Editing Tinnitus (section)

==Management==
If a specific underlying cause is determined, treating it may lead to improvements.<ref name="Baguley McFerran Hall 2013"/> Otherwise, the primary treatment for tinnitus is [[talk therapy]],<ref name=Lang2013/> [[sound therapy]], or [[hearing aid]]s. There are no effective drugs that treat tinnitus.<ref name="Baguley McFerran Hall 2013"/><ref>{{Cite web |date=20 March 2015 |title=Drug Therapies |url=https://www.ata.org/managing-your-tinnitus/treatment-options/drug-therapies |access-date=3 March 2022 |website=[[American Tinnitus Association]] |language=en |quote=There are presently no FDA-approved drugs specifically for tinnitus, and no medications that have been shown to reverse the neural hyperactivity at the root of tinnitus. Drugs cannot cure tinnitus, but they may provide relief from some severe tinnitus symptoms.}}</ref><ref>{{cite journal |last1=Kleinjung |first1=Tobias |last2=Langguth |first2=Berthold |title=Avenue for Future Tinnitus Treatments |journal=Otolaryngologic Clinics of North America |date=August 2020 |volume=53 |issue=4 |pages=667–683 |doi=10.1016/j.otc.2020.03.013 |pmid=32381341 |doi-access=free }}</ref>

===Psychological===
The best-supported treatment for tinnitus is [[cognitive behavioral therapy]] (CBT).<ref name=Lang2013/><ref name=":0" /><ref name=Hoarre2011/> It decreases the stress those with tinnitus feel.<ref>{{Cite journal |vauthors=Hesser H, Weise C, Zetterquist Westin V, Andersson G |title=A systematic review and meta-analysis of randomized controlled trials of cognitive–behavioral therapy for tinnitus distress |journal=Clinical Psychology Review |volume=31 |pages=545–553 |year=2011 |doi= 10.1016/j.cpr.2010.12.006 |pmid=21237544 |issue=4}}</ref> This appears to be independent of any effect on depression or anxiety.<ref name=Hoarre2011>{{Cite journal |vauthors=Hoare D, Kowalkowski V, Knag S, Hall D |title=Systematic review and meta-analyses of randomized controlled trials examining tinnitus management |journal=The Laryngoscope |volume=121 |issue=7 |pages=1555–1564 |year=2011 |doi= 10.1002/lary.21825 |pmid=21671234 |pmc=3477633}}</ref> [[Acceptance and commitment therapy]] (ACT) also shows promise in the treatment of tinnitus.<ref>{{cite journal |last1=Ost |first1=LG |title=The efficacy of Acceptance and Commitment Therapy: an updated systematic review and meta-analysis |journal=Behaviour Research and Therapy |date=October 2014 |volume=61 |pages=105–121 |pmid=25193001 |doi=10.1016/j.brat.2014.07.018}}</ref> [[Relaxation technique]]s may also help.<ref name="Baguley McFerran Hall 2013"/> A clinical protocol called Progressive Tinnitus Management has been developed by the [[United States Department of Veterans Affairs]].<ref>{{Cite web |vauthors=Henry J, Zaugg T, Myers P, Kendall C |title=Chapter 9 – Level 5 Individualized Support |work=Progressive Tinnitus Management: Clinical Handbook for Audiologists |publisher=US Department of Veterans Affairs, National Center for Rehabilitative Auditory Research |url=http://www.ncrar.research.va.gov/Education/Documents/TinnitusDocuments/Index.asp |year=2012 |access-date=20 December 2013 |url-status=live |archive-url=https://web.archive.org/web/20131220223240/http://www.ncrar.research.va.gov/Education/Documents/TinnitusDocuments/Index.asp |archive-date=20 December 2013 }}</ref>

===Sound-based interventions===
The application of [[sound therapy]] by either [[hearing aids]] or [[tinnitus masker]]s may help the brain ignore the specific tinnitus frequency. Although these methods are poorly supported by evidence, there are no negative effects.<ref name="Baguley McFerran Hall 2013"/><ref name="pmid24622861">{{cite journal | vauthors = Hoare DJ, Searchfield GD, El Refaie A, Henry JA | title = Sound therapy for tinnitus management: practicable options | journal = Journal of the American Academy of Audiology | volume = 25 | issue = 1 | pages = 62–75 | year = 2014 | pmid = 24622861 | doi = 10.3766/jaaa.25.1.5}}</ref><ref>{{cite journal |last1=Sereda |first1=Magdalena |last2=Xia |first2=Jun |last3=El Refaie |first3=Amr |last4=Hall |first4=Deborah A |last5=Hoare |first5=Derek J |title=Sound therapy (using amplification devices and/or sound generators) for tinnitus |journal=Cochrane Database of Systematic Reviews |date=27 December 2018 |volume=2018 |issue=12 |pages=CD013094 |doi=10.1002/14651858.CD013094.pub2 |pmid=30589445 |pmc=6517157 }}</ref> There are several approaches for tinnitus sound therapy. The first is sound modification to compensate for the individual's [[hearing loss]]. The second is tailored music therapy, notched at the tinnitus frequency, which may affect [[lateral inhibition]] of the notched neural region, suppressing tinnitus.<ref>{{cite journal |last1=Shore |first1=Susan E. |last2=Roberts |first2=Larry E. |last3=Langguth |first3=Berthold |title=Maladaptive plasticity in tinnitus – triggers, mechanisms and treatment |journal=Nature Reviews Neurology |date=March 2016 |volume=12 |issue=3 |pages=150–160 |doi=10.1038/nrneurol.2016.12 |pmid=26868680 |pmc=4895692 }}</ref><ref name="Hesse Doc04">{{cite journal |last1=Hesse |first1=Gerhard |title=Evidence and evidence gaps in tinnitus therapy |journal=GMS Current Topics in Otorhinolaryngology – Head and Neck Surgery; 15:Doc04 |date=15 December 2016 |volume=15 |pages=Doc04 |doi=10.3205/cto000131 |pmid=28025604 |pmc=5169077 }}</ref> 

There is some tentative evidence supporting [[tinnitus retraining therapy]], which aims to reduce tinnitus-related neuronal activity.<ref name="Baguley McFerran Hall 2013"/><ref name="pmid20238353">{{cite journal | vauthors = Phillips JS, McFerran D | title = Tinnitus Retraining Therapy (TRT) for tinnitus | journal = Cochrane Database of Systematic Reviews | issue = 3 | pages = CD007330 | year = 2010 | volume = 2010 | pmid = 20238353 | doi = 10.1002/14651858.CD007330.pub2 | pmc = 7209976 }}</ref><ref name="Hesse Doc04"/> An alternative tinnitus treatment uses mobile applications that include various methods including [[Tinnitus masking|masking]], sound therapy, and relaxation exercises.<ref>{{cite journal |last1=Casale |first1=Manuele |last2=Costantino |first2=Andrea |last3=Rinaldi |first3=Vittorio |last4=Forte |first4=Antonio |last5=Grimaldi |first5=Marta |last6=Sabatino |first6=Lorenzo |last7=Oliveto |first7=Giuseppe |last8=Aloise |first8=Fabio |last9=Pontari |first9=Domenico |last10=Salvinelli |first10=Fabrizio |title=Mobile applications in otolaryngology for patients: An update: Otolaryngology Apps for Patients |journal=Laryngoscope Investigative Otolaryngology |date=December 2018 |volume=3 |issue=6 |pages=434–438 |doi=10.1002/lio2.201 |pmid=30599026 |pmc=6302723 }}</ref><ref>{{cite journal |last1=Mosa |first1=Abu Saleh Mohammad |last2=Yoo |first2=Illhoi |last3=Sheets |first3=Lincoln |title=A Systematic Review of Healthcare Applications for Smartphones |journal=BMC Medical Informatics and Decision Making |date=December 2012 |volume=12 |issue=1 |pages=67 |doi=10.1186/1472-6947-12-67 |pmid=22781312 |pmc=3534499 |doi-access=free }}</ref> Such applications can work as a separate device or as a [[hearing aid]] control system.<ref>{{cite journal |last1=Kalle |first1=Sven |last2=Schlee |first2=Winfried |last3=Pryss |first3=Rüdiger C. |last4=Probst |first4=Thomas |last5=Reichert |first5=Manfred |last6=Langguth |first6=Berthold |last7=Spiliopoulou |first7=Myra |title=Review of Smart Services for Tinnitus Self-Help, Diagnostics and Treatments |journal=Frontiers in Neuroscience |date=20 August 2018 |volume=12 |pages=541 |doi=10.3389/fnins.2018.00541 |pmid=30177869 |pmc=6109754 |doi-access=free }}</ref>

[[Neuromonics]] is another sound-based intervention. Its protocol follows the principle of systematic desensitization and involves a structured rehabilitation program lasting 12 months. Neuromonics therapy employs customized sound signals delivered through a device worn by the patient, which aims to target the specific frequency range associated with their tinnitus perception.<ref>{{cite journal | last1=Hobson | first1=Jonathan | last2=Chisholm | first2=Edward | last3=El Refaie | first3=Amr | title=Sound therapy (masking) in the management of tinnitus in adults | journal=Cochrane Database of Systematic Reviews | date=2012-11-14 | volume=11 | issue=11 | pages=CD006371 | pmid=23152235 | pmc=7390392 | doi=10.1002/14651858.CD006371.pub3 | doi-access=free }}</ref>

=== Physical therapy ===
Physical therapy for tinnitus focuses on relaxing jaw and neck muscles that may contribute to symptoms. Muscle tension, particularly in the jaw muscles like the [[Masseter muscle|masseter]] and [[Medial pterygoid muscle|medial pterygoid]], can radiate to the ears, leading to '''somatic tinnitus'''. Specialized physical therapists use neuromuscular techniques to alleviate tension in these areas, which may reduce tinnitus intensity and associated pain in connected areas, such as the jaw, teeth, and ears.<ref>[https://doi.org/10.3390/jcm13123496 The Effect of Physical Therapy on Somatosensory Tinnitus]</ref>

===Medications===
{{As of|2018}} there were no medications effective for idiopathic tinnitus.<ref name="Baguley McFerran Hall 2013"/><ref name=CPG2014/><ref name="Bauer2018">{{cite journal |last1=Bauer |first1=CA |title=Tinnitus |journal=New England Journal of Medicine |date=March 2018 |volume=378 |issue=13 |pages=1224–1231 |doi=10.1056/NEJMcp1506631 |pmid=29601255}}</ref> There is not enough evidence to determine if [[antidepressant]]s<ref>{{cite journal |last=Baldo |first=P |author2=Doree, C |author3=Molin, P |author4=McFerran, D |author5= Cecco, S |title=Antidepressants for patients with tinnitus |journal=Cochrane Database of Systematic Reviews |date=12 September 2012 |volume=2012 |issue=9 |page=CD003853 |pmid=22972065 |doi=10.1002/14651858.CD003853.pub3|pmc=7156891 }}</ref> or [[acamprosate]] are useful.<ref>{{cite journal |last=Savage |first=J |author2=Cook, S |author3=Waddell, A |title=Tinnitus |journal=BMJ Clinical Evidence |date=12 November 2009 |volume=2009 |pmid=21726476 |pmc=2907768}}</ref> There are conflicting studies regarding the effectiveness of [[benzodiazepines]] for tinnitus.<ref name="Baguley McFerran Hall 2013"/><ref name="Bauer2018"/><ref name="Savage2014">{{cite journal |last1=Savage |first1=J |last2=Waddell |first2=A |title=Tinnitus |journal=BMJ Clinical Evidence |date=October 2014 |volume=2014 |pages=0506 |pmid=25328113 |pmc=4202663 }}</ref><ref name="pmid34205776">{{cite journal |vauthors=Kim SH, Kim D, Lee JM, Lee SK, Kang HJ, Yeo SG |title=Review of Pharmacotherapy for Tinnitus |journal=Healthcare |volume=9 |issue=6 |date=June 2021 |page=779 |pmid=34205776 |pmc=8235102 |doi=10.3390/healthcare9060779|doi-access=free }}</ref> The usefulness of [[melatonin]], as of 2015, is unclear.<ref>{{cite journal |last1=Miroddi |first1=M |last2=Bruno |first2=R |last3=Galletti |first3=F |last4=Calapai |first4=F |last5=Navarra |first5=M |last6=Gangemi |first6=S |last7=Calapai |first7=G |title=Clinical pharmacology of melatonin in the treatment of tinnitus: a review. |journal=European Journal of Clinical Pharmacology |date=March 2015 |volume=71 |issue=3 |pages=263–270 |doi=10.1007/s00228-015-1805-3 |pmid=25597877|s2cid=16466238 }}</ref> It is unclear if [[anticonvulsant]]s are useful for treating tinnitus.<ref name="Baguley McFerran Hall 2013"/><ref>{{cite journal |last1=Hoekstra |first1=Carlijn EL |last2=Rynja |first2=Sybren P |last3=van Zanten |first3=Gijsbert A |last4=Rovers |first4=Maroeska M |title=Anticonvulsants for tinnitus |journal=Cochrane Database of Systematic Reviews |date=6 July 2011 |volume=2011 |issue=7 |pages=CD007960 |doi=10.1002/14651858.CD007960.pub2 |pmid=21735419 |pmc=6599822 }}</ref> Steroid injections into the middle ear also do not seem to be effective.<ref>{{cite journal |last1=Pichora-Fuller |first1=M. Kathleen |last2=Santaguida |first2=Pasqualina |last3=Hammill |first3=Amanda |last4=Oremus |first4=Mark |last5=Westerberg |first5=Brian |last6=Ali |first6=Usman |last7=Patterson |first7=Christopher |last8=Raina |first8=Parminder |title=Evaluation and Treatment of Tinnitus: Comparative Effectiveness |journal=Comparative Effectiveness Reviews |series=AHRQ Comparative Effectiveness Reviews |issue=122 |date=2013 |url=https://www.ncbi.nlm.nih.gov/books/NBK158963/ |pmid=24049842 }}</ref><ref>{{cite journal |last1=Lavigne |first1=P |last2=Lavigne |first2=F |last3=Saliba |first3=I |author-link3=Issam Saliba |date=23 June 2015 |title=Intratympanic corticosteroids injections: a systematic review of literature |journal=European Archives of Oto-Rhino-Laryngology |volume=273 |issue=9 |pages=2271–2278 |doi=10.1007/s00405-015-3689-3 |pmid=26100030 |s2cid=36037973}}</ref> There is no evidence to suggest that the use of [[betahistine]] to treat tinnitus is effective.<ref>{{Cite journal|last1=Hall|first1=Deborah A|last2=Wegner|first2=Inge|last3=Smit|first3=Adriana Leni|last4=McFerran|first4=Don|last5=Stegeman|first5=Inge|date=2018|editor-last=Cochrane ENT Group|title=Betahistine for tinnitus|journal=Cochrane Database of Systematic Reviews|language=en|volume=12|issue=8|pages=CD013093|doi=10.1002/14651858.CD013093|pmid=30908589|pmc=6513648}}</ref>

[[Botulinum toxin]] injection has succeeded in some of the rare cases of objective tinnitus from a palatal tremor.<ref name="pmid27273401">{{cite journal | vauthors = Slengerik-Hansen J, Ovesen T | title = Botulinum Toxin Treatment of Objective Tinnitus Because of Essential Palatal Tremor: A Systematic Review | journal = Otology & Neurotology | volume = 37 | issue = 7 | pages = 820–828 | year = 2016 | pmid = 27273401 | doi = 10.1097/MAO.0000000000001090 | s2cid = 23675169 }}</ref>

[[Caroverine]] is used in a few countries to treat tinnitus.<ref name=Martindale36>{{cite book |editor1-last=Sweetman |editor1-first=Sean C. |title=Martindale |date=2009 |publisher=Pharmaceutical Press |isbn=978-0-85369-840-1 |page=2277 |edition= 36th}}</ref> The evidence for its usefulness is very weak.<ref name=Langguth2009>{{cite journal |last1=Langguth |first1=B |last2=Salvi |first2=R |last3=Elgoyhen |first3=AB |title=Emerging pharmacotherapy of tinnitus. |journal=Expert Opinion on Emerging Drugs |date=December 2009 |volume=14 |issue=4 |pages=687–702 |doi=10.1517/14728210903206975 |pmid=19712015 |pmc=2832848}}</ref>

===Neuromodulation===
In 2020, information about clinical trials indicated that bimodal neuromodulation may reduce the symptoms of tinnitus. It is a noninvasive technique that involves applying an electrical stimulus to the tongue while also administering sounds.<ref>{{cite journal |last1=Kwon |first1=Diana |title=New Tinnitus Treatment Alleviated Annoying Ringing in the Ears |journal=Scientific American |date=7 October 2020 |volume=2 |issue=6 |pages=None |url=https://www.scientificamerican.com/article/new-tinnitus-treatment-alleviates-annoying-ringing-in-the-ears1/ |publisher=Springer Nature America, Inc.|doi=10.1038/scientificamerican122020-2VzL6BO1nViUY4ozIqWxY8 }}</ref> Equipment associated with the treatments is available through physicians. Studies with it and similar devices continue in several research centers.{{citation needed|date=December 2020}}

In March 2023, the US [[Food and Drug Administration]] (FDA) approved Neuromod's Lenire device as a treatment option for tinnitus.<ref name="George 2023">{{cite web |last1=George |first1=Judy |title=First Bimodal Neuromodulation Device for Tinnitus Gets FDA Nod |website=MedPage Today |date=8 March 2023 |url=https://www.medpagetoday.com/surgery/otolaryngology/103453 |access-date=23 July 2024}}</ref><ref name="Everts 2023">{{cite web |last=Everts |first=Quinn |title=FDA Grants De Novo Approval to Non-Invasive Tinnitus Treatment Device |website=Drug Topics |date=14 March 2023 |url=https://www.drugtopics.com/view/fda-grants-de-novo-approval-to-non-invasive-tinnitus-treatment-device |access-date=23 July 2024}}</ref><ref name="Philpott 2024">{{cite web |last=Philpott |first=Jenna | title=Neuromod inks contract to treat US veterans with tinnitus device |website=Medical Device Network |date=18 June 2024 |url=https://www.medicaldevice-network.com/news/neuromod-inks-contract-to-treat-us-veterans-with-tinnitus-device/ |access-date=23 July 2024}}</ref> In June 2024, the US Department of Veterans Affairs (VA) announced it would begin offering the treatment to veterans with tinnitus, making it the first bimodal neuromodulation device to be awarded a Federal Supply Schedule (FSS) contract from the US Government.<ref name="Philpott 2024" />

Some evidence supports neuromodulation techniques such as [[transcranial magnetic stimulation]],<ref name="Baguley McFerran Hall 2013"/><ref>{{cite journal |last=Meng |first=Z |author2=Liu, S |author3=Zheng, Y |author4= Phillips, JS |title=Repetitive transcranial magnetic stimulation for tinnitus |journal=Cochrane Database of Systematic Reviews |date=5 October 2011 |issue=10 |pages=CD007946 |pmid=21975776 |doi=10.1002/14651858.CD007946.pub2}}</ref> [[transcranial direct current stimulation]], and [[neurofeedback]].{{cn|date=February 2025}}

===Alternative medicine===
''[[Ginkgo biloba]]'' does not appear to be effective.<ref name="Bauer2018"/><ref>{{cite journal |last=Hilton |first=MP |author2=Zimmermann, EF |author3=Hunt, WT |title=Ginkgo biloba for tinnitus |journal=Cochrane Database of Systematic Reviews |date=28 March 2013 |volume=2013 |issue=3 |pages=CD003852 |pmid=23543524 |doi=10.1002/14651858.CD003852.pub3|s2cid=205171459 |doi-access=free |pmc=11669941 }}</ref> The [[American Academy of Otolaryngology]] recommends against taking [[melatonin]] or [[zinc]] supplements to relieve symptoms of tinnitus, and reported that evidence for the efficacy of many dietary supplements (such as lipoflavonoids, garlic, traditional Chinese/Korean herbal medicine, honeybee larvae, and various other vitamins and minerals, as well as homeopathic preparations) did not exist.<ref name=CPG2014/> A 2016 Cochrane Review also concluded that evidence was not sufficient to support taking zinc supplements to reduce symptoms associated with tinnitus.<ref>{{Cite journal |last1=Person |first1=Osmar C |last2=Puga |first2=Maria ES |last3=da Silva |first3=Edina MK |last4=Torloni |first4=Maria R |date=23 November 2016 |title=Zinc supplements for tinnitus |journal=Cochrane Database of Systematic Reviews |volume=2016 |issue=11 |pages=CD009832 |doi=10.1002/14651858.cd009832.pub2 |pmid=27879981 |pmc=6464312 }}</ref>