The consequences of tinnitus (tin) range from nuisance distraction to catastrophic. Some individuals quickly learn to ignore the spontaneous auditory sensations, but others are plagued with relentless awareness of competing, sometimes noxious sounds. The unfortunate “bottom line” conclusion of the authors of this article is that there are no proven effective pharmacotherapeutic treatments for TIN. Since epidemiologic surveys in Europe and North America conclude that TIN may affect as many as 10% of adults, there is a compelling need to identify effective interventions.

There is no test that proves the diagnosis of TIN. Rather, it is a subjective report. Investigation for CNS pathology (MRI) is suggested when TIN is not symmetric in both ears, when audiometry indicates unilateral abnormality, if there is asymmetric hearing loss, or if there are positive neurologic findings. One special group — patients with TIN that is pulsatile and synchronous with heartbeat — requires even more detailed investigation.

TIN is associated with depression and anxiety, each of which potentially merits treatment in its own right. Treatment specific to TIN is generally based on sound generators, of which there are a great variety, and for which outcome data are sparse.

Uncommonly, TIN may be remedied when it is associated with an ototoxic medication or simple mechanical cerumen impaction. Some patients report meaningful benefits from the combination of sound-generation devices and cognitive behavioral therapy. Evolving treatments that involve magnetic brain stimulation show some promise. Highly effective treatments to reduce or resolve TIN remain elusive.