Clinical practice guideline: tinnitus.
Level 5 - mechanism / opinion, no new human data
Clinical practice guideline and expert consensus document without new primary human trial data
PubMed 25273878 · doi:10.1177/0194599814545325
What was done
A multidisciplinary panel developed an evidence-based clinical practice guideline for clinicians managing adult patients (aged 18 years and older) with persistent (lasting 6 months or longer), bothersome primary tinnitus. The guideline defines recommendations for patient evaluation, diagnostic testing, specialty referral, and therapeutic interventions.
What was found
The abstract presents clinical consensus recommendations and options; no numerical data or effect sizes are reported. The panel made strong recommendations to differentiate bothersome from nonbothersome tinnitus and against ordering head and neck imaging for nonpulsatile, non-localized tinnitus without asymmetric hearing loss or focal neurologic abnormalities. Recommended actions include targeted history and physical examinations, prompt comprehensive audiologic exams for unilateral or persistent cases, patient education, hearing aid evaluations when hearing loss is documented, and cognitive behavioral therapy. The panel recommended against routine medications (antidepressants, anticonvulsants, anxiolytics, intratympanic agents), dietary supplements (Ginkgo biloba, melatonin, zinc), and transcranial magnetic stimulation. Sound therapy and universal initial audiologic exams were listed as options, and no recommendation was made regarding acupuncture.
Why it matters
This guideline provides a standardized, multidisciplinary framework that discourages unproven pharmacological treatments and routine neuroimaging while emphasizing evidence-supported strategies such as cognitive behavioral therapy and hearing rehabilitation.
Limits
As an abstract of a clinical practice guideline, no quantitative results, sample sizes, or statistical effect estimates are provided. The recommendations apply strictly to adults with primary persistent bothersome tinnitus and explicitly exclude pediatric patients, secondary or acute tinnitus, and nonbothersome presentations.
Cited by
- supports The American Academy of Otolaryngology–Head and Neck Surgery clinical practice guidelines endorse hearing aid amplification and cognitive behavioral therapy as effective interventions for bothersome tinnitus.