Clinical Practice Guideline: Tinnitus

Otolaryngology—Head Neck Surgery

Tunkel, D. E., Bauer, C. A., et al. (2014).

Otolaryngology—Head Neck Surgery, 251(2 Suppl), S1-S40.

This is a guideline providing recommendations for screening, assessment, and treatment of adults with tinnitus. The target audience of this guideline includes audiologists, primary care clinicians, specialty physicians, and mental health professionals.

American Academy of Otolaryngology—Head and Neck Surgery Foundation

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

Recommendations for tinnitus assessment are as follows:<div><ul> <li>"Clinicians must distinguish patients with bothersome tinnitus from patients with non-bothersome tinnitus" (Strongly Recommended; Level B Evidence; p. S15).</li> <li>"Clinicians should perform a targeted history and physical examination at the initial evaluation of a patient with presumed primary tinnitus to identify conditions that if promptly identified and managed may relieve tinnitus" (Recommended; Level C Evidence; p. S8).</li> <li>"Clinicians should obtain a prompt, comprehensive audiologic examination in patients with tinnitus that is unilateral, associated with hearing difficulties, or persistent (≥ 6 months)" (Recommended; Level C Evidence; p. S12).</li> <li>"Clinicians should distinguish patients with bothersome tinnitus of recent onset from those with persistent symptoms (≥ 6 months) to prioritize intervention and facilitate discussions about natural history and follow-up care" (Recommended; Level B Evidence; p. S17).</li> <li>"Clinicians may obtain an initial comprehensive audiologic examination in patients who present with tinnitus (regardless of laterality, duration, or perceived hearing status)" (Optional; Level B Evidence; p. S13).</li></ul></div>

Recommendations for tinnitus intervention are as follows:<div><ul> <li>"Clinicians should educate patients with persistent, bothersome tinnitus about management strategies" (Recommended; Level B Evidence; p. S17).</li> <li>"Clinicians should recommend [cognitive behavioral therapy (CBT)] to patients with persistent, bothersome tinnitus" (Recommended; Level A Evidence; p. S23).</li> <li>"Clinicians should recommend a hearing aid evaluation for patients with hearing loss and persistent, bothersome tinnitus" (Recommended; Level C Evidence; p. S19).</li> <li>"Clinicians may recommend sound therapy to patients with persistent, bothersome tinnitus" (Optional; Level B Evidence; p. S21).</li></ul></div>