Patients with tinnitus hear sounds in their ears when there isn’t any external source. The type of sound heard varies based on the cause of the tinnitus, including clicking, ringing, humming, hissing, or buzzing.
Tinnitus is more of a symptom than a standalone health condition. The ringing in the ear isn’t the exact problem; it signifies that something else is wrong.
The tinnitus’s severity and whether it is temporary or permanent depends on its root cause. When the root cause is identified and handled, the tinnitus will disappear. An audiological exam can often identify the cause of tinnitus.
Common Causes of Tinnitus
Since tinnitus treatment is heavily dependent on identifying the root cause of the tinnitus noise, let's examine some common causes of tinnitus.
1. Exposure to Loud Noise
Exposure to loud noise is a major cause of tinnitus. Sudden or consistent exposure to loud noises can damage your eardrum or the hairs in your inner ear.
These hair cells can either be bent or broken. If they’re bent, the tinnitus will be temporary; once they straighten, the ringing will disappear. However, if they’re damaged, the tinnitus will be permanent because there’s no way to restore damaged hair cells.
2. Earwax Blockage
The accumulation of cerumen or earwax in your ear can block your ear canal, causing tinnitus. If your body produces excess earwax over time, the wax will solidify and form a lump that blocks the ear.
Attempting to clean your ear at home using objects like cotton buds can push the earwax deeper into the ear and affect the flow of sound signals into the inner ear, which results in tinnitus.
In most cases, the tinnitus will disappear after removing the excess wax. Doctors are the only ones who should perform earwax removal.
Aging can cause tinnitus, which often degenerates to hearing loss.
The older you get, the more different body parts like the ears begin to wear out. This wearing out is more pronounced if you’ve been exposed to loud noises over the years. There’s very little that you can do to handle age-based tinnitus.
4. Tumors or Trauma
Benign, non-cancerous ear tumors can affect ear function. In some cases, lumps form in blood vessels close to the ear. This reduces the pathway for blood flow in the affected blood vessel.
To ensure that blood still flows through the blood vessels, blood flow pressure increases. This increase in blood pressure can cause tinnitus.
Similarly, trauma to the head caused by a punch, kick, or blow can cause tinnitus.
Various diseases like autoimmune inner ear disease and Meniere's disease can cause tinnitus.
For instance, autoimmune inner ear disease makes the body attack your internal ear structures, especially inner ear hair cells. If it’s not given prompt medical attention, the condition can permanently damage all the hair cells.
6. Ototoxic Medications
Ototoxic medications treat various health conditions, but they can have ear-related side effects. Many over-the-counter drugs are ototoxic.
Common examples are antimalarial drugs, Aminoglycoside antibiotics, anti-inflammatory medications, painkillers like ibuprofen and aspirin, and cancer chemotherapy drugs.
Discontinuing the medication can cure tinnitus caused by ototoxic medications.
Why Is It Hard to Find Tinnitus Medications?
Tinnitus is one of the few health conditions that has given doctors, pharmacists, and health care professionals a hard time. Despite how long tinnitus has been around and its prevalence, there’s still no FDA-approved drug to treat tinnitus.
Several factors cause difficulty in finding an appropriate medication for tinnitus. Let's examine them.
1. A Limited Understanding of the Biological Basis of Tinnitus
Healthcare professionals don’t fully understand the mechanism behind tinnitus. We don’t know much about tinnitus beyond its clinical presentation and description.
Until the underlying mechanism behind tinnitus is understood, healthcare professionals can’t develop therapies or medications targeted explicitly at curing tinnitus.
2. The Heterogeneity of the Tinnitus Population
Heterogeneous means unlike, distinct, or different from each other. The tinnitus population’s heterogeneity means that the samples, symptoms, causes, or etiology are different.
No two tinnitus cases are alike. The cause of tinnitus in patient A may be different from the cause of tinnitus in patient B. In the same manner, the severity of the ringing in the ear differs from person to person.
The tinnitus population’s heterogeneity makes it hard to produce a one-size-fits-all medication. For instance, if scientists produce a medication to cure tinnitus caused by autoimmune inner ear disease, it will not cure tinnitus caused by earwax blockage or tumors.
3. Cost of Production
While this may like an odd obstacle to tinnitus medication development, it’s an important reason there’s no tinnitus drug. The cost associated with developing drugs to treat tinnitus is explicitly high.
This is partly due to the extensive research and test that development requires. Because tinnitus’s causes are different, scientists will have to research each cause independently.
Unifying the cures for each independent cause to form a single medication will be no small feat, and it’ll require lots of funds.
4. The Wide Range of Tinnitus Causes
As noted above, the range of medical conditions responsible for tinnitus is so wide that it will be very difficult to create a specific medication to cure it.
Considering that the causes of tinnitus are both external and internal, a drug may effectively combat some internal causes like an autoimmune disease. Still, external factors like sudden exposure to loud noise may be beyond the drug’s control.
5. Lack of an Accepted Tinnitus Nosology
Nosology is the classification of diseases. For a disease to be classified, you need to identify one singular cause, its symptoms, and its effect on the body.
Nosology makes nosography possible. Nosography is a description that allows a diagnostic label to be given to a situation.
Because tinnitus has multiple causes, different symptoms, and varying effects on people, it’s hard to adopt an accepted tinnitus nosology.
Doctors can’t put a diagnostic label on tinnitus in the absence of nosology, so they can’t create a medication.
Tinnitus Medication Options
Even though there has been no specific tinnitus medication, doctors have studied drugs developed for other health conditions to determine whether they can relieve tinnitus symptoms.
In this section, we will examine some drugs that doctors prescribe to relieve tinnitus. Notice that we said to relieve, not cure. These drugs will reduce the severity of the ringing and give you relief, but they will not permanently resolve your tinnitus.
Hopefully, you’ll be able to go about your daily activities without much difficulty when taking these drugs.
If an ear infection caused your tinnitus, antibiotics could treat it. You don’t take antibiotics to cure the tinnitus; rather, they treat the ear infection responsible for the tinnitus. The most common antibiotic given for ear infections is amoxicillin.
The tinnitus will stop after treating the ear infection. You may experience some side effects like indigestion, nausea, or vomiting when taking the drug.
In clinical studies by the National Institute of Health, there was inconclusive evidence that tricyclic antidepressants are an effective tinnitus treatment.
The 2006 study indicated some positive effects in one group that received a selective serotonin reuptake inhibitor (SSRI), which “merits further investigation.”
Another piece of research by Robert A Dobie found that tricyclic antidepressants reduce complaints of tinnitus in comparison with the placebo group in patients with severe tinnitus caused by depression or other disorders.
For most cases of tinnitus, antidepressants may not be an effective treatment. However, they may help with symptoms in certain cases.
Unfortunately, the side effects of these medications may be harsh, affecting the quality of life as much as or more than the normal symptoms of tinnitus.
According to the American Tinnitus Association, a few common antidepressants used to treat tinnitus include:
Misoprostol treats stomach ulcers in hypertensive and diabetic patients. It also may relieve tinnitus symptoms. Some studies have shown that Misoprostol reduces the loudness of tinnitus.
It’s often prescribed for chronic tinnitus, especially for people with hypertension and diabetes. However, large studies have not been conducted to discover whether Misoprostol should be recommended for tinnitus treatment, and the FDA hasn’t approved it for tinnitus treatments.
Side effects of using Misoprostol include stomach upset, diarrhea, gas, stomach pain, and nausea.
Lidocaine is a local anesthetic used to treat abnormal heart rhythms. Studies have shown that lidocaine can help manage tinnitus, especially in cases caused by diseases that affect the inner ear hair cells.
For lidocaine to be effective, it must be given intravenously or injected directly into the labyrinth through the middle ear.
The side effects of lidocaine often outweigh its potency in reducing tinnitus severity, so it isn’t recommended.
Dexamethasone is a steroid used to treat tinnitus caused by Meniere's disease, hearing loss, or autoimmune inner ear disease.
Dexamethasone for tinnitus is intratympanic. An ear surgeon administers an intratympanic injection during an in-office, awake surgical procedure.
The surgeon passes a long narrow bore needle through the ear canal and the eardrum into the middle ear. They inject the dexamethasone into the space in the middle ear, where the inner ear absorbs it.
While dexamethasone may not totally eliminate tinnitus, it relieves the symptoms and enables people with tinnitus to carry out daily activities without difficulty.
Campral is also known as Acamprosate, and it’s used to treat alcoholism. Several studies have suggested that Campral is effective in reducing the severity of tinnitus. This is especially true for tinnitus related to increased excitatory spontaneous brain activities.
Acamprosate helps restore the inhibitory/excitatory balance in the brain, thereby reducing tinnitus severity. Campral is also linked to the electrophysiological improvement of the distal portion of the auditory nerve and the cochlear.
The FDA hasn’t approved Campral, but some doctors prescribe it to tinnitus patients. Side effects of Campral include diarrhea, nausea, and vomiting.
7. Anti-Anxiety Medications
Anti-anxiety medications have been used to help manage tinnitus’s effects of tinnitus but haven’t been shown to treat tinnitus itself.
According to the American Tinnitus Association, research has shown “very limited efficacy in patients without depression, anxiety or obsessive-compulsive disorder.”
Like tricyclic antidepressants, these medications are more impactful for those with tinnitus caused by mental or depressive disorders.
According to the Mayo Clinic, anti-anxiety medications used for tinnitus aren’t without their slate of side effects and can be habit-forming.
The American Tinnitus Association says you might use these anti-anxiety medications to treat tinnitus:
8. Off-label Medications
Off-label medications are used for purposes that they weren’t originally intended for (or approved for by the FDA). Many off-label medications are used to relieve tinnitus symptoms, but these have not been scientifically proven to relieve tinnitus symptoms. Some off-label medicines used to treat tinnitus are anticonvulsants and antihistamines.
Side Effects of Tinnitus Medications
Most of the medications used to treat tinnitus have side effects. Common side effects are dry mouth, fatigue, nausea, memory impairment, and vomiting.
It’s important to take these drugs under the supervision of a healthcare professional.
In some cases, the side effects far outweigh the medication’s benefits. For instance, psychoactive tinnitus medications reduce the brain's ability to change and adapt. This can make it difficult for the patient to ignore tinnitus noise, actually exacerbating their condition instead of managing it.
Some of these medications may also counteract other medications that a tinnitus patient takes to manage other conditions.
There’s no FDA-approved drug to treat tinnitus, but there may be a few medications that can help manage its symptoms. Tinnitus medications are generally used to help people experiencing tinnitus caused by a mental or depressive disorder.
Considering the side effects of some of these medications, it’s advised that you only take them when prescribed by your doctor. You must ensure that you only take the dosage prescribed by your doctor.
Aside from these medications, other tinnitus treatments can relieve tinnitus symptoms, such as masking using hearing aids. Your doctor will help you identify which of these other tinnitus treatments you should use.
If you think you have tinnitus, you should consult an Ear, Nose, and Throat doctor and an audiologist to be diagnosed.
“Often the treatment for tinnitus works. Patients are some of the most grateful ones I have had over the years.” - Drew Sutton, MD, Board-Certified Otolaryngologist.
What Is Ménière's Disease? — Diagnosis and Treatment | NIDCD
Antidepressants for patients with tinnitus | NCBI