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A variety of non-pharmacologic treatments are being evaluated to improve the symptoms of tinnitus. Tinnitus describes the perception of any sound in the ear in the absence of an external stimulus and is a malfunction in the processing of auditory signals. In the majority of cases, tinnitus is subjective, in that it can be heard only by the patient, and is frequently self-limited. A hearing impairment, often noise-induced or related to aging, may be associated with tinnitus.
Most patients habituate to tinnitus; however, others may seek medical care if the tinnitus becomes too disruptive. Treatment has focused on counseling or use of tinnitus maskers that produce a broad band of continuous external noise that diverts attention or masks the tinnitus. Transcutaneous electrical stimulation to the external ear, transmeatal low-power laser irradiation, electromagnetic energy, transcranial direct current stimulation, and transcranial magnetic stimulation have also been proposed for the treatment of tinnitus.
Tinnitus retraining focuses counseling and behavioral retraining on the associations induced by tinnitus perception. The goal is not to eliminate the tinnitus itself, but to retrain the subcortical and cortical centers involved in processing the tinnitus signals. As part of the overall therapy, maskers are used to induce habituation to the tinnitus. In contrast to the typical use of maskers, in retraining therapy, the masker is not intended to drown out or mask the tinnitus, but is set at a level such that the tinnitus can still be detected. This strategy is thought to enhance habituation by increasing the neuronal activity within the auditory system such that the tinnitus is difficult to detect.
NOTE: This policy does not address pharmacologic treatment of tinnitus (e.g., the use of neurotoxins, amitriptyline or other tricyclic antidepressants).
Treatment of tinnitus with any of the following is considered EXPERIMENTAL/INVESTIGATIVE due to the lack of clinical evidence demonstrating an impact on improved health outcomes:
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Acknowledgements:
CPT® codes copyright American Medical Association® 2022. All rights reserved.
CDT codes copyright American Dental Association® 2022. All rights reserved.