Clinical Practice Guideline: Tinnitus Update.

Summary

This is the American Academy of Otolaryngology-Head and Neck Surgery Foundation's update of its 2014 tinnitus guideline, written by a panel of otolaryngologists, audiologists, a psychiatrist, a neurologist, a radiologist, other clinicians and a patient advocate from the American Tinnitus Association. It covers adults whose tinnitus has lasted six months or more and bothers them. It does not test a new idea about what causes tinnitus; it weighs the existing evidence and turns it into 'key action statements' that tell clinicians what to do. The strongest recommendations are about care, not cures: tell bothersome tinnitus apart from tinnitus that does not bother the patient, ask about thoughts of self-harm, and do not order brain scans unless there are specific warning signs. For treatment it recommends hearing aids when there is hearing difficulty, a cochlear implant evaluation when hearing loss is severe enough, and cognitive behavioral therapy (a talking therapy that changes how a person reacts to the sound). It recommends against antidepressants, anticonvulsants, anti-anxiety drugs, medicines injected through the eardrum, dietary supplements and repetitive transcranial magnetic stimulation (magnetic pulses applied to the scalp) as tinnitus treatments. It newly allows clinicians to offer bimodal neuromodulation, devices that pair sound with mild electrical stimulation of the tongue or the skin, as an option.

Key findings

• Strong recommendations: separate bothersome from non-bothersome tinnitus, ask about risk of self-harm, and avoid brain imaging unless specific concerning features are present.
• Recommends a full hearing test, patient education, hearing aid evaluation for those with hearing difficulty, cochlear implant referral when criteria are met, and cognitive behavioral therapy.
• Recommends against antidepressants, anticonvulsants, anxiolytics, intratympanic medications, dietary supplements and rTMS for treating persistent, bothersome tinnitus.
• Lists bimodal neuromodulation (sound paired with electrical stimulation) as an option clinicians may offer, alongside sound enrichment and asking about somatosensory features.