What kinds of treatments are available for tinnitus?

Older classical therapies are barely helpful in tinnitus treatment. Patients usually try these limited classical treatments and use different treatment options or drugs before consulting us. Almost no one could get a favorable result with these classical methods that have remained in the past. Classical methods can provide a success rate of just 1-5%.

From a general point of view, the scientific methods used for the treatment of tinnitus in the past and today are as follows:

• Hearing aids: (+ masking integration) It is usually useful for people with hearing loss accompanied by tinnitus. New generation hearing aids make it possible to hear and suppress the tinnitus.

• Drug Therapies: The classical drug treatments have lost their popularity. We use new drug therapy protocols for tinnitus. There are also some studies, which are still ongoing. At five different units, research studies are carried out with different molecules. The results of these studies are expected to be published 3-5 years later, at the earliest.

• Consultancy: It helps you learn how to live with tinnitus.

• Masking device: It is a small electronic device intended for masking the sound in tinnitus. The treatment is temporary, and sound reoccurs. With its masking feature, it can provide solution to tinnitus that accompanies hearing loss, within the scope of its only intended use.

• Sound producing devices: They are devices that help patients to sleep better. It is located near the bed and suppresses the tinnitus by producing sounds that give you pleasure, such as the sound of sea waves, waterfalls, rain or summer nights, which will give you pleasure. It is not curative. However, if the tinnitus is mild, it can help patients to fall into sleep.

• Acoustic neural stimulation: It is intended for desensitizing the ear by giving a signal called broadband acoustic signal. It is uses with headphones.

• Cognitive behavioral therapy (CBT): It is intended for reducing or correcting the negative response to tinnitus. It is also aimed to turn negative automatic thought into more positive and realistic thought. The aim is to reduce anxiety and depression to improve the general quality of life. In addition, many treatment procedures have been described, such as Mindfulness-Based Stress Reduction (MBSR), Acceptance and Commitment Therapy (ACT), Tinnitus Activities Treatment (TAT), Tinnitus Retraining Therapy (TRT) and Progressive Tinnitus Management (PTM).

These treatments may cover long periods. They may last for a period of up to 30 months. Working groups composed of very serious multidisciplinary physicians are needed. The patient should be long suffering and be able to follow the treatments on a regular basis. When the characteristics of the methods are considered, it can be said that the concepts of time and expectation may pose a problem in terms of the success in such teratments.

• Treatments that involve transtympanic inner ear injections: Cortisone injections into the ear have been commonly used for a time in the past. However, adequate success could not be achieved with such procedures, as well. Cortisone applied in fluid form flows through the eustachian tube (the ear canal) and drains into the nasal passage. Therefore, studies are ongoing for making cortisone in the gel form. It should be kept in mind that it can be a treatment that can be carried out usually in the first days of the sudden sensorineural hearing loss or Meniere's disease. It has almost no chance of success in the treatment of chronic tinnitus.

The medicine coded AM-101, programmed for use in the treatment of sudden sensorineural hearing loss and acute tinnitus, which is esketamine hydrochloride, i.e. an antagonist of N-Methyl-D-Aspartate (NMDA) receptor, is still in testing stage. In addition, it has been reported from Japan that there are new investigations on TrkB antagonist (7, 8 dihydroxyflavone) intended for cell regeneration.

• Deep Brain Stimulation (DBS): Deep Brain Stimulation (DBS) is a recognized clinical procedure for patients with Parkinson's disease, shivering problem, and other chronic medical conditions. It is based on the concept of stimulating the brain through electromagnetic energy. However, unlike rTMS and tDCS, DBS is an invasive procedure, in which electrodes are surgically placed (directly) into the brain. Most of the data on the efficacy of DBS come from mostly people who report that they have been treated for another condition (such as Parkinson), and that the treatment has only reduced tinnitus as an environmental benefit. Although DBS can be considered to be a treatment suitable for only tinnitus, researchers should well determine the boundaries of the electrodes—that will be placed for stimulation—in the brain. For this reason, it has yet to be used in the treatment of tinnitus. It is still an investigational treatment procedure. It has yet to come into routine use.

• Brain Surface Implants: Some researchers intend to use implants on the surface of the brain, i.e., electrodes surgically placed on the outside of the brain. As in other brain stimulation techniques, there are some hope-inspiring preliminary evidence about implants on the brain surface. However, more research is needed to identify the ideal electrode location in the brain. Moreover, this approach is complicated due to the significant risks associated with neurosurgery. It has yet to come into routine use.

• Vagus Nerve Stimulation (VNS): The vagus nerve passes through the neck and connects the brain to the heart and digestive system. The use of implanted electrodes for applying electrostimulation to the vagus nerve has been shown to be effective in the treatment of epilepsy and depression. Some researchers have reported that the same procedure could also be helpful for patients with tinnitus. Like other devices in the body, VNS carries the risks related to surgical implantation. It has been tried in only 11 people to date, and it is very expensive. Therefore, it is considered as the last resort.

• r-TMS (Repetitive Transcranial Magnetic Stimulation): It is one of the newest treatment procedures. This device has been commonly used in respected medical faculties in the world since 2011. Its new versions have been developed in the last two years, and it has consequently taken its final shape. We began to use the new generation r-TMS device and gained successful results in the treatment of tinnitus. With r-TMS devices, we can reach success rates up to 65-70%, depending on the causes of tinnitus. In Turkey, we carry out this treatment with a scientific point of view in the field of tinnitus treatment. Today, there is no treatment that provides a 100% solution in this regard. Successful results achieved with the treatments intended for tinnitus has increased significantly, by means of the new inventions and methods. Even this increase is considered to be a revolution in the treatment of tinnitus. Strong electromagnetic signals are known to reduce impaired neural hyperactivity. Tinnitus is believed to be a function of hyperactivity in the brain's neural cortex. Therefore, many researchers believe that this signal can reduce the sensation and severity of tinnitus.. Recurrent Transcranial Magnetic Stimulation uses a strong, noninvasive magnetic coil located on the skull, for transmitting electromagnetic vibrations to the underlying brain tissue. Treatment protocols including coil location, stimulation frequency, stimulation intensity, and the frequency of patient care are very important for ensuring the clinical efficacy of r-TMS. Therefore, ensuring the procedure to be carried out consciously by units composed of people who have full knowledge of the subject is important for gaining successful results.

• Transcranial Direct Current Stimulation (tDCS): Transcranial Direct Current Stimulation minimizes the neural hyperactivity that underlies the tinnitus. It is another form of non-invasive electromagnetic treatment. 
It is applied by means of electrodes that transmit electromagnetic pulses from the patient's scalp to the underlying brain tissue. The magnitude of the electrical stimulation varies depending on the neural stimulation under each electron. Successful results have been obtained from tDCS used in studies for the treatment of tinnitus. Some studies conducted in Texas (the US) and Australia have shown that patients have benefited from the treatment at the rate of up to 40-48%. This method will very soon come into use with other treatments in our clinic.