Table 1.
Evidence for several tinnitus treatments and recommendations of the various guidelines (listed in alphabetical order; modified from [36])
| Intervention | Source of evidence | Number of study participants | Efficacy (immediate) | Efficacy (long term) | Potential harm | US (2014) | European (2019) | NICE (2020) | German (2021) |
|---|---|---|---|---|---|---|---|---|---|
| Anticonvulsants | Cochrane [59] | 453 | Insufficient evidence | Not reported | Side effects reported in 18% of participants | Clinicians should not routinely recommend anticonvulsants for a primary indication of treating persistent, bothersome tinnitus (recommendation against) | Weak recommendation against pharmacological treatment | Not mentioned | Strong recommendation against pharmacological treatment |
| Antidepressants | Cochrane [60] | 610 | Insufficient evidence | Not reported | Side effects common | Clinicians should not routinely recommend antidepressants for a primary indication of treating persistent, bothersome tinnitus (recommendation against) | Weak recommendation against pharmacological treatment | Not mentioned | Strong recommendation against pharmacological treatment |
| Auditory training | Systematic review [48] | 269 | Available evidence of insufficient quality to make conclusion about efficacy | Not reported | Not reported | Not mentioned | Not mentioned | Not mentioned | Recommendation for auditory training |
| Betahistine | Cochrane [74] | 303 | No significant effects on tinnitus loudness or distress | Not reported | Side effects on placebo level | Not mentioned | Weak recommendation against pharmacological treatment | Do not offer betahistine to treat tinnitus | Strong recommendation against pharmacological treatment |
| Cochlear implant | Meta-analysis [75] | 674 | Tinnitus score (SMD: − 1.32) | Not reported | not reported | Not mentioned | No recommendation for cochlear implants | Not mentioned | Strong recommendation for cochlear implants in patients with tinnitus and severe hearing loss/deafness |
| Cognitive behavioral therapy | Cochrane [42] | 2733 |
Tinnitus severity (SMD): − 0.56 THI: − 10.91 |
No evidence due to lack of data | Adverse effects are rare | Clinicians should recommend CBT to patients with persistent, bothersome tinnitus (recommendation) | Strong recommendation for cognitive behavioral therapy |
If tinnitus is still causing an impact on emotional and social wellbeing, and day-to-day activities, consider a stepped approach as follows: 1. Digital tinnitus-related cognitive behavioral therapy (CBT) 2. Group-based tinnitus-related psychological interventions including mindfulness-based cognitive therapy, acceptance, and commitment therapy or CBT 3. Individual tinnitus-related CBT |
Strong recommendation for cognitive behavioral therapy |
| Dexamethasone (intratympanic administration) | Meta-analysis [76] | 220 | No significant effect compared with placebo | No significant effect compared with placebo | Complications such as hearing loss, eardrum perforation, and middle ear inflammation are rare | Clinicians should not routinely recommend intratympanic medications for a primary indication of treating persistent, bothersome tinnitus (recommendation against) | Weak recommendation against pharmacological treatment | Not mentioned | Strong recommendation against pharmacological treatment |
| Ginkgo biloba | Cochrane [58] | 1915 | Little to no effect at 3 to 6 months compared to placebo, but the evidence is very uncertain | Little to no effect at 3 to 6 months compared to placebo, but the evidence is very uncertain | Incidence of side effects, low | Clinicians should not recommend Ginkgo biloba, for treating patients with persistent, bothersome tinnitus (recommendation against) | Weak recommendation against pharmacological treatment | Not mentioned | Strong recommendation against pharmacological treatment |
| Hearing aid | Cochrane [47] | 590 | No significant effects on tinnitus loudness or distress | No data | Not reported | Clinicians should recommend a hearing aid evaluation for patients with hearing loss and persistent, bothersome tinnitus (recommendation) | Weak recommendation for hearing aids |
Offer amplification devices to people with tinnitus who have a hearing loss that affects their ability to communicate Consider amplification devices for people with tinnitus who have a hearing loss but do not have difficulties communicating Do not offer amplification devices to people with tinnitus but no hearing loss |
Recommendation for hearing aids in case of hearing loss |
| Hyperbaric oxygen | Cochrane [77, 78] | 392 | No significant improvements in tinnitus for chronic tinnitus | No significant improvements in tinnitus for chronic tinnitus | Not reported | Not mentioned | Not mentioned | Not mentioned | Not mentioned |
| Sound therapy | Cochrane [47] | 590 | No significant effects on tinnitus loudness or distress | No data | Not reported | Clinicians may recommend sound therapy to patients with persistent, bothersome tinnitus. (option) | No recommendation | Recommendation for research | Recommendation against sound generators, recommendation against specific sound therapies |
| Tinnitus retraining therapy | Meta-analysis [56] | 1345 | Significantly increased treatment response | Significantly increased treatment response | Not reported | Not mentioned | No recommendation | Not mentioned | Can be considered for long-term treatment |
| Transcranial direct current stimulation | Meta-analysis [79] | 1031 |
Loudness (SMD) − 0.35 Distress (SMD): − 0.5 |
Not reported | Not reported | Not mentioned | No recommendation for transcranial electrical stimulation | Recommendation for research | Recommendation against transcranial electrical stimulation |
| Transcranial magnetic stimulation | Meta-analysis [63, 80] | 945 | Tinnitus severity (SMD): − 0.45 | Tinnitus severity (SMD): − 0.42 | Not reported | Clinicians should not recommend TMS for the routine treatment of patients with persistent, bothersome tinnitus (recommendation against) | Recommendation against transcranial magnetic stimulation | Recommendation for research | Recommendation against transcranial magnetic stimulation |
| Zinc | Cochrane [81] | 209 | No evidence for improvement of tinnitus severity by oral zinc supplementation | No evidence for improvement of tinnitus severity by oral zinc supplementation | Not reported | Clinicians should not recommend zinc, for treating patients with persistent, bothersome tinnitus (recommendation against) | Weak recommendation against pharmacological treatment | Not mentioned | Strong recommendation against pharmacological treatment |