Therapy and Treatment Options

Medications

There are currently no FDA-approved drugs specifically for tinnitus. However, there are pharmacological options to address the stress, anxiety, and depression that are caused by (and can sometimes exacerbate) tinnitus.

There are no medications that have been shown to reverse the neural hyperactivity that is thought to cause tinnitus. Drugs cannot cure tinnitus, but they may provide relief from the negative distress caused by severe tinnitus.

Patients should consult their healthcare providers for guidance on medications that may be appropriate for their situation. Not all drugs are effective or appropriate for all patients. Moreover, the introduction of any drug can result in undesired side effects and/or counteract existing prescription drug treatments.

Antidepressants and Antianxiety Drugs

The medications most often used in tinnitus management are psychoactive drugs that treat the behavioral issues related to tinnitus. These drugs can help relieve the stress, anxiety, and depression related to tinnitus, minimizing the psychological burden of the condition. Because there is a circular relationship between negative emotions and tinnitus (tinnitus causes anxiety, which makes tinnitus seem worse, which causes more anxiety...) psychoactive drugs may make tinnitus itself less noticeable for some patients.

Common antidepressant drugs used in relation to tinnitus include:

  • Clomipramine (Anafranil)
  • Desipramine (Norpramin)
  • Imipramine (Tofranil)
  • Nortriptyline (Pamelor)
  • Protriptyline (Vivactil)

Commonly used antianxiety medications include:

  • Alprazolam (Xanax)
  • Clonazepam (Klonopin)
  • Diazepam (Valium)
  • Lorazepam (Ativan)

Again, antidepressants and antianxiety drugs may help to alleviate the emotional and psychological burden of tinnitus for some patients, but they do not appear to impact tinnitus itself. Research shows very limited efficacy in patients without anxiety, depression, or obsessive-compulsive disorder.  Moreover, some research suggests that antidepressants and antianxiety medications may reduce neural plasticity, making it harder for patients to naturally habituate to tinnitus over time. However, for patients with significant behavioral issues, psychoactive drugs may provide beneficial relief.

Off-Label Medications

“Off-label” refers to any medication that is being used for a purpose other than what it has been approved for by the U.S. Food and Drug Administration (FDA). An array of drugs has been anecdotally used off-label for tinnitus relief. These include antihistamines, anticonvulsants, anesthetics, and even anti-alcohol drugs. However, there is very little scientific evidence illustrating that any of these medications provide measurable tinnitus improvement.

Over-the-Counter Drugs and Supplements

A number of over-the-counter substances (pills, powders, herbs, drops, etc.) are misleadingly marketed as “tinnitus remedies” and even "miracle cures." There is no reliable scientific evidence that these products — or the ingredients within them — have any impact on tinnitus. While there may be anecdotal success stories about these products, any reported improvements are likely due to a short-term placebo effect. Patients should beware of these products, as they are not fully regulated for safety by the FDA and have no scientifically measurable effect.

Drug Development

The search for a drug-based cure for tinnitus is one of the most robust areas of research, with several major biopharmaceutical firms investing heavily towards this goal. While this bodes well for new drug developments in the future, it is impossible to estimate if/when a broadly effective, patient-ready tinnitus medication will be available on the market.

Considerations

Side effects: Most prescription drugs include some possible undesirable side effects. Patients should work with their healthcare provider to determine whether the potential benefit of a drug outweighs the possible side effects.

Drug interactions: Some medications may counteract prescriptions the patient is taking for another medical condition. Patients should consult their healthcare provider to determine the best medication for their unique medical situation.

Reduced neural plasticity: Some psychoactive drugs may reduce the brain’s natural ability to adapt and change, making it more difficult for a patient to habituate (learn to ignore) the sound of their tinnitus.

Medical supervision: Psychoactive drugs are very powerful medications and should only be used under regular supervision from a trained healthcare professional. Patients should not start, stop, or modify their dosage or schedules without first consulting their healthcare provider.

References

Baldo, P., Doree, C., Molin, P., McFerran, D. and Cecco, S. (2012) “Antidepressants for Patients with Tinnitus.” Cochrane Database of Systematic Reviews, Issue 9. Art. No.: CD003853. DOI: 10.1002/14651858.CD003853.pub3.

Folmer, R.L., Theodoroff, S.M., Martin, W.H., Shi, Y. (2014) “Experimental, Controversial and Futuristic Treatments for Chronic Tinnitus.” Journal of the American Academy of Audiology, 25:106-125.

Hilton, M.P., Zimmermann, E.F. and Hunt, W.T. (2013) “Ginkgo Biloba for Tinnitus.” Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD003852. DOI: 10.1002/14651858.CD003852.pub3.

Hoekstra, C.E.L., Rynja, S.P., van Zanten, G.A. and Rovers, M.M. (2011)  “Anticonvulsants for Tinnitus.” Cochrane Database of Systematic Reviews, Issue 7. Art. No.: CD007960. DOI: 10.1002/14651858.CD007960.pub2.

Salvi, R., Lobarinas, E., and Sun, W. (2009) “Pharmacological Treatments for Tinnitus: New and Old.” Drugs of the Future, 34(5): 381–400.