Tinnitus Management with Hearing Aids

Patient Selection

The American Academy of Otolaryngology-Head and Neck Surgery recommends hearing aids for patients with hearing loss and persistent, bothersome tinnitus (≥6 months duration), as they improve quality of life and reduce tinnitus-related distress through amplification of external sounds 1, 2, 3
Patients must have persistent tinnitus, with symptoms present for ≥6 months, to distinguish those most likely to benefit from intervention 1, 3, 4
Tinnitus must be subjectively bothersome to the patient, warranting active management 1, 2, 3
Any degree of hearing loss qualifies, including mild unilateral sensorineural hearing loss, as even minimal hearing loss-associated tinnitus may benefit from amplification 1, 2, 3, 5

The American Academy of Otolaryngology-Head and Neck Surgery provides a formal recommendation (Grade C evidence, high confidence) that clinicians should recommend hearing aid evaluation for all patients meeting the above criteria 1, 2, 3, 5, 6, 4
Hearing aids improve function and quality of life by alleviating both hearing loss and tinnitus perception 1, 2, 3, 5, 6

Real-ear measures must confirm prescriptive targets are met to avoid under-amplification 7
Annual monitoring is required for adults, with self-assessment tools to determine impact on quality of life 8, 7

CROS/BiCROS systems may be considered for unilateral severe hearing loss 9, 10, 8
Bone-anchored devices may be considered for patients with severe-to-profound unilateral loss and normal contralateral hearing 9, 10
Cochlear implants may be considered when appropriately fit amplification fails and the "60/60" guideline is met (pure tone average ≥60 dB and word recognition ≤60%) 7
Cognitive-behavioral therapy should be recommended as it has RCT-level evidence for persistent, bothersome tinnitus 1, 2, 3, 5, 6, 4

Hearing aids are a management strategy, not curative treatment 1, 2, 3
Do not recommend medications, such as antidepressants, anticonvulsants, anxiolytics, or intratympanic medications, for primary tinnitus treatment (Grade B evidence against) 1, 2, 5, 6
Do not delay intervention, as waiting beyond 6 months provides no additional benefit and may defer helpful treatment 1, 3, 6, 4
Do not skip verification, as real-ear measurements are essential to identify under-amplification as a cause of treatment failure 7