The American Academy of Otolaryngology–Head and Neck Surgery Foundation has updated its clinical practice guideline for adults with tinnitus that is persistent (6 months or more) and bothersome. The multidisciplinary panel included otolaryngologists, audiologists, a psychiatrist, a neurologist, a radiologist, a geriatrician and a patient advocate.
Three recommendations are strong: distinguish bothersome from non-bothersome tinnitus; ask about risk of self-harm in bothersome tinnitus; and do not order neuroimaging to evaluate tinnitus unless specific concerning features are present. The guideline also recommends a targeted history and examination, comprehensive audiology, education, hearing aid evaluation for those with hearing difficulty, cochlear implant referral when audiological criteria are met, cognitive behavioural therapy, and documenting outcomes.
It recommends against routinely using antidepressants, anticonvulsants, anxiolytics or intratympanic drugs to treat the tinnitus itself, against dietary supplements, and against rTMS. Sound enrichment and bimodal neuromodulation are options. The self-harm question is the change most clinics will need to build in; the advice against drugs does not stop treating coexisting depression or anxiety on its own merits.
- Ask every patient with bothersome tinnitus about thoughts of self-harm, and act on the answer.
- Arrange comprehensive audiology, and a hearing aid evaluation if hearing is affected.
- Offer or refer for cognitive behavioural therapy for persistent, bothersome tinnitus.
- Avoid prescribing antidepressants, anticonvulsants, anxiolytics or supplements to treat the tinnitus itself.
- Do not order MRI for tinnitus alone unless red-flag features are present.
Why it matters
It makes self-harm screening a strong recommendation and steers effort from drugs and scans towards hearing care and CBT.
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