The American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) today published the Clinical Practice Guideline (CPG): Tinnitus Update in Otolaryngology–Head and Neck Surgery. More than 50 million people in the United States have reported experiencing tinnitus, and for some it brings significant anxiety, depression, sleep problems, and difficulty functioning. Yet the care patients receive varies widely, both in the treatments offered and in how closely clinicians follow published guidelines.
"Tinnitus is often described as ringing in the ears, but for many people it's much more than a sound. It can affect sleep, concentration, mood, and the ability to enjoy everyday life," said Meredith E. Adams, MD, MS, Chair of the AAO-HNSF Guideline Update Group.
Tinnitus is the perception of sound when there is no external source of the sound. It affects an estimated 10% to 15% of adults. While most people are only mildly affected, up to one-third of patients with tinnitus may have clinically significant depressive symptoms. Tinnitus is also the most common service-connected disability among U.S. military veterans, with nearly three million veterans receiving disability compensation for the condition. The updated guideline focuses on adults whose tinnitus is persistent and bothersome, meaning it lasts six months or longer and affects their quality of life.
"This update reflects what we've learned over the past decade. Every patient with tinnitus should receive a comprehensive hearing evaluation, and clinicians should ask directly about emotional distress and thoughts of self-harm. Strategies like cognitive behavioral therapy, hearing aids, and sound enrichment can help people manage their tinnitus, but there's no single approach that works for everyone, so we encourage patients to talk openly with their clinicians about which options are right for them," said Dr. Adams.
This multidisciplinary guideline updates the AAO-HNSF 2014 guideline and provides 16 research-based key action statements. They address a thorough initial history and physical exam; distinguishing bothersome from non-bothersome tinnitus; asking about risk of self-harm; comprehensive hearing evaluation; limiting imaging to patients with specific, concerning features; and patient education and counseling. They also cover hearing aids, cochlear implant evaluation, sound enrichment, cognitive behavioral therapy, and follow-up to track how well treatments are working. The guideline recommends against routinely using medications, dietary supplements, or repetitive transcranial magnetic stimulation to treat tinnitus. It also includes new statements on self-harm, somatosensory tinnitus (tinnitus that changes with head, neck, or jaw movement), cochlear implantation, bimodal neuromodulation, and follow-up.
The Guideline Update Group was led by the AAO-HNSF and included otolaryngologists, audiologists, otologists/neurotologists, a geriatrician, a behavioral neuroscientist, a neurologist, a radiologist, a psychiatrist, an internist, a nurse practitioner, an otolaryngology resident, and a consumer advocate. The guideline has been endorsed by the following organizations: American Academy of Audiology, American Geriatrics Society, American Neurotology Society, American Otological Society, American Speech-Language-Hearing Association, American Tinnitus Association, and Society of Otorhinolaryngology and Head-Neck Nurses.
