What To Tell Your Tinnitus Patients Who Want A Pill!

Although there is no clear evidence that there is a pill to treat tinnitus, this is what many sufferers want.1 Furthermore, some patients, who are sincere, report benefit. And…my impression is that a lot of health-care professions actually recommend a trial period. What to do?

First, it is important to appreciate the Dauman and Tyler Psychological Model of Tinnitus, distinguishing the tinnitus from the reactions. There are pills for anxiety and depression, and for sleep.2

Here I want to discuss an approach for supplements. I am not recommending supplements be suggested, as there is no evidence. I offer these comments to those clinicians who do choose to recommend supplements. And these suggestions should be offered only after a proper hearing and health care evaluation.

  1. Encourage them to seek counseling, hearing aids, and sound therapy.
  2. They might benefit from a self-help book.3
  3. Be clear that there is no evidence supporting their effectiveness.
  4. Make sure that they know and understand the side effects
  5. Make sure they understand the cost and the duration of the expected regime.
  6. Suggest they perform a single-subject study on themselves.
  7. It might also be helpful to educate their partners.4

The single-subject study on themselves
Tell them to change only one thing at a time. I usually use the example of coffee. If you think coffee is making your tinnitus worse, stop drinking coffee for 3 weeks; don’t change anything else in your life. If your tinnitus does not get any better, go back to drinking 5 cups of coffee a day! The duration of the trial might depend on the recommended duration of the trial with the particular supplement (and, of course, some might recommend a long trial so that the expense is greater)!

An addition to the single-subject design might be to do a “blinded” experiment.

The sufferer could enroll the help of a friend or partner.5 The experiment would then be, which of two different ‘pills’ is best? The sufferer takes one set of pills for the prescribed duration, and then the other set of pills for the same duration. The sufferer should not know (by size, colour, or labeling) which ones are for tinnitus and which ones are not (maybe vitamin pill). Before the trial begins and at the end of each week, the sufferer could rate the loudness of their tinnitus on a scale of 0 (the quietest tinnitus) to 100% (the loudest tinnitus) and using a questionnaire, such as the Tinnitus Primary Functions Questionnaire. At the end of the trial (after both sets of pills have been taken), and after the sufferers have decided if either was helpful or not, the friend or partner can disclose which was which.

Please keep in mind I am NOT recommended this. I am just trying to suggest a systematic approach.

Finally, I want to also emphasize, as I tell sufferers, “The more you are thinking about your tinnitus, the more you are thinking about your tinnitus!... And such a trial can also have a negative impacting on learning to accept and own your tinnitus.”

References

  1. Tyler RS. Patient preferences and willingness to pay for tinnitus treatments., J Am Acad Audiol 2012 February;23(2):115–25. PMID:22353680.
  2. Dauman R, Tyler RS. Some considerations on the classification of tinnitus, Kugler & Ghedini Publications; 1992.
  3. Tyler RS. (Ed). The Consumer Handbook on Tinnitus. Second Edition, Sedona, AZ: Auricle Ink Publishers; 2016.
  4. Tyler R, Ji H, Perreau H, Witt S, et al. Development and validation of the Tinnitus Primary Function Questionnaire. Am J Audiol 2014;23:260–72.
  5. Mancini PC, Tyler RS, Smith S, et al. Tinnitus: How Partners Can Help? Am J Audiol 2019;28:85–94.
About the author

Rich Tyler, PhD

Dr. Rich Tyler was trained as a clinical audiologist at The University of Western Ontario and then completed a PhD in Psychoacoustics and The University of Iowa. He worked initially at the Institute of Hearing Research in the United Kingdom and is currently a Professor in both the Department of Otolaryngology - Head & Neck Surgery and in the Department of Communication Sciences and Disorders at the University of Iowa.  Rich sees patients weekly, and hosts an annual Tinnitus Treatment Workshop every June.