Table 3.

Tinnitus guideline recommendations regarding treatments for tinnitus.

Country	Medicine	Audiological	Psychological	Sound therapies	Other	Treatments recommended against using
Germany	None for tinnitus but refers to, for example, some for co-morbid depression, e.g., glutamate-antagonists.	Hearing aids for patients with hearing loss; Cochlear Implants for patients with deafness.	General counseling (including information provision). Tinnitus specific CBT (aimed at reducing attention focusing toward the ear noise, reappraisal of the tinnitus and its consequences) individual or group-settings, also treatment for comorbidities. Hospital treatment for decompensated tinnitus and/or with severe psychiatric comorbidity. An absence of conclusive evidence of effectiveness for self-help groups.	Audio therapy including “notched music,” “coordinated reset” or music therapy.	Absence of evidence of effectiveness for: acupuncture, cervical vertebral spine therapy/physiotherapy, hyperbaric oxygen; and, electric stimulation (e.g., transcutaneous electric stimulation, ear and cervical spine; vagus stimulation); Acoustic Coordinated-Reset Neuromodulation. Uncertain recommendation for rTMS.	Sound therapy including Noiser and TRT. Hearing aids for patients with only tinnitus. Medicines (including: steroids, melatonin, antidepressants, Sulpirid, Apraxolam, Sertraline, Botox A, Pramiprexol, Nortriptyline, Piribedil, Vardenafil, Trazodone, Atorvastatin, Gabapentin, anticonvulsants, Paroxetine, Lamotrigine, Cyclandelat, Baclofen, Nicotinamide, Tocainid, Misoprostol, Egb 761, Amitriptyline, Misoprostol, Pramipexole Dopamine. Herbal medicines and vitamins (including Ginkgo biloba zinc).
Netherlands	None	Consider a trial of hearing aids. In patients with high TQ (>60) or THI (>78) scores, and have severe hearing loss or deafness and have not responded to CBT, consider Cochlear Implant.	Educational material about tinnitus and treatment options considered essential. Specialised CBT for patients with TQ > 30 or THI > 36.	TRT can only be contemplated in case tinnitus is very mild (TQ <30) and the patients specifically asks for TRT.	None	rTMS. TDCS. Gingko biloba. Acupuncture. Auditive perceptual training. Hyperbaric oxygen.
Sweden	None for tinnitus specifically but does state that if necessary, sleeping pills or antidepressants, can be used to treat sleep disorders or depression (no drug types, names, or dosage provided).	For people with tinnitus and hearing loss hearing aids are fitted.	Individual or group tinnitus information meetings. For patients without hearing loss, this is based on a modified version of TRT protocol. There is reference to CBT in case of stress/anxiety/depression, but no clear recommendation.	Sound stimulation as part of TRT for people without hearing loss.	For middle ear dysfunctions such as otosclerosis, surgery is possible – no clear recommendation is provided. For tensions or pain in the jaw, neck, shoulders or back, referral to “bite” therapist, or physiotherapist.	None
USA	None	Clinicians should recommend a hearing aid evaluation for patients with hearing loss and persistent, bothersome tinnitus.	Clinicians should educate patients with persistent, bothersome tinnitus about management strategies. Clinicians should recommend cognitive behavior therapy to patients with persistent, bothersome tinnitus.	Clinicians may recommend sound therapy (e.g., TMT, TRT) to patients with persistent, bothersome tinnitus but patients must be informed of potential outcomes as well as costs associated with sound therapy.	No recommendation can be made regarding the effect of acupuncture in patients with persistent bothersome tinnitus based on the poor quality of trials, no benefit, and minimal harm.	Clinicians should not routinely recommend: Medicine (including antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for a primary indication of treating persistent, bothersome tinnitus. Dietary supplements and herbal medicines (e.g., Ginkgo biloba, melatonin, zinc). TMS.

CBT, Cognitive behavioral therapy; NS, not specified; rTMS, repetitive Transcranial magnetic stimulation; TCDS, Transcranial direct stimulation; THI, Tinnitus handicap inventory; TMS, Transcranial magnetic stimulation; TMT, Tinnitus management therapy; TQ, Tinnitus questionnaire; TRT, Tinnitus retraining therapy.