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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“Given the amount of time and effort involved, I was surprised to learn that this type of representation of tinnitus is actually “not helpful for diagnostic purposes, for guiding intervention, or for assessing outcomes of intervention” (Tunkel et al. 2014).”
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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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