Tinnitus: noninvasive, nonpharmacologic treatments

Policy context

Tinnitus is the perception of noise or ringing in the ears. There are a variety of potential nondrug treatments for the condition, but the long and short-term effectiveness of these treatments is not certain. Treatments to be considered include tinnitus retraining therapy (TRT), tinnitus feedback therapy (TFT), and other combinations of noise-masking and cognitive therapy. This topic is proposed based on concerns related to the safety, efficacy, and value of the test.

Primary criteria ranking

• Safety = Medium
• Efficacy = High
• Cost = High

Documents

• Draft key questions: comment and response 
• Final key questions 
• Final evidence report 
• Addendum: state agency utilization data 
• Final findings and decision 

Background

Tinnitus, the conscious perception of sound in the absence of an external source, is a common medical symptom (not a disease). The experience of tinnitus is very heterogeneous in terms of the type (e.g., ringing, buzzing, hissing, music), intensity (e.g., pulsatile or rhythmical), frequency (e.g., constant or intermittent), and location (e.g., one or both ears) of the perceived sound. There are two main types of tinnitus: objective and subjective. In objective tinnitus, which is very rare (<1% of tinnitus cases), the sounds have an origin within the patient’s body and are perceived by both the patient and examiner. In subjective tinnitus, the sounds are perceived by only the patient, are not associated with an underlying condition that might explain the sound, and can be associated with hearing loss. This common experience of tinnitus is usually described as sensorineural (i.e., tinnitus with a neurophysiologic origin) and can result in comorbidities that include depression, anxiety, and sleep disturbance, all of which may negatively impact a patient’s overall quality of life. Risk factors for tinnitus include hearing loss, noise exposure, and age; obesity, smoking status, alcohol use, head injuries, and hypertension have also been identified as possible risk factors.

There is currently no cure for tinnitus that is not otherwise caused by an underlying anatomical condition (e.g., tumors of the head and neck, temporomandibular joint dysfunction) and because tinnitus can be chronic, treatment is focused on both the tinnitus and associated comorbidities that affect a patient’s quality of life. There are no pharmacologic treatments for the primary indication of tinnitus that are approved by the US Food and Drug Administration. Nonpharmacologic, noninvasive treatments of tinnitus include sound therapies that mask the tinnitus sounds, neuromodulation techniques that may habituate the patient to the tinnitus sounds, or psychological and behavioral therapies that help the patient cope with or reduce the distress from tinnitus.