Tinnitus Diagnosis and management Disease classification Classify patients as having either bothersome tinnitus or non-bothersome tinnitus. B Classify patients with bothersome tinnitus as having symptoms of recent onset (< 6 months) or persistent symptoms ( 6 months) to prioritize intervention and facilitate discussions about natural history and follow-up care. B Audiologic examination Q Does the patient have unilateral tinnitus? Q Does the patient have persistent tinnitus (> 6 months)? Q Does the patient have associated hearing difficulties? Yes to any Obtain a prompt, comprehensive audiologic examination in patients with tinnitus that is unilateral, persistent (> 6 months), or associated with hearing difficulties. B No to all Imaging studies Q Does the patient have pulsatile tinnitus? Q Does the patient have focal neurological abnormalities? Q Does the patient have asymmetric hearing loss? Q Does the patient have unilateral tinnitus? Yes to any Avoid obtaining imaging studies of the head and neck as part of the evaluation of patients with tinnitus, unless they have 1 or more of the following: tinnitus that localizes to 1 ear, pulsatile tinnitus, focal neurological abnormalities, or asymmetric hearing loss. D No to all General counseling Q Does the patient have persistent, bothersome tinnitus? Yes Educate patients with persistent, bothersome tinnitus about management strategies. B Pharmacologic treatment Avoid routinely initiating antidepressants, anticonvulsants, anxiolytics, or intratympanic medications as a treatment for persistent, bothersome tinnitus. D Sound therapy Consider providing sound therapy in patients with persistent, bothersome tinnitus. C Cognitive behavioral therapy Refer patients with persistent, bothersome tinnitus for CBT. B No Continue management and follow-up as clinically appropriate.