Clinical practice guideline: tinnitus
Abstract
OBJECTIVE: Tinnitus is the perception of sound without an external source. More than 50 million people in the United States have reported experiencing tinnitus, resulting in an estimated prevalence of 10% to 15% in adults. Despite the high prevalence of tinnitus and its potential significant effect on quality of life, there are no evidence-based, multidisciplinary clinical practice guidelines to assist clinicians with management. The focus of this guideline is on tinnitus that is both bothersome and persistent (lasting 6 months or longer), which often negatively affects the patient's quality of life. The target audience for the guideline is any clinician, including nonphysicians, involved in managing patients with tinnitus. The target patient population is limited to adults (18 years and older) with primary tinnitus that is persistent and bothersome. PURPOSE: The purpose of this guideline is to provide evidence-based recommendations for clinicians managing patients with tinnitus. This guideline provides clinicians with a logical framework to improve patient care and mitigate the personal and social effects of persistent, bothersome tinnitus. It will discuss the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary tinnitus, with recommendations to guide the evaluation and measurement of the effect of tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers. ACTION STATEMENTS: The development group made a strong recommendation that clinicians distinguish patients with bothersome tinnitus from patients with nonbothersome tinnitus. The development group made a strong recommendation against obtaining imaging studies of the head and neck in patients with tinnitus, specifically to evaluate tinnitus that does not localize to 1 ear, is nonpulsatile, and is not associated with focal neurologic abnormalities or an asymmetric hearing loss. The panel made the following recommendations: Clinicians should (a) perform a targeted history and physical examination at the initial evaluation of a patient with presumed primary tinnitus to identify conditions that if promptly identified and managed may relieve tinnitus; (b) obtain a prompt, comprehensive audiologic examination in patients with tinnitus that is unilateral, persistent (≥ 6 months), or associated with hearing difficulties; (c) distinguish patients with bothersome tinnitus of recent onset from those with persistent symptoms (≥ 6 months) to prioritize intervention and facilitate discussions about natural history and follow-up care; (d) educate patients with persistent, bothersome tinnitus about management strategies; (e) recommend a hearing aid evaluation for patients who have persistent, bothersome tinnitus associated with documented hearing loss; and (f) recommend cognitive behavioral therapy to patients with persistent, bothersome tinnitus. The panel recommended against (a) antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for the routine treatment of patients with persistent, bothersome tinnitus; (b) Ginkgo biloba, melatonin, zinc, or other dietary supplements for treating patients with persistent, bothersome tinnitus; and (c) transcranial magnetic stimulation for the routine treatment of patients with persistent, bothersome tinnitus. The development group provided the following options: Clinicians may (a) obtain an initial comprehensive audiologic examination in patients who present with tinnitus (regardless of laterality, duration, or perceived hearing status); and (b) recommend sound therapy to patients with persistent, bothersome tinnitus. The development group provided no recommendation regarding the effect of acupuncture in patients with persistent, bothersome tinnitus.
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CBT is the only intervention strongly recommended in clinical practice guidelines for tinnitus.
“Currently, CBT is the only intervention strongly recommended in clinical practice guidelines for tinnitus (Tunkel et al., 2014; Cima et al., 2019; Ogawa et al., 2020)”
From Research trends and hotspots of cognitive behavioral therapy for tinnitus: a bibliometric analysis (2025) · cites this paper as Tunkel et al., 2014
ACT is an effective treatment for patients with persistent and bothersome tinnitus.
“The American Academy of Otolaryngology–Head and Neck Surgery guidelines recommended that ACT was an effective treatment for patients with persistent and bothersome tinnitus [5].”
From Validation of the Tinnitus Acceptance Questionnaire: Japanese Version (2022) · cites this paper as [5]
The American Academy of Otolaryngology evidence-based guidelines recommend CBT for tinnitus management.
“The American Academy of Otolaryngology evidence-based guidelines for tinnitus management recommend the use of CBT (Tunkel et al. 2014).”
From Psychological Therapy for People with Tinnitus: A Scoping Review of Treatment Components. (2017) · cites this paper as Tunkel et al. 2014
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Henry, J. A., Thielman, E. J., Zaugg, T. L., Kaelin, C., Choma, C., Chang, B., Hahn, S., & Fuller, B. E. (2017) · International Journal of Audiology · doi:10.1080/14992027.2017.1338762 · Cited by 33 · see citing works
Self-citationPsychoacoustic classification of persistent tinnitus
Suzuki, F. A. D. B., Suzuki, F. A., Onishi, E. T., & Penido, N. D. O. (2017) · Brazilian Journal of Otorhinolaryngology · doi:10.1016/j.bjorl.2017.07.005 · Cited by 33 · see citing works
Hall, D. A., Mehta, R. L., & Fackrell, K. (2017) · American Journal of Audiology · doi:10.1044/2017_aja-16-0129 · Cited by 32 · see citing works
Tinnitus, Depression, Anxiety, and Suicide in Recent Veterans: A Retrospective Analysis
Martz, E., Jelleberg, C., Dougherty, D. D., Wolters, C. L., & Schneiderman, A. (2018) · Ear and Hearing · doi:10.1097/aud.0000000000000573 · Cited by 32 · see citing works
Mavrogeni, P., Maihoub, S., Tamás, L. T., & Molnár, A. (2022) · Journal of Otology · doi:10.1016/j.joto.2022.04.003 · Cited by 32 · see citing works
- Authors
- Tunkel, D. E., Bauer, C. A., Sun, G. H., Rosenfeld, R. M., Chandrasekhar, S. S., Cunningham, E. R., Archer, S. M., Blakley, B. W., Carter, J. M., Granieri, E. C., Henry, J. A., Hollingsworth, D., Khan, F. A., Mitchell, S., Monfared, A., Newman, C. W., Omole, F. S., Phillips, C. D., Robinson, S. K., Taw, M. B., Tyler, R. S., Waguespack, R., & Whamond, E. J.
- Affiliations
- Johns Hopkins University (US)
- SIU Medicine (US)
- Partnership for Health Analytic Research (US)
- SUNY Downstate Health Sciences University (US)
- New York Otology New York New York USA
- American Academy of Otolaryngology — Head and Neck Surgery (US)
- University of Kentucky (US)
- University of Manitoba (CA)
- Tulane University (US)
- Columbia University Irving Medical Center (US)
- Portland VA Medical Center (US)
- Virginia Commonwealth University (US)
- Ochsner Health System (US)
- Houston Christian University (US)
- George Washington University (US)
- Cleveland Clinic Lerner College of Medicine (US)
- Morehouse School of Medicine (US)
- NewYork–Presbyterian Hospital (US)
- University of California San Diego (US)
- University of California, Los Angeles (US)
- University of Iowa (US)
- University of Alabama (US)
- Consumers United for Evidence‐Based Healthcare Fredericton New Brunswick Canada
- ORCID
- Venue
- Otolaryngology–Head and Neck Surgery
- Publisher
- Wiley
- Published
- 2014-10
- Volume
- 151
- Issue
- S2
- Pages
- S1-S40
- ISSN
- 0161-6439 (ISSN-L)
- 0194-5998
- 1097-6817
- OpenAlex
- W2118772689
- Cited by
- 769
- References
- 250
- Citations by year
- 2026: 21 · 2025: 60 · 2024: 97 · 2023: 87 · 2022: 91 · 2021: 91 · 2020: 83 · 2019: 74 · 2018: 43 · 2017: 52 · 2016: 41 · 2015: 25 · 2014: 3
- FWCI
- 24.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Otolaryngology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Academy of Otolaryngology-Head and Neck Surgery
- Topics
- Life Sciences › Neuroscience › Sensory Systems › Hearing, Cochlea, Tinnitus, Genetics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hearing Loss and Rehabilitation
- Health Sciences › Health Professions › Speech and Hearing › Noise Effects and Management
- Keywords
- tinnitus, tinnitus management, tinnitus evaluation, hearing loss, hearing aids, cognitive behavioral therapy, tinnitus retraining therapy, tinnitus masking
- MeSH terms
- Adolescent, Adult, Humans, Tinnitus, Practice Guidelines as Topic, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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