An updated clinical practice guideline published in Otolaryngology–Head and Neck Surgery on 1 October covers adults with tinnitus that is persistent (six months or more) and bothersome. It was written by a multidisciplinary panel including otolaryngologists, audiologists, a psychiatrist, a neurologist, a radiologist and a consumer representative.
Three recommendations are strong. Distinguish bothersome from non-bothersome tinnitus. Ask about risk of self-harm in patients with bothersome tinnitus. Do not order neuroimaging to evaluate tinnitus unless specific concerning features are present — in usual practice, unilateral or pulsatile tinnitus, focal neurology or asymmetric hearing loss.
The guideline also recommends a targeted history and examination, a comprehensive audiological assessment, education about the natural history, a hearing aid evaluation for patients with hearing difficulty, cochlear implant referral where criteria are met, cognitive behavioural therapy, and documenting outcomes of treatment. It recommends against routinely using antidepressants, anticonvulsants, anxiolytics or intratympanic drugs for tinnitus itself, against dietary supplements, and against rTMS. Sound enrichment and bimodal neuromodulation are options.
The practice changes are the explicit self-harm question and the firm line against both routine imaging and routine drugs — the two things most often offered in a busy clinic in place of a structured plan.
- Ask whether the tinnitus is bothersome, and ask directly about thoughts of self-harm if it is.
- Arrange a full audiological assessment; most bothersome tinnitus comes with some hearing loss.
- Do not order MRI or CT for tinnitus alone; reserve imaging for unilateral or pulsatile tinnitus, asymmetric loss or neurological signs.
- Offer cognitive behavioural therapy and, where hearing is reduced, a hearing aid evaluation.
- Avoid prescribing antidepressants, anticonvulsants, anxiolytics or supplements for tinnitus itself; treat depression or anxiety on their own merits.
Why it matters
It replaces the common cycle of scan, supplement and reassurance with a structured, evidence-based plan.
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