Recommended Tinnitus Treatments

Clinical Practice Guidelines

In 2014, the American Academy of Otolarynoglogy - Head and neck surgery (AAO-HNS) published clinical practice guidelines (CPG) addressed to ENTs and family doctors that provides evidence-based recommendations on how to manage tinnitus. These categorized recommendations provide a clear structure for clinicians to follow when assessing and managing patients with tinnitus, emphasizing evidence-based practices and discouraging unproven or potentially harmful treatments.

"Strong recommendations" and "Recommendations" are based on the most robust evidence and clearest benefit-to-risk ratios, while "Options" and "No recommendations" indicate areas where evidence is less clear or where patient preferences may play a larger role in decision-making. Here's a categorized summary of the key recommendations:

"Strong" Recommendations:

• Distinguish between bothersome and non-bothersome tinnitus (see this article on tinnitus for the definitions of these terms).
  
  
• Do NOT prescribe routine imaging studies for tinnitus unless there are red flags (only in one ear, neurological signs associated, asymmetrical hearing loss, pulsatile component)
  
  

Recommendations:

• Assessment:
  • Perform a targeted history and physical examination at initial evaluation.
  • Obtain a prompt, comprehensive audiologic examination for specific tinnitus cases (example: lasting more than 6 months, one ear affected).
  • Distinguish between recent-onset and persistent tinnitus (6 months or more).
• Management:
  • Educate patients about management strategies.
  • Recommend a hearing aid evaluation for patients with hearing loss.
  • Recommend cognitive behavioral therapy for persistent, bothersome tinnitus.

Recommendations "Against":

• Routine use of antidepressants, anticonvulsants, anxiolytics, or intratympanic medications.
• Use of dietary supplements (e.g., Ginkgo biloba, melatonin, zinc) for tinnitus treatment.
• Routine use of transcranial magnetic stimulation.
  
  

"Optional" Recommendations:

• Obtain an initial (meaning less than 6 months after appearance of the symptom) comprehensive audiologic examination for all tinnitus patients.
• Consider recommending sound therapy.

No Recommendations:

• Acupuncture, due to insufficient evidence.

Follow-up and Monitoring

Reassessment: Clinicians should evaluate patients with persistent tinnitus for anxiety and depression.

Quality of Life: The impact of tinnitus on quality of life should be assessed using validated questionnaires.