A guideline update group has revised the US clinical practice guideline on tinnitus, with an executive summary in Otolaryngology–Head and Neck Surgery. It covers adults with persistent (six months or more), bothersome tinnitus, and excludes pulsatile and objective tinnitus and tinnitus with an identifiable cause other than sensorineural hearing loss.
The strong recommendations are to distinguish bothersome from non-bothersome tinnitus, to ask about risk of self-harm in patients with bothersome tinnitus, and not to order neuroimaging solely for tinnitus unless specific concerning features are present. Further recommendations include a targeted history and examination, comprehensive audiology, education about natural history and management, hearing aid evaluation for those with hearing difficulty, cochlear implant referral when audiological criteria are met, cognitive behavioural therapy, and documenting outcomes.
The guideline recommends against routinely using antidepressants, anticonvulsants, anxiolytics or intratympanic medicines as primary tinnitus treatment, against dietary supplements, and against repetitive transcranial magnetic stimulation. Sound enrichment, asking about somatosensory features and bimodal neuromodulation are listed as options. The self-harm question is the item most likely to be new to many clinics, and it is easy to add.
- Ask every patient with bothersome tinnitus about thoughts of self-harm.
- Arrange comprehensive audiology, and a hearing aid assessment when hearing is impaired.
- Offer or refer for cognitive behavioural therapy for persistent, bothersome tinnitus.
- Do not prescribe antidepressants, anticonvulsants, anxiolytics or supplements as primary tinnitus treatment.
- Avoid neuroimaging for tinnitus alone unless there are concerning features such as unilateral or pulsatile symptoms.
Why it matters
The guideline moves tinnitus care away from scans and prescriptions towards audiology, psychological therapy and safety screening.
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