Tinnitus guideline covers diagnosis, treatment

A clinical guideline on diagnosing and treating tinnitus was released last week by the American Academy of Otolaryngology-Head and Neck Surgery.

The guideline provides evidence-based recommendations for managing patients with tinnitus, from initial evaluation to referrals for specialty treatment of underlying pathology. It includes a logical framework for helping patients find the most appropriate interventions to deal with the condition, especially persistent, bothersome tinnitus.

Diagnostic recommendations include the following:

• Perform a targeted history and physical at initial evaluation to identify any conditions that could be treated to relieve tinnitus.
• Obtain a prompt, comprehensive audiologic examination in patients with tinnitus that is unilateral, lasting at least 6 months, or associated with hearing difficulties. (Such an exam is optional in tinnitus patients without these factors.)
• Do not obtain imaging studies to evaluate tinnitus, unless the patient has tinnitus that localizes to 1 ear, pulsatile tinnitus, focal neurologic abnormalities, or asymmetric hearing loss.
• Distinguish whether tinnitus is bothersome or not, and whether it is of recent onset or persistent (≥6 months).

To treat persistent, bothersome tinnitus, clinicians should:

• educate patients about management strategies;
• recommend a hearing aid evaluation if hearing loss is present;
• recommend cognitive behavioral therapy (examples of which are included in the guideline);
• optionally recommend sound therapy;
• not routinely recommend antidepressants, anticonvulsants, anxiolytics, or intratympanic medications to treat tinnitus;
• not recommend Ginkgo biloba, melatonin, zinc or other dietary supplements to treat tinnitus; and
• not recommend transcranial magnetic stimulation for routine treatment.

No recommendation could be made regarding the effects of acupuncture on persistent, bothersome tinnitus, the guideline said. Research needs in the field are also listed in the document. The guideline was published in a supplement to Otolaryngology-Head and Neck Surgery on Oct. 1.