German S3 Guideline 017/064: Chronic Tinnitus

Association of the Scientific Medical Societies. (2015).

Germany: Association of the Scientific Medical Societies, (AWMF-Register Nr. 017/064 Klasse: S3 Chronischer Tinnitus), Retrieved May 15, 2018 from

This is the updated 2015 guideline from the German Society of Otorhinolaryngology and Head and Neck Surgery that provides recommendations for the assessment and treatment of chronic idiopathic tinnitus in adolescents and adults. The target audience includes all relevant professionals involved in the management of tinnitus such as physicians, physiologists, and audiologists. Although several recommendations are outside the scope of audiology, many of the recommended options for tinnitus management in this document are often provided by audiologists.

Association of the Scientific Medical Societies (Germany)

The data in this guideline are included in another document which can be found in the Associated Article section below.

Assessment of chronic idiopathic tinnitus should be individualized for adolescents and adults based on their case history and severity of symptoms as measured by a tinnitus questionnaire. Appropriate diagnostic assessments may include:<ul> <li>“eardrum microscopy, nasopharyngoscopy, and eustachian tube function; </li> <li>exploratory neurological examination; </li> <li>auscultation of the ear and carotid artery, especially with pulse synchronous tinnitus; </li> <li>audiometry with air and bone conduction; </li> <li>tympanometry and stapedial reflex, including recording any possible respiration or pulsesynchronous changes; </li> <li>TEOAE and DPOAE; </li> <li>exploratory vestibular testing, including caloric reflex testing wherever necessary" (Section 4.2); </li> <li>subjective assessment (e.g., threshold of discomfort, determination of tinnitus loudness and frequency, masking levels);</li> <li>brainstem audiometry; or </li> <li>speech audiometry (No Grade Provided).</li></ul>

Due to weak evidence, the effectiveness of sound therapies (e.g., auditory discrimination) is uncertain. Therefore, a general recommendation for or against the implementation of sound therapies to alleviate tinnitus cannot be made (No recommendation).<p>Due to a lack of evidence, tinnitus retraining therapy is not recommended for individuals with chronic idiopathic tinnitus (No recommendation).</p>

Based on the weak evidence found, "a recommendation for noise generators/noise CDs cannot be made for the indication of tinnitus” (Open Recommendation; Section 5.1 b).

“The treatment of a chronic tinnitus sufferer should always include a consultation or tinnitus counselling” (No Grade Provided; Section 5.1 a).

When collecting the case history of a patient with chronic tinnitus, questions to ask include:<ul> <li>which side experiences tinnitus;</li> <li>characteristics of the patient’s tinnitus;</li> <li>timing of tinnitus episodes;</li> <li>possible causes of tinnitus;</li> <li>impact on life;</li> <li>patient sensitivity to all sounds;</li> <li>co-morbid difficulties;</li> <li>current medications; </li> <li>recent surgeries; and </li> <li>any possible injuries/exposures that may have exacerbated tinnitus symptoms (No Grade Provided).</li></ul>

In regards to the use of devices to treat chronic tinnitus in adolescents and adults:<ul> <li>From studies with moderate or weak levels of evidence, “a recommendation for the use of hearing aids cannot be made for the indication of tinnitus. Hearing aids and middle ear implants can be recommended for the treatment of an appropriate accompanying hearing loss” (Open Recommendation; Section 5.1 b). </li> <li>“Studies of cochlear implant implantation for the indication of tinnitus alone without hearing loss do not exist ... A recommendation cannot be made for cochlear implant implantation solely because of tinnitus. Instead, a primary indication of deafness or hearing loss bordering on deafness must be present” (Recommendation; Section 5.4.1 a).</li></ul>