BlueCross BlueShield of Tennessee Medical Policy Manual

Treatment of Tinnitus

DESCRIPTION

Tinnitus describes the perception of any sound in the ear in the absence of an external stimulus. Hearing impairment, often noise-induced or related to aging, is commonly associated with tinnitus. Clinically, tinnitus is subdivided into subjective and objective types. In the majority of cases, tinnitus is subjective and frequently self-limited. Common causes of objective tinnitus include middle ear and skull-based tumors, vascular abnormalities, and metabolic derangements. The American Academy of Otolaryngology defines ‘persistent’ tinnitus as six months or longer in duration and ‘bothersome’ as causing individual distress, affected quality of life and/or functional health status.

A variety of nonpharmacologic treatments are being evaluated to improve the subjective symptoms of tinnitus. These approaches include use of tinnitus maskers (e.g. Neuromonics® Tinnitus Treatment) electrical stimulation, transmeatal laser irradiation, electromagnetic energy, tinnitus-retraining therapy, cognitive and behavioral therapies, transcranial magnetic stimulation, transcutaneous electrical stimulation, and sound therapy. Tinnitus retraining, also referred to as tinnitus habituation therapy, is another proposed treatment option.

Cognitive behavioral therapy (CBT), originally developed for treatment of depression and anxiety, has been shown to be effective in the treatment of tinnitus related distress. CBT teaches skills to identify negative thoughts that result in distress and how restructure them. Current literature indicates that cognitive behavior therapy can improve coping skills and quality of life while decrease tinnitus-associated distress and annoyance.

Note: This policy does not address surgical (e.g. cochlear or brainstem implants); pharmacologic treatment of tinnitus (e.g. use of amitriptyline or other tricyclic antidepressants), or injection of botulinum toxin.

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

Current evidence is insufficient to show improved health outcomes in patients treated with tinnitus maskers, electrical stimulation, transmeatal laser irradiation, electromagnetic energy, tinnitus-retraining therapy, sound therapy, transcranial magnetic stimulation, or transcutaneous electrical stimulation. Therefore, these treatments are considered investigational.

SOURCES

Agency for Healthcare Research and Quality. (2013, August). Comparative Effectiveness Review; Number 122: Evaluation and Treatment of Tinnitus: Comparative Effectiveness. Retrieved December 5, 2016 from http://www.ahrq.gov.

American Academy of Otolaryngology. (2014). Clinical practice guideline: tinnitus. Retrieved February 28, 2017 from http://www.entnet.org.

BlueCross BlueShield Association. Evidence Positioning System. (3:2019). Treatment of tinnitus (8.01.39). Retrieved April 5, 2019 from https://www.evidencepositioningsystem.com/. (47 articles and/or guidelines reviewed)

Folmer, R.L., Theodoroff, S.M., Casiana, L., Shi, Y., Griest, S., & Vachhani, J. (2015). Repetitive transcranial magnetic stimulation treatment for chronic tinnitus: a randomized clinical trial. JAMA Otolaryngology-Head and Neck Surgery, 141 (8), 716-722. Abstract retrieved March 2, 2018 from PubMed database.

Henry, J.A., McMillan, G., Dann, S., Bennett, K., Griest, S., Theodoroff, S., et al. (2017). Tinnitus management: randomized controlled trial comparing extended-wear hearing aids, conventional hearing aids, and combination instruments. Journal of the American Academy of Audiology, 28 (6), 546-561. Abstract retrieved March 2, 2018 from PubMed database.

Piccirillo, J. F. (2016). Transcranial magnetic stimulation for chronic tinnitus. JAMA, 315 (5), 506-507. (Level 2 evidence)

Shim, H. J., Kwak, M. Y., An, Y. H., Kim, D. H., Kim, Y. J., & Kim H. J. (2015). Feasibility and safety of transcutaneous vagus nerve stimulation paired with notched music therapy for the treatment of chronic tinnitus. Journal of Audiology & Otology, 19 (3), 159-167. (Level 3 evidence)

Soleimani, R., Jalali, M.M., & Hasandokht, T. (2016). Therapeutic impact of repetitive transcranial magnetic stimulation (rTMS) on tinnitus: a systematic review and meta-analysis. European Archives of Oto-Rhino-Laryngology, 273 (7), 1663-1675. Abstract retrieved March 2, 2018 from PubMed database.

Stein, A., Wunderlich, R., Lau, P., Engell, A., Wolbrink, A.,Shaykevich, A., et al. (2016). Clinical trial on tonal tinnitus with tailor-made notched music training. BMC Neurology, 16, 38. (Level 2 evidence)

Tugumia, D., Samelli, A., Matas, C., Magliaro, F., and Rabelo, C. (2016). Auditory training program in subjects with tinnitus. CoDAS, 28 (1), 27-33. (Level 2 evidence)

U. S. Food and Drug Administration. (2007, July). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K070599 (Tinnitus Masker Device). Retrieved July 19, 2011 from http://www.accessdata.fda.gov.

U. S. Food and Drug Administration. (2008, March). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K080955 (Zen Program™). Retrieved June 21, 2012 from http://www.accessdata.fda.gov.

U. S. Food and Drug Administration. (2011, December). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K112752 (ANM T30® Tinnitus Therapy System). Retrieved June 21, 2012 from http://www.accessdata.fda.gov.

Zenner, H., Vonthein, R., Zenner, B., Leuchtweis, R., Plontke S., Torka, W. (2013). Standardized tinnitus-specific individual cognitive-behavioral therapy: a controlled outcome study with 286 tinnitus patients. Hearing Research, 298, 117-25. Retrieved February 28, 2017 from PubMed database.

ORIGINAL EFFECTIVE DATE:  12/1/2002

MOST RECENT REVIEW DATE:  5/9/2019

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