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

The edition in brief

The updated US clinical practice guideline on persistent, bothersome tinnitus in adults makes strong recommendations to separate 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 where hearing is impaired, cochlear implant referral when criteria are met, and cognitive behavioural therapy. It recommends against routine antidepressants, anticonvulsants, anxiolytics, intratympanic drugs, dietary supplements and rTMS for tinnitus itself. A retrospective cohort of 1,309 patients with sudden sensorineural hearing loss in Shanghai linked 11-20 sessions of hyperbaric oxygen plus steroids with higher odds of partial recovery than steroids alone (OR 2.24, 1.43-3.50), but treatment was not randomised. In 110 patients after head and neck radiotherapy, completing lymphoedema treatment was associated with better swallowing outcomes at 15 months. A meta-analysis of 32 studies linked worse pretreatment quality-of-life scores to higher mortality in head and neck cancer.