The American Academy of Otolaryngology-Head and Neck Surgery Foundation has updated its clinical practice guideline on tinnitus, focusing on adults whose tinnitus is persistent (six months or more) and bothersome. Tinnitus affects an estimated 10% to 15% of adults. The panel included otolaryngologists, audiologists, a psychiatrist, a geriatrician, a radiologist and a patient advocate.
Three strong recommendations stand out: distinguish bothersome from non-bothersome tinnitus; ask patients with bothersome tinnitus about risk of self-harm; and do not order neuroimaging to evaluate tinnitus unless specific concerning features are present.
Clinicians should take a targeted history and examination, arrange comprehensive audiology, educate patients about natural history and management, recommend hearing aid evaluation for those with hearing difficulty, refer for cochlear implant assessment when audiological criteria are met, recommend cognitive behavioural therapy, and document outcomes. The panel recommends against routine antidepressants, anticonvulsants, anxiolytics or intratympanic medicines for tinnitus itself, against dietary supplements, and against repetitive transcranial magnetic stimulation. Sound enrichment and bimodal neuromodulation are options.
For ENT surgeons and GPs, the shift is towards hearing rehabilitation and psychological therapy, and away from imaging and prescriptions. The self-harm question is the one most likely to be missed.
- Ask every patient with bothersome tinnitus about thoughts of self-harm.
- Arrange comprehensive audiology rather than routine neuroimaging.
- Recommend hearing aid evaluation when tinnitus comes with hearing difficulty.
- Recommend cognitive behavioural therapy for persistent, bothersome tinnitus.
- Do not prescribe antidepressants, anticonvulsants, anxiolytics or supplements for tinnitus itself.
Why it matters
Much of what patients are commonly offered for tinnitus, from scans to supplements, is not recommended, while the self-harm question often goes unasked.
Don't overread it
The advice against antidepressants applies to treating tinnitus itself; coexisting depression or anxiety should still be treated on its own merits.
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