Drugs

No specific drugs for treatment of chronic tinnitus that are both frequently effective and non-toxic have yet been developed, but research continues. On the other hand, sedatives, anxiolytics or anti-depressants are quite often needed for treating the background state of the patient. Such drugs without counselling are rarely going to be effective though.

Surgery

Surgery for tinnitus is never justified. It often exacerbates the condition. If you are in doubt, obtain a second or even a third opinion.

Hearing Aids

One of the first things to consider is whether to fit a hearing aid or aids, or improve or extend an existing fitting. Rather smaller than usual degrees of hearing loss can usefully be aided and thereby help the tinnitus also, especially if explained to the patient that it is a treatment for the tinnitus as well.

To this end, the patient's acoustic environment should also be enriched, particularly at the quietest times, by addition of background noise at a level that becomes clearly audible when amplified by the hearing aid. Where possible and appropriate, fittings should be non-occluding and binaural. Poor hearing-aid fittings can lead to frustration, loudness discomfort and anxiety, and thus are liable to make tinnitus worse.

'Maskers'

'Tinnitus maskers', in their original usage, have proved disappointing in perhaps half of those treated in this way. Moreover complete masking, better described as suppression, may inhibit the process of habituation.

Nevertheless, some patients still find a white noise generator (WNG) useful as a masker to provide temporary symptomatic relief, i.e. comfort while the masking effect is taking place.

Diet

Dietary regimes are occasionally helpful. This should start with careful questioning to detect possible tinnitogenic dietary components (e.g. caffeine), drinks or medication, and be followed by dietary exclusion trials to confirm or disprove the potential benefits for that individual. Do not become obsessed with diet. If you enjoy a particular food and you find it gives your tinnitus a temporary increase, IT IS JUST TEMPORARY! So enjoy that glass of red wine, that piece of chocolate or that coffee with the knowledge that your tinnitus will settle down in time - it is all about quality of life!

Hypnotherapy and Alternative Medicine

Hypnotherapeutic techniques can be of indirect help, by aiding relaxation. Methods of alternative medicine, including acupuncture and herbal preparations, only rarely seem to have any beneficial effect on tinnitus, but can be of worthwhile supportive value if the patient believes they are helping.

Tinnitus Retraining Therapy

Professor P. Jastreboff and Dr. J.Hazell developed Tinnitus Retraining Therapy (TRT). They believe that if a sensory system is repeatedly exposed to a non-threatening stimulus, the system will eventually habituate to it. There are two components to TRT:

• Providing counselling so that the patient is not afraid of the tinnitus, and
• Exposing the patient to low levels of background noise. It is believed that the low levels of background noise facilitate the habituation process.

This procedure is not without controversy. It has been widely criticised for its lack of supporting data, its apparent disregard of widely held psychological principles, and the manner in which it has been promoted.

Chasing cures

Chasing cures for tinnitus is counter-productive as it encourages you to focus on your tinnitus. There is no cure for tinnitus at this point in time. It is better to learn to manage it so that it has little or no effect on your quality of life.