What are the guideline sources, guidelines and references for Tinnitus ?
Guideline sources The following summarized guidelines for the evaluation and management of tinnitus are prepared by our editorial team based on guidelines from the American Cochlear Implant Alliance (ACI Alliance 2022) and the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO- HNSF 2014). 1 2 Pathway Tinnitus Diagnosis and management Guidelines 1. Classification and risk stratification Disease classification: Classify patients as having either bothersome tinnitus or non-bothersome tinnitus. B https://web.pathway.md/diseases/rec6Z6csiCcDsHCBw 1/3 6/24/23, 4:06 PM Tinnitus Pathway 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 2. Diagnostic investigations Initial evaluation: elicit a targeted history and perform a focused physical examination as part of the initial evaluation of patients with presumed primary tinnitus to identify conditions that, if promptly identified and managed, may relieve tinnitus. B Audiologic examination: obtain a prompt, comprehensive audiologic examination in patients with tinnitus that is unilateral, persistent (> 6 months), or associated with hearing difficulties. B Imaging studies: 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 3. Medical management Pharmacologic treatment: avoid routinely initiating antidepressants, anticonvulsants, anxiolytics, or intratympanic medications as a treatment for persistent, bothersome tinnitus. D 4. Nonpharmacologic interventions Hearing aid evaluation: refer patients with hearing loss and persistent, bothersome tinnitus for a hearing aid evaluation. B 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 Dietary supplements: avoid recommending Ginkgo biloba, melatonin, zinc, or other dietary supplements for symptom relief in patients with persistent, bothersome tinnitus. D Acupuncture: insufficient evidence to make a recommendation regarding the effect of acupuncture in patients with persistent bothersome tinnitus. 5. Therapeutic procedures Transcranial magnetic stimulation: avoid transcranial magnetic stimulation for the routine treatment of patients with persistent, bothersome tinnitus. D Cochlear implants: obtain standard medical workup and monitoring in patients with sudden and/or rapid progression of single-sided deadness to determine if the hearing spontaneously https://web.pathway.md/diseases/rec6Z6csiCcDsHCBw 2/3 6/24/23, 4:06 PM Tinnitus Pathway improves or is recoverable with treatment. Offer cochlear implantation not earlier than 3-6 months after the sudden hearing loss to allow ample time for potential recovery of hearing. E Show 13 more 6. Patient education General counseling: educate patients with persistent, bothersome tinnitus about management strategies. B References 1. Tunkel DE, Bauer CA, Sun GH et al. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg. 2014 Oct;151 2 Suppl):S1 S40. Open 2. Lisa R Park, Amanda M Griffin, Douglas P Sladen et al. American Cochlear Implant Alliance Task Force Guidelines for Clinical Assessment and Management of Cochlear Implantation in Children With Single- Sided Deafness. Ear Hear. 2022 Mar/Apr;43 2 255 267. Open https://web.pathway.md/diseases/rec6Z6csiCcDsHCBw 3/3