Which evidence-based treatments do audiologists recommend for chronic tinnitus?
Executive summary
Chronic tinnitus is managed most reliably by non-pharmacological, individualized interventions: audiologists commonly recommend hearing correction (including hearing aids), sound therapy/masking, structured counseling and tinnitus retraining, and cognitive behavioral therapy to reduce distress and improve habituation [1] [2] [3]. Emerging neuromodulation devices such as bimodal stimulation (Lenire) and experimental brain‑stimulation techniques show promise but remain adjunctive and subject to ongoing evaluation [4] [1] [5].
1. Hearing correction and sound enrichment: make the ears do the work
When tinnitus coexists with hearing loss, fitting hearing aids is a frontline, evidence‑based recommendation because increased external sound input can reduce perception and distress from tinnitus by enriching auditory input and diverting attention [6] [1]. Audiologists also deploy dedicated sound generators and maskers—steady or tailored sounds presented to the ear—to provide relief, especially in quiet environments or at night; major specialty guidance endorses sound therapy as a reasonable option, though its effectiveness as a sole therapy is variably supported [2] [1].
2. Cognitive behavioral therapy: change the response, not the noise
Cognitive behavioral therapy (CBT) is an established, evidence‑based approach to reduce the emotional and functional impact of chronic tinnitus by addressing maladaptive thoughts, anxiety and sleep disturbance; audiology programs increasingly collaborate with CBT providers and deliver internet‑based CBT to extend access [3] [1]. Multiple reviews and clinical practice resources emphasize CBT for tinnitus distress because it improves quality of life even when the phantom sound persists [1] [7].
3. Counseling and tinnitus retraining therapy: structured habituation
Directed counseling—education about tinnitus mechanisms, realistic expectations, and strategies to avoid sensitization—is a foundational step in audiologic care and is embedded in tinnitus retraining therapy (TRT), which pairs counseling with sound enrichment to promote habituation; systematic guidance recommends a stepwise, individualized plan that begins with diagnosis and counseling [2] [1] [7]. TRT outcomes vary across studies, but its core principle—reducing fear and attention toward tinnitus—aligns with multidisciplinary consensus [1].
4. Neuromodulation and other emerging therapies: promising but not universal
New modalities that target central auditory processing—repetitive transcranial magnetic stimulation (rTMS), electrical stimulation, and bimodal neuromodulation combining sound with tongue or somatosensory stimulation—have yielded encouraging results in trials and clinical series; the Lenire device, for example, is FDA‑cleared and real‑world chart reviews report high responder rates, yet these therapies are still being defined for who benefits most and how durable effects are [4] [1] [5]. Expert reviews frame these as emerging options rather than replacements for established management, and national associations urge cautious, individualized use [1] [5].
5. Pharmacology and supplements: largely unsupported
Clinical guidelines and systematic reviews find insufficient evidence to support routine drug treatment for chronic tinnitus and specifically advise against recommending many agents and supplements—including betahistine, Ginkgo biloba, antidepressants as tinnitus cures, benzodiazepines, zinc, melatonin, cannabis, oxytocin, steroids and gabapentin—because trials have failed to show consistent benefit for tinnitus itself [8]. Dietary changes or supplements may help a subset of individuals, but professional guidance warns these are not primary treatments for most patients [8].
6. Individualized, stepwise care and current gaps
Leading reviews stress that management should be tailored: assess chronicity, laterality, hearing status and the degree of bother to guide whether audiologic interventions, CBT referral, neuromodulation trials or medical workup are appropriate, and clinicians should avoid over‑medicalizing benign tinnitus to prevent unnecessary sensitization [2] [7] [1]. Major gaps remain—no single cure exists for all patients, many interventions yield variable benefit across populations, and research continues to refine predictors of response and long‑term outcomes [1] [7].
7. Bottom line
Audiologists recommend a multimodal, evidence‑based strategy for chronic tinnitus: correctable hearing loss should be treated with hearing aids and sound enrichment; counseling and habituation approaches (TRT) plus CBT address distress and functioning; emerging neuromodulation offers additional options for selected patients; and routine pharmacologic or supplement treatments are not supported by current guideline evidence [6] [2] [3] [4] [8].