The tinnitus guideline update: ask about self-harm, skip routine imaging and drugs, offer CBT

The edition in brief

The American Academy of Otolaryngology-Head and Neck Surgery Foundation has updated its guideline on persistent, bothersome tinnitus in adults. Strong recommendations: distinguish bothersome from non-bothersome tinnitus, ask about self-harm, and avoid neuroimaging unless specific concerning features are present. Clinicians should take a targeted history and examination, arrange comprehensive audiology, educate patients, recommend hearing aid evaluation when hearing is affected, refer for cochlear implant assessment when criteria are met, and recommend cognitive behavioural therapy. The guideline advises against routine antidepressants, anticonvulsants, anxiolytics or intratympanic drugs for tinnitus itself, against dietary supplements and against repetitive transcranial magnetic stimulation; sound enrichment and bimodal neuromodulation are options. In a retrospective cohort of 1,309 patients with sudden sensorineural hearing loss in Shanghai, adding 11 to 20 hyperbaric oxygen sessions to steroids was associated with roughly double the odds of slight or partial recovery at the end of treatment. In a US database of 228,340 thyroid and parathyroid operations, postoperative pneumothorax occurred in 0.10% and was associated with a 16-fold higher hazard of death at one year. In 5,012 matched pairs, depression or anxiety was associated with more epistaxis, readmission and emergency visits after septoplasty with turbinoplasty. The pearl: unilateral or pulsatile tinnitus is the exception that does need investigation.