The updated clinical practice guideline covers adults with persistent (6 months or more), bothersome tinnitus. It excludes people with an identifiable cause other than sensorineural hearing loss, and pulsatile or objective tinnitus.
The group made strong recommendations to distinguish bothersome from nonbothersome tinnitus, to ask about self-harm risk in bothersome tinnitus, and not to obtain neuroradiological imaging for tinnitus alone unless concerning features are present. Recommendations include a targeted history and examination, a comprehensive audiological evaluation, patient education, hearing aid evaluation for hearing difficulty, cochlear implant referral when criteria are met, and cognitive behavioural therapy.
It recommends against routine antidepressants, anticonvulsants, anxiolytics and intratympanic drugs, against dietary supplements, and against repetitive transcranial magnetic stimulation. Sound enrichment and bimodal neuromodulation are options. The guideline was produced by an American otolaryngology guideline group, so local availability, particularly of audiology and CBT, shapes how far it can be followed in India.
- Separate bothersome from nonbothersome tinnitus at the first visit.
- Ask about self-harm in people whose tinnitus is bothersome.
- Request audiometry for every patient with tinnitus; avoid MRI or CT for tinnitus alone without concerning features.
- Offer cognitive behavioural therapy and a hearing aid evaluation where hearing loss is present.
- Avoid starting antidepressants, anticonvulsants, anxiolytics or supplements for tinnitus itself.
Why it matters
It replaces habits such as routine scans and medication trials with a structured approach.
Don't overread it
This is a US guideline for persistent bothersome tinnitus with sensorineural hearing loss, and it does not cover pulsatile or secondary tinnitus.
The statistics, in plain English
Guideline strength reflects the balance of benefit, harm and evidence quality, not the size of the effect. A 'strong recommendation' against imaging or drugs means harms or lack of benefit were judged to outweigh any gain, not that every study showed harm.
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