Treatments - Effective tinnitus treatments

Discover the most effective tinnitus treatments backed by the 2014 American Academy of Otolaryngology guidelines.

Clinical Practice Guidelines - Plain Summary

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 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:

1. Distinguish between bothersome and non-bothersome tinnitus.
2. Do not obtain imaging studies for tinnitus, unless specific indications are present.

Recommendations:

1. 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).
2. Management:
   • Educate patients about management strategies.
   • Recommend a hearing aid evaluation for patients with hearing loss.
   • Recommend cognitive behavioral therapy for persistent, bothersome tinnitus.
3. 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.
   • Routine use of imaging studies for tinnitus unless there are red flags (only in one ear, neurological signs associated, asymmetrical hearing loss, pulsatile component)

Optional Recommendations:

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

No Recommendations:

1. 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.

For those interested in exploring the complete Clinical Practice Guideline article, here is the reference:

Tunkel DE, Bauer CA, Sun GH, Rosenfeld RM, Chandrasekhar SS, Cunningham ER Jr, Archer SM, Blakley BW, Carter JM, Granieri EC, Henry JA, Hollingsworth D, Khan FA, Mitchell S, Monfared A, Newman CW, Omole FS, Phillips CD, Robinson SK, Taw MB, Tyler RS, Waguespack R, Whamond EJ. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg. 2014 Oct;151(2 Suppl):S1-S40. doi: 10.1177/0194599814545325. PMID: 25273878.