Treatment of Primary Tinnitus

Tinnitus affects an estimated 10% to 15% of people in the United States. At least 1 in 5 patients with chronic tinnitus will seek care. Tinnitus may be primary (without a clear cause) or secondary. Secondary tinnitus is most often due to a vascular or neuromuscular cause. Red flag symptoms that may prompt further evaluation with imaging include unilateral hearing loss, pulsatile tinnitus, or focal neurologic abnormalities.

If primary tinnitus does not bother the patient, no intervention is required. Treatment of tinnitus focuses on alleviating symptoms and patient distress. The Tinnitus Handicap Inventory or Tinnitus Questionnaire may be used to evaluate patient distress. Tinnitus may also be associated with other comorbidities such as sleep or mood disorders.

Cognitive behavior therapy (CBT) is the mainstay of treatment for primary tinnitus that causes patient distress, particularly for improving quality of life. In-person, individual CBT seems to be the most effective format compared with group or internet-based CBT. Educational counseling also improves outcomes in patients with tinnitus. Counseling recommends that patients avoid loud sound exposure and use hearing protection and shares information about the potential for improvement or resolution in patients and the potential for worsening symptoms in some patients. A 5-year study demonstrated resolution of tinnitus in nearly 20% of patients.

Primary tinnitus is associated with sensorineural hearing loss. Consultation with an audiologist may be considered for patients with tinnitus that is bothersome, chronic, or unilateral. Hearing aids and cochlear implants improve tinnitus outcomes in eligible patients. Sound therapy uses other sounds to mask tinnitus and may be helpful. There are no significant associated adverse effects. Tinnitus retraining therapy combines sound therapy with counseling.

Medications may help treat associated mood disorders in patients with primary tinnitus. Selective serotonin reuptake inhibitors and tricyclic antidepressants may improve mood symptoms and general disability. One pilot study of naltrexone 50 mg daily demonstrated promising results at reducing patient distress from tinnitus. Some medications may worsen tinnitus or have a low risk:benefit ratio. These include benzodiazepines (due to adverse effects and potential for abuse) and anticonvulsants (due to adverse effects).

Current treatments with limited evidence or insufficient evidence include transcranial magnetic stimulation, acupuncture, hyperbaric oxygen, and surgery (eg, microvascular decompression of the cranial nerve VIII).

The US Department of Veterans Affairs and US Department of Defense published a guideline for the management of tinnitus. A summary of the guideline may be found in the February 2026 AFP Practice Guidelines.