Tinnitus treatments compared

Changes the relationship with the sound rather than the sound itself. The most consistently supported approach for tinnitus distress.

Evidence: Multiple systematic reviews and meta-analyses of randomised trials, including a network meta-analysis

Worth knowing: Does not reduce loudness. People sometimes read a strong evidence rating as meaning the tinnitus will get quieter; it means daily life gets easier.

Acceptance-based approaches. In one head-to-head trial, ACT outperformed tinnitus retraining therapy on distress.

Evidence: Systematic review and meta-analysis, plus a head-to-head randomised trial against TRT

Worth knowing: A smaller literature than CBT, with fewer replications behind it.

Counselling combined with low-level sound, aimed at habituation over months rather than weeks.

Evidence: Systematic reviews, with methodological limitations noted in the guideline literature

Worth knowing: Trial quality is uneven and protocols vary between clinics, which makes results harder to compare than the volume of literature suggests.

Background sound to reduce the contrast between tinnitus and silence. Widely used, low risk, easy to try.

Evidence: Guideline support and controlled trials, with mixed results for specific variants

Worth knowing: Evidence is strongest for coping and sleep, weakest for changing the tinnitus itself. Notched-sound variants have produced mixed results in larger analyses.

For the substantial share of people whose tinnitus comes with hearing loss, amplification is often the single most effective option available.

Evidence: Multicentre clinical studies and guideline support; fewer large randomised trials than the clinical consensus implies

Worth knowing: Only relevant where hearing loss is present. Benefit varies considerably between individuals.

In people implanted for severe hearing loss, tinnitus in the implanted ear often reduces substantially.

Evidence: Clinical studies in single-sided deafness populations

Worth knowing: Applies only to people who already meet the criteria for implantation. It is not a tinnitus treatment on its own terms.

Pairs sound with mild tongue stimulation. FDA-approved, with some of the largest trials in the field.

Evidence: Multi-site pivotal trials and clinical-practice data

Worth knowing: Much of the trial work is associated with the manufacturer, and independent replication at comparable scale is limited. Cost is significant.

Magnetic pulses aimed at brain regions associated with tinnitus.

Evidence: Meta-analyses with inconsistent findings and acknowledged unresolved methodological issues

Worth knowing: Short-term effects look more promising than long-term ones, and protocols differ widely between studies.

One of the most commonly tried alternative approaches for tinnitus.

Evidence: Many trials, systematically reviewed, with persistent quality and blinding problems

Worth knowing: Despite dozens of trials, methodological weaknesses mean the literature has not settled the question either way.

Better trial data than most tinnitus supplements, particularly where poor sleep is part of the picture.

Evidence: Randomised trials, including a comparison against sertraline

Worth knowing: Benefit appears tied to improving sleep rather than acting on tinnitus directly.

Widely sold for tinnitus. There is some real research, mostly small and often in people who were deficient.

Evidence: Small studies, some showing effects in deficient populations

Worth knowing: The evidence is considerably weaker than the marketing implies, and does not support routine supplementation.

Pairs nerve stimulation with tones, on the theory that this drives targeted plasticity.

Evidence: Early-stage trials and mechanistic work

Worth knowing: Still exploratory as a standalone treatment. Most of the practical development has gone into bimodal devices instead.

Training aimed at altering the brain activity patterns associated with tinnitus.

Evidence: Small controlled studies, including a 24-participant trial

Worth knowing: Study sizes are small. In the trial most often cited, the distress benefit held for six months while the loudness benefit did not.

The most widely recommended supplement for tinnitus.

Evidence: Randomised controlled trials, including large well-designed negative trials

Worth knowing: The largest and best-designed trials found no benefit over placebo. Included here precisely because it is so often recommended.