Updated tinnitus guideline: ask about self-harm, skip routine imaging, offer CBT

The edition in brief

The updated US clinical practice guideline on tinnitus, published in Otolaryngology–Head and Neck Surgery, makes strong recommendations to distinguish bothersome from non-bothersome tinnitus, to ask about self-harm, and not to order neuroimaging for tinnitus alone without concerning features. It recommends audiological evaluation, hearing aid assessment, cochlear implant referral where criteria are met, and cognitive behavioural therapy, and advises against routine antidepressants, anticonvulsants, anxiolytics, intratympanic drugs, supplements and rTMS. In 110 patients with internal lymphoedema three months after head and neck radiotherapy, the 72 who received treatment had better swallowing physiology and patient-reported scores at 15 months. A cost-effectiveness model of perioperative pembrolizumab found an ICER of $134,700 per QALY for PD-L1 CPS above 10 but about $2.2 million for CPS 1 to 10. A meta-analysis of 32 studies linked worse pretreatment quality of life, especially physical functioning (HR 1.16 per 10 points), to higher mortality. The pearl covers when unilateral tinnitus needs an MRI.