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Miniseminar to Present AAO-HNSF Clinical Practice Guideline on Tinnitus

More than 50 million people in the United States have reported experiencing tinnitus, resulting in an estimated prevalence of 10 percent-15 percent in adults. Despite the high prevalence of tinnitus and its potential significant influence on quality of life (QOL), no evidence-based, multidisciplinary Clinical Practice Guidelines (CPGs) have been developed to assist clinicians with management, until now. The AAO-HNSF is pleased to present the newest CPG with official publication occurring in October.

The focus of this guideline is on tinnitus that is both bothersome and persistent (lasting six months or longer), which often negatively influences the patient’s QOL. The target audience for the guideline is any clinician, including non-physicians, involved in managing patients with tinnitus. The target patient population is limited to adults 18 years and older.

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 impact of persistent, bothersome tinnitus. The CPG and Miniseminar will discuss the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. Focus will then turn to the evaluation and treatment of patients with persistent primary tinnitus, with recommendations to guide the evaluation and measurement of the influence of tinnitus and to determine the most appropriate interventions to improve symptoms and QOL for tinnitus sufferers.

The development group made a strong recommendation that clinicians distinguish patients with bothersome tinnitus from patients with non-bothersome tinnitus. The development group made a strong recommendation against obtaining imaging studies of the head and neck in patients with tinnitus, specifically to evaluate the tinnitus, which does not localize to one ear, is non-pulsatile, and is not associated with focal neurologic abnormalities or an asymmetric hearing loss. The panel made the following recommendations: (1) Clinicians should 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; (2) Clinicians should obtain a prompt, comprehensive audiologic examination in patients with tinnitus that is unilateral, persistent (≥6months), or associated with hearing difficulties; (3) Clinicians should distinguish patients with bothersome tinnitus of recent onset from those with persistent symptoms (≥6months) to prioritize intervention and facilitate discussions about natural history and follow up care; (4) Clinicians should educate patients with persistent, bothersome tinnitus about management strategies; (5) Clinicians should recommend a hearing aid evaluation for patients  persistent, bothersome tinnitus associated with documented hearing loss; and (6) Clinicians should recommend Cognitive Behavioral Therapy (CBT) to patients with persistent, bothersome tinnitus. The panel recommended against: (1) Antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for the routine treatment of patients with persistent, bothersome tinnitus; (2) Ginkgo biloba, melatonin, zinc, or other dietary supplements for treating patients with persistent, bothersome tinnitus; and (3) Transcranial magnetic stimulation (TMS) for the routine treatment of patients with persistent, bothersome tinnitus. The development group provided the following options: (1) Clinicians may obtain an initial comprehensive audiologic examination in patients who present with tinnitus (regardless of laterality, duration, or perceived hearing status); and (2) Clinicians may 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.

Clinical Practice Guidelines on Tinnitus

  • 10:30 am -11:50 am, today
  • Moderator: David E. Tunkel, MD

 

OTHER SESSIONS  OF INTEREST

Instruction Course— Understanding Clinical  Practice Guidelines                 

  • 12:30 pm -1:30 pm, Sunday
  • Instructors: Richard M. Rosenfeld, MD, MPH, and Stephanie Jones