Tinnitus affects 10-15% of Indians. Most ENT doctors see multiple cases weekly. Here are straight answers. What is the minimum workup before labelling tinnitus as idiopathic? Pure tone audiogram (PTA) with high-frequency testing up to 8 kHz. Tympanometry. If unilateral: MRI internal auditory canal with gadolinium to rule out vestibular schwannoma. Blood pressure check (pulsatile tinnitus needs vascular workup — carotid Doppler and CT angiography). Thyroid function. Do not skip MRI in unilateral cases. What is the most effective treatment available today? Tinnitus Retraining Therapy (TRT) combining directive counselling and sound therapy has the best evidence. Cognitive Behavioural Therapy (CBT) reduces tinnitus distress scores significantly and is the only treatment with consistent Level 1 evidence for quality of life improvement. Sound therapy alone (white noise, notched music therapy) reduces loudness perception in 60-70% of patients with 6 months use. Which drugs actually work for tinnitus? Honestly, none have strong evidence. Betahistine helps if there is a Meniere's component. Melatonin 3 mg at night improves sleep disruption from tinnitus. Antidepressants (amitriptyline, nortriptyline) help when tinnitus distress is driving depression or insomnia. Do not prescribe vasodilators or 'neuro-vitamins' routinely — there is no evidence for them. When should you refer to audiology vs psychiatry? Audiology for: hearing aid fitting (even mild HL helps tinnitus), TRT device programming, and sound therapy counselling. Psychiatry/psychology for: Tinnitus Handicap Inventory (THI) score above 56 (severe category), suicidal ideation (tinnitus drives it in some patients), or clear anxiety/depression comorbidity. Always screen with THI at first visit. What should you tell patients who ask 'will this ever go away'? Acute tinnitus (under 3 months) post noise-exposure or after acute sensorineural hearing loss: 50% resolve spontaneously within 1 year. Chronic tinnitus (over 6 months): complete resolution is unlikely but habituation — where tinnitus is no longer bothersome — is achievable in 80% with proper TRT. That is the realistic goal to communicate. Is transcranial magnetic stimulation (TMS) available and useful in India? TMS for tinnitus is available at select neuro centres in metro India. Evidence shows modest short-term benefit in chronic tinnitus, but effects are not durable beyond 3 months without repeat sessions. It is not yet standard of care. Mention it as an option to patients who have failed TRT and CBT and have severe THI scores.