Cited by 769Hearing, Cochlea, Tinnitus, GeneticsHearing Loss and RehabilitationNoise Effects and Management

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Clinical Practice Guideline: Tinnitus

Tunkel, David E., Bauer, Carol A., Sun, Gordon H., Rosenfeld, Richard M., Chandrasekhar, Sujana S., Cunningham, Eugene R., Archer, Sanford M., Blakley, Brian W., Carter, John M., Granieri, Evelyn C., Henry, James A., Hollingsworth, Deena, Khan, Fawad A., Mitchell, Scott, Monfared, Ashkan, Newman, Craig W., Omole, Folashade S., Phillips, C. Douglas, Robinson, Shannon K., Taw, Malcolm B., Tyler, Richard S., Waguespack, Richard, Whamond, Elizabeth J.·2014·Otolaryngology–Head and Neck Surgery

DOI 10.1177/0194599814545325

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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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Positive Association between Tinnitus and Arterial Hypertension
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Randomized Controlled Trial in Clinical Settings to Evaluate Effectiveness of Coping Skills Education Used With Progressive Tinnitus Management
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Self-citation
Effectiveness of audiologist-delivered cognitive Behavioral therapy for tinnitus and hyperacusis rehabilitation: outcomes for patients treated in routine practice
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Different bimodal neuromodulation settings reduce tinnitus symptoms in a large randomized trial
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Systematic review and meta-analysis of late auditory evoked potentials as a candidate biomarker in the assessment of tinnitus
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“Tinnitus patients are systematically evaluated at an outpatient clinic by an ear-nose-throat (ENT) physician, audiologist, and/or psychologist in a multidisciplinary setting [14, 15].”
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Husain, F., Gander, P., Jansen, J. N., & Shen, S. (2018) · Journal of american academy of audiology · doi:10.3766/jaaa.16154 · Cited by 42
Efficacy of pharmacologic treatment in tinnitus patients without specific or treatable origin: A network meta-analysis of randomised controlled trials
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Validation of Online Versions of Tinnitus Questionnaires Translated into Swedish
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Multisite Randomized Controlled Trial to Compare Two Methods of Tinnitus Intervention to Two Control Conditions
Henry, J. A., Stewart, B. J., Griest, S. E., Kaelin, C., Zaugg, T. L., & Carlson, K. F. (2016) · Ear and Hearing · doi:10.1097/aud.0000000000000330 · Cited by 44
Self-citation
The progression of chronic tinnitus over the years
Simoes, J. P., Neff, P. K. A., Langguth, B., Schlee, W., & Schecklmann, M. (2021) · Scientific Reports · doi:10.1038/s41598-021-83068-5 · Cited by 43
Antioxidant therapy in the elderly with tinnitus
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Acute effects and after-effects of acoustic coordinated reset neuromodulation in patients with chronic subjective tinnitus
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Customized Versus Noncustomized Sound Therapy for Treatment of Tinnitus: A Randomized Crossover Clinical Trial
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Multidisciplinary Tinnitus Research: Challenges and Future Directions From the Perspective of Early Stage Researchers
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Factors related to tinnitus and hyperacusis handicap in older people
Aazh, H., Lammaing, K., & Moore, B. C. J. (2017) · International Journal of Audiology · doi:10.1080/14992027.2017.1335887 · Cited by 40
Efficacy of tinnitus retraining therapy in the treatment of tinnitus: A meta-analysis and systematic review
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Objective and Measurable Biomarkers in Chronic Subjective Tinnitus
Kang, D. W., Kim, S. S., Park, D.-C., Kim, S. H., & Yeo, S. G. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22126619 · Cited by 41
Psychometric Validity, Reliability, and Responsiveness of the Tinnitus Functional Index
Chandra, N., Chang, K., Lee, A. C., Shekhawat, G., & Searchfield, G. (2018) · Journal of american academy of audiology · doi:10.3766/jaaa.16171 · Cited by 39
Internet/smartphone-based applications for the treatment of tinnitus: a systematic review
Nagaraj, M. K., & Prabhu, P. (2019) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-019-05743-8 · Cited by 40
Dismantling internet-based cognitive behavioral therapy for tinnitus. The contribution of applied relaxation: A randomized controlled trial
Beukes, E. W., Andersson, G., Fagelson, M. A., & Manchaiah, V. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100402 · Cited by 37
Tinnitus Screener: Results From the First 100 Participants in an Epidemiology Study
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Self-citation
Combined Amplification and Sound Generation for Tinnitus: A Scoping Review
Tutaj, L., Hoare, D. J., & Sereda, M. (2017) · Ear and Hearing · doi:10.1097/aud.0000000000000516 · Cited by 38
One Size Does Not Fit All: Developing Common Standards for Outcomes in Early-Phase Clinical Trials of Sound-, Psychology-, and Pharmacology-Based Interventions for Chronic Subjective Tinnitus in Adults
Hall, D. A., Hibbert, A., Smith, H. L., Haider, H. F., Londero, A., Mazurek, B., Fackrell, K., & initiative, F. T. C. O. M. I. T. (. (2019) · Trends in Hearing · doi:10.1177/2331216518824827 · Cited by 42
“The Tinnitus Guideline Development Group acting on behalf of the American Academy of Otolaryngology Head and Neck Surgery has appealed for further research to ‘‘determine which questionnaire is most useful for assessing relevant treatment effects’’ (Tunkel et al., 2014, p. S32).”
Health Care Utilization and Mental Health Diagnoses Among Veterans With Tinnitus
Carlson, K. F., Gilbert, T. A., O'Neil, M. E., Zaugg, T. L., Manning, C. A., Kaelin, C., Thielman, E. J., Reavis, K. M., & Henry, J. A. (2019) · American Journal of Audiology · doi:10.1044/2018_aja-ttr17-18-0042 · Cited by 37
Self-citation
Audiologist-Supported Internet-Based Cognitive Behavioral Therapy for Tinnitus in the United States: A Pilot Trial
Beukes, E. W., Andersson, G., Fagelson, M., & Manchaiah, V. (2021) · American Journal of Audiology · doi:10.1044/2021_aja-20-00222 · Cited by 34
Evidence and evidence gaps in tinnitus therapy
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Big Five Personality Traits are Associated with Tinnitus Improvement Over Time
Simoes, J. P., Schlee, W., Schecklmann, M., Langguth, B., Farahmand, D., & Neff, P. K. A. (2019) · Scientific Reports · doi:10.1038/s41598-019-53845-4 · Cited by 36
A revised grading system for the Tinnitus Handicap Inventory based on a large clinical population
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“Moreover, approximately one-third of adults experiencing tinnitus report that it is bothersome, i.e. negatively affects his or her daily performance (Tunkel et al. 2014).”
Influential
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Equity and person-centeredness in provision of tinnitus services in UK National Health Service audiology departments
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A systematic review of techniques and effects of self-help interventions for tinnitus: Application of taxonomies from health psychology
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Towards a Mechanistic-Driven Precision Medicine Approach for Tinnitus
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Development and field testing of a smartphone “App” for tinnitus management
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Self-citation
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“Although the current approach to tinnitus is based on symptomatic approaches, its classification continues to be established by its origin or etiology.1--3 In the Clinical Practice Guideline Tinnitus -- CPGT, Tunkel et al. (2014)4 addressed the importance of classification to direct the treatment, considering individu…”
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Tinnitus characteristics and associated variables on Tinnitus Handicap Inventory among a Hungarian population
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“org/licenses/by-nc-nd/4 impaction to otosclerosis, cochlear abnormalities, and auditory nerve and central nervous system pathologies [Tunkel et al., 2014].”

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: Tunkel, David E.
Bauer, Carol A.
Rosenfeld, Richard M.
Chandrasekhar, Sujana S.
Blakley, Brian W.
Carter, John M.
Henry, James A.
Khan, Fawad A.
Omole, Folashade S.
Phillips, C. Douglas
Tyler, Richard S.
Waguespack, Richard
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
DOI: 10.1177/0194599814545325
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
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Otolaryngology (publishedVersion)
PubMed (publishedVersion)
Funders: American Academy of Otolaryngology-Head and Neck Surgery
Topics: Life Sciences › Neuroscience › Sensory Systems › Hearing, Cochlea, Tinnitus, Genetics
Health Sciences › Health Professions › Speech and Hearing › Hearing Loss and Rehabilitation
Physical Sciences › Physics and Astronomy › Acoustics and Ultrasonics › 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

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