The DOI matches its Crossref record; 247 of the 250 references it cites were found in a registry or an index.
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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In the citing paper
“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
In the citing paper
“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]
In the citing paper
“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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Reverse Correlation Uncovers More Complete Tinnitus Spectra
Hoyland, A., Barnett, N. V., Roop, B. W., Alexandrou, D., Caplan, M., Mills, J., Parrell, B., Chari, D. A., & Lammert, A. C. (2023) · IEEE Open Journal of Engineering in Medicine and Biology · doi:10.1109/ojemb.2023.3275051 · Cited by 4
Reliability and validity of the mandarin version of the tinnitus primary function questionnaire
Lü, T., Liu, J.-H., Li, G., Xiang, T., Ma, Y., Zhong, J., Chen, J., He, Y.-R., Huang, H.-M., Zhang, Z.-Y., et al. (2019) · Medicine · doi:10.1097/md.0000000000016104 · Cited by 5
“All of the subjects recruited to the study were diagnosed with primary tinnitus([32]) and consulted the hearing clinic of West China Hospital of Sichuan University in Sichuan Province of China from July 15, 2017 toOctober 14, 2017 and December 13, 2017 to September 21, 2018.”
Validation of the Tinnitus Acceptance Questionnaire: Japanese Version
Takabatake, S., Takahashi, M., Kabaya, K., Sekiya, Y., Sekiya, K., Harata, I., Kondo, M., & Akechi, T. (2022) · Audiology Research · doi:10.3390/audiolres12010006 · Cited by 4
Quality of Life: Tinnitus and Psychopathological Symptoms
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Self-citationCoco, L., Hooker, E. R., Gilbert, T. A., Prewitt, A. L., Reavis, K. M., O'Neil, M. E., Clark, K. D., Henry, J. A., Zaugg, T. L., & Carlson, K. F. (2023) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000896 · Cited by 4
Self-citationTheta–Beta/Gamma Coupling Identifies Bothersome Tinnitus Induced by Thalamocortical Dysrhythmia
Wang, Y., Zhang, J., Huang, X., Huang, S., Feng, Y., Shi, H., Wang, H., Salvi, R., & Yin, S. (2025) · Brain and Behavior · doi:10.1002/brb3.70437 · Cited by 4
“These severe symptoms are referred to as bothersome (BT) (Tunkel et al. 2014) or decompensated (Leńarz 1998) tinnitus.”
A Scoping Review of Otologic Manifestations of Hematologic Malignancies
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“It is of high importance to point out that most authoritative learned societies and established guidelines do not recommend pharmacological treatments for chronic tinnitus [76–78].”
Auditory hallucinations in cognitive neurology
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Does insular cortex lesion cause tinnitus in rats?
Karimi, M., Farahani, S., Nasirinezhad, F., Jalaie, S., Mokrian, H., & Shahbazi, A. (2022) · PubMed Central · doi:10.22038/ijbms.2022.63698.14083 · Cited by 3
Effect of tinnitus on sound localization ability in patients with normal hearing
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The association of subjective and objective sleep measures with chronic tinnitus
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“In the Beaver Dam Offspring Study (2005-2008) of over 3,000 adults aged 21-84, 10.6% reported tinnitus of at least moderate severity or difficulty falling asleep [21].”
BackgroundInfluentialNeuroanatomical Insights: Convergence and Divergence of Tinnitus with Normal or Mild Hearing Loss
Shen, X., Li, J., Pan, H., Wang, L., Leng, Y., Xiao, H., Liu, B., & Fan, W. (2025) · Biomedicines · doi:10.3390/biomedicines13020286 · Cited by 4
Heart Rate Variability Biofeedback for Tinnitus: Preliminary Findings from Multiple Case Studies
Kutyana, A. M. (2015) · Biofeedback · doi:10.5298/1081-5937-43.3.04 · Cited by 4
Hearing Disorders Associated With Mild Traumatic Brain Injury (mTBI)
Singh, T., & Seidman, M. D. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-812344-7.00011-x · Cited by 4
Development and Evaluation of Portal do Zumbido: A Novel Telehealth Approach to Tinnitus
de Matos, I. L., Ferreira, M. C., & Mondelli, M. F. C. G. (2020) · International Archives of Otorhinolaryngology · doi:10.1055/s-0040-1709113 · Cited by 4
Tinnitus features according to caffeine consumption
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Munjal, T., Silchenko, A., Pfeifer, K. J., Han, S. S., Yankulova, J. K., Fitzgerald, M., Adamchic, I., & Tass, P. (2021) · Frontiers in Network Physiology · doi:10.3389/fnetp.2021.734344 · Cited by 4
[Principles of diagnosis and treatment of tinnitus].
Shelesko, E. V., Chernikova, N. A., Fomochkina, L., Lebedeva, M. A., Nikonova, S. D., Doronina, V. A., & Zinkevich, D. (2021) · Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova · doi:10.17116/jnevro202112111199 · Cited by 5
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Clinical Features of Non-Lateralized Tinnitus
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BackgroundA Unilateral Cochlear Implant for Tinnitus
Elgandy, M. S., Tyler, R. S., Dunn, C. C., Hansen, M. R., & Gantz, B. J. (2018) · The International Tinnitus Journal · doi:10.5935/0946-5448.20180022 · Cited by 4
Self-citationEffectiveness and safety of acupuncture for treatment of tinnitus
Yang, Y., Fu, Q., Fu, L., Wang, X., Zhong, J., & Zhang, Q. (2020) · Medicine · doi:10.1097/md.0000000000022501 · Cited by 4
“Not surprisingly, tinnitus imparts an enormous economic and social burden.([3]) Because the aetiology and pathogenesis of tinnitus are not clear, evidence-based treatment options for tinnitus are still limited.”
Husain, F. T. (2021) · The Psychology of learning and motivation/The psychology of learning and motivation · doi:10.1016/bs.plm.2021.02.002 · Cited by 5
Giuliani, N. P. (2021) · American Journal of Audiology · doi:10.1044/2021_aja-21-00025 · Cited by 4
Thompson, D. M., Taylor, J., Hall, D. A., Walker, D. M., McMurran, M., Casey, A., Stockdale, D., Featherstone, D., & Hoare, D. J. (2018) · Aston Publications Explorer (Aston University) · Cited by 4
Åhnblad, P., & Nordkvist, A. (2017) · The International Tinnitus Journal · doi:10.5935/0946-5448.20170028 · Cited by 4
Letter to the Editor: Misophonia: A Need for Audiological Diagnostic Guidelines
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Neural Oscillations and Tinnitus: A Review of Pathogenesis and Therapy
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Meta-analysis Update on Cognitive Behavioral Therapy for Tinnitus
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Tinnitus in Normal-Hearing Individuals: Is Outer Hair Cell Dysfunction the Mechanism?
Chimona, T. S., Vrentzou, M., Erotokritakis, E., Tsakiraki, E. S., Asimakopoulou, P., & Papadakis, C. E. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14155232 · Cited by 3
Central functional connectivity reorganization in idiopathic tinnitus
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Thalamocortical dysrhythmia-related sleep spindle desynchronization in patients with tinnitus
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Towards a psychological framework on time perception in patients with chronic tinnitus
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Lv, H., Liu, J., Chen, Q., Ji, J., Zhai, J., Zhang, Z., Wang, Z., Gong, S., & Wang, Z. (2024) · IEEE Transactions on Neural Systems and Rehabilitation Engineering · doi:10.1109/tnsre.2024.3373335 · Cited by 3
Tinnitus Prevalence, Associated Characteristics, and Treatment Patterns among Adults in Saudi Arabia
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Alucinaciones auditivas en neurología cognitiva
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“This approach has received the greatest attention in the literature on tinnitus management [16–18] and is one of the limited interventions recommendations by the AAO-HNS [8].”
InfluentialDesenvolvimento de um sistema de apoio a pacientes com zumbido
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Corticosteroids in Otorhinolaryngology
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Acceptability of Cognitive Behavioral Therapy for Tinnitus: A Study With Veterans and Nonveterans
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Clark, K. D., Coco, L., Zaugg, T. L., DeFrancesco, S., Kaelin, C., Henry, J. A., & Carlson, K. F. (2023) · American Journal of Audiology · doi:10.1044/2023_aja-23-00040 · Cited by 3
Self-citationNoninvasive Treatment of Venous Pulsatile Tinnitus with an Internal Jugular Vein Compression Collar
Succop, B. S., Thompson, N. J., Dedmon, M. M., Gelinne, A., Selleck, A., Reed, S., & Sindelar, M. B. D. (2024) · The Laryngoscope · doi:10.1002/lary.31326 · Cited by 3
Lelic, D., Caporali, S., Parker, D., Nielsen, J., & Balling, L. W. (2024) · Frontiers in Audiology and Otology · doi:10.3389/fauot.2024.1322596 · Cited by 3
Differences in brain functional connectivity between tinnitus with or without hearing loss
Song, J., Wang, Y., Ouyang, F., Zeng, X., & Yang, J. (2024) · Neuroreport · doi:10.1097/wnr.0000000000002057 · Cited by 3
Rossi, N. A. A., Corona, K. K., Yoshiyasu, Y., Young, D. L., & McKinnon, B. J. (2024) · Otology & Neurotology Open · doi:10.1097/ono.0000000000000059 · Cited by 3
An Integrated Physical Regulation Theory and Classification of Acute Tinnitus
Ma, X., Li, J., Lai, J., & Yu, L. (2021) · Current Medical Science · doi:10.1007/s11596-021-2322-5 · Cited by 3
Wei, X., Lv, H., Chen, Q., Wang, Z., Zhao, P., Liu, C., Gong, S., Yang, Z., & Wang, Z. (2021) · Frontiers in Neuroscience · doi:10.3389/fnins.2021.709482 · Cited by 4
Indications of Kampo Medicine for Neuro-Otologic Disease
Okayasu, T., Ohyama, H., Kitano, K., Mitani, K., & Kitahara, T. (2021) · 日本東洋醫學雜誌 · doi:10.3937/kampomed.72.1 · Cited by 3
Integrating pharmacogenomics into clinical trials of hearing disorders
Brutnell, T. P., Wang, X., & Bao, J. (2022) · The Journal of the Acoustical Society of America · doi:10.1121/10.0015092 · Cited by 3
Tinnitus Education for Audiologists Is a Ship at Sea: Is It Coming or Going?
Fagelson, M. A. (2023) · Audiology Research · doi:10.3390/audiolres13030034 · Cited by 3
Mennemeier, M., & George, M. S. (2017) · JAMA Otolaryngology–Head & Neck Surgery · doi:10.1001/jamaoto.2016.4055 · Cited by 3
Tinnitus Perspectives among Israeli Ear, Nose and Throat Physicians: A Nationwide Survey
Handzel, O., Tamir, S. O., Marom, T., Shushan, S., Goldfarb, A. R., Cinamon, U., Gluck, O., & Oron, Y. (2018) · The Journal of International Advanced Otology · doi:10.5152/iao.2018.5627 · Cited by 3
Wang, S., Chen, Z., Dai, J., Yu, F., & Kang, H. (2021) · Medicine · doi:10.1097/md.0000000000023883 · Cited by 3
“Unexplained subjective tinnitus is also called idiopathic tinnitus.([3]) Due to the high incidence of tinnitus, especially persistent annoying subjective tinnitus can cause anxiety, depression and insomnia in patients, and seriously affect the quality of lives of patients.”
Effects of sound source localization of masking sound on perception level of simulated tinnitus
Kubota, Y., Takahashi, K., Nonomura, Y., Yamagishi, T., Ohshima, S., Izumi, S., Morita, Y., Aizawa, N., & Horii, A. (2022) · Scientific Reports · doi:10.1038/s41598-022-05535-x · Cited by 3
Current Therapeutic Trends for Tinnitus Cure and Control: A Scoping Review
CHHAYA, V. A., Patel, D., Mehta, S. P., Rajvir, J. P., Jhinjhuwadia, V. J., Sehgal, P., & KHAMBHOLJA, K. M. (2023) · Indian Journal of Otolaryngology and Head & Neck Surgery · doi:10.1007/s12070-023-03910-2 · Cited by 3
Comparison of ChatGPT and Gemini as sources of references in otorhinolaryngologyPreprint
Jędrzejczak, W. W., Pastucha, M., Skarżyńśki, H., & Kochanek, K. (2024) · medRxiv · doi:10.1101/2024.08.12.24311896 · Cited by 3
Research trends and hotspots of cognitive behavioral therapy for tinnitus: a bibliometric analysis
He, Y., Liu, J., Cheng, H., Ye, H., Li, C., Gao, Y., & Xu, X. (2025) · Frontiers in Neuroscience · doi:10.3389/fnins.2025.1536224 · Cited by 2
“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), and it has been proven to significantly reduce tinnitus-related distress, anxiety, and depression, and improve the quality of life…”
Kabaya, K., Takahashi, M., Esaki, S., Minakata, T., & Iwasaki, S. (2024) · Otology & Neurotology · doi:10.1097/mao.0000000000004278 · Cited by 2
Fuchten, D., Smit, A. L., & Stegeman, I. (2024) · Frontiers in Neurology · doi:10.3389/fneur.2024.1376826 · Cited by 2
Harmon, E. D., & Goodman, M. L. (2025) · The Nurse Practitioner · doi:10.1097/01.npr.0000000000000274 · Cited by 2
NMDA Receptors: Next therapeutic targets for Tinnitus?
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Ni, T., Jiang, Y., Lin, Z., Ruan, J., Wang, Y., Liu, Y., & Han, Z. (2025) · Frontiers in Neuroscience · doi:10.3389/fnins.2025.1544723 · Cited by 2
“…as a potential option for the management of persistent and bothersome tinnitus when patients are counseled to maintain expectations of potential treatment benefits, although the evidence supporting its efficacy remained limited due to high risk of bias and small sample sizes (Tunkel et al., 2014).”
Schumacher, C. G., Moreira, H. G., Moraes, D. A. D. O., Lazzari, L. R., Garcia, M. V., & Didoné, D. D. (2025) · CoDAS · doi:10.1590/2317-1782/e20240211pt · Cited by 2
Multi-modal virtual reality system for tinnitus treatment methods and validation
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“In October 2014, the American Academy of Otolaryngology in collaboration with a group of leading clinician researchers released new Clinical Practice Guidelines (CPG) for the assessment and management of tinnitus (Tunkel et al., 2014).”
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Ganesan, P., Rodrigo, H., Schmiedge, J., Reiter, R., Swapna, S., & Manchaiah, V. K. C. (2021) · The Journal of International Advanced Otology · doi:10.5152/iao.2021.21169 · Cited by 2
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Self-citationGuo, Y., Ho, L. F., Chen, L., Tsang, P. H., Chen, M., Chan, K. L., Ng, B. F. L., & Lin, Z. X. (2023) · Medicine · doi:10.1097/md.0000000000034315 · Cited by 2
Cognitive behavioral therapy for patients suffering with tinnitus distress
Miller, L. (2023) · JAAPA · doi:10.1097/01.jaa.0000947036.33633.84 · Cited by 2
Meade, T., Higgins, A., & Lin, D. (2023) · American Journal of Otolaryngology · doi:10.1016/j.amjoto.2023.104205 · Cited by 2
Balatsouras, D. G., Papitsi, I., Koukoutsis, G., & Katotomichelakis, M. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1252343 · Cited by 2
“According to the Clinical Practice Guideline for Tinnitus of the American Academy of Otolaryngology-Head and Neck Surgery (Tunkel et al., 2014), the period to distinguish between recent onset and persistent tinnitus is 6 months.”
Portmann, D., Estève-Fraysse, M.-J., Frachet, B., Herpin, F., Rigaudier, F., & Juhel, C. (2024) · Audiology Research · doi:10.3390/audiolres14020031 · Cited by 1
Tekumalla, S., Perlov, N. M., Gokhale, S., Awosanya, S., Urdang, Z. D., Croce, J., Bixler, A., Willcox, T. O., Chiffer, R. C., & Fitzgerald, D. C. (2024) · Otolaryngology · doi:10.1002/ohn.777 · Cited by 2
Metadata
- 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
- 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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