Tinnitus sound or noise levels can lead to tinnitus. Ear plugs or other measures can help with prevention. Several medicines have ototoxic effects, and can have a cumulative effect that can increase the damage done by noise. If ototoxic medications must be administered, close attention by the physician to prescription details, such as dose and dosage interval, can reduce the damage done. If there is an underlying cause, treating it may lead to improvements. Otherwise, the primary treatment for tinnitus is talk therapy and sound therapy; there are no effective medications. The best supported treatment for tinnitus is a type of
Tinnitus retraining therapy large proportion of dropouts; reported 'success' ratios may not take these subjects into account. There are few available studies, but most show that tinnitus naturally declines over time (years) in a large proportion of subjects surveyed, without any treatment. The annoyance of tinnitus also tends to decline over time. In at least some, tinnitus spontaneously disappears. A Cochrane review found only one sufficiently rigorous study of TRT and noted that while the study suggested benefit in the treatment of tinnitus, the study quality was not good enough to draw firm conclusions. A separate Cochrane review of sound therapy (though they