behavioural Therapy): reframes negative beliefs and catastrophic thoughts about tinnitus. Online CBT modules are effective.
Hearing aid: first choice when hearing loss accompanies tinnitus. Sound enrichment provides background sound; tinnitus perception lessens. Combined devices (hearing aid + tinnitus masker) help in selected cases.
For comorbid depression/anxiety, antidepressant therapy aids tinnitus management. Drugs like gabapentin, clonazepam may be tried in some cases; effect is limited.
Frequently Asked Questions
- Most patients' brains habituate to tinnitus and awareness diminishes. The process may take 6–24 months; active approach (TRT, sound enrichment) shortens it.
- This is expected. Low-level background sound (fan, white-noise app, aquarium sound) reduces awareness. If you don't prefer silent sleep, sleep-sound apps help.
- MRI is recommended with unilateral sensorineural hearing loss (rule out acoustic neuroma). With normal hearing and long-standing tinnitus, MRI decision is case-by-case.
- Occupational noise exposure worsens tinnitus. Wear noise-reducing earplugs to the extent practical + reduce workplace noise exposure. Annual audiometry follow-up advised.
- Stress amplifies tinnitus perception but does not cause it. Most tinnitus has underlying hearing loss; stress raises awareness.
References
Request a consultation
Reach us on WhatsApp with your questions or use the contact form.