Assessing the cause of tinnitus for therapeutic options

The important development of tinnitus research in the last few years has improved the knowledge of tinnitus mechanisms, its diagnosis and its treatment. From a peripheral point of view, tinnitus is considered today as a brain reaction to erroneous input activity from the auditory or somatosensorial systems.

An accurate diagnosis is crucial to design the best therapeutic options. Treatment should be based on tinnitus aetiology as a first step. Medical counselling is a very effective tool, and it should be mandatory for all patients. Drug treatment experiments could take a step forward in the next few years. NMDA-antagonists or GABA-agonists are some of the targets of the research. The transtympanic delivery path is a good option for cochlear fluctuant diseases and gives us the possibility of higher dosages and fewer systemic side effects. Stimulation of the somatosensory pathways can help us to control somatic modulated tinnitus and it could be done through muscular training, electro-stimulation or pharmaceutical approaches. Auditory management is based in the fact that acoustic deprivation is the most powerful engine for tinnitus generation. Patients can be treated through passive training therapies as hearing aids, retraining therapies or filtered music approaches. Active acoustic training through auditory discrimination is a new promising approach and so is the repetitive transcranial magnetic stimulation over the auditory cortex.

The combination of different approaches simultaneously will bring the best results for tinnitus relief and efforts should be made towards finding the best combination for each patient.