Clinical practice guideline: Tinnitus

David E. Tunkel, Carol A. Bauer, Gordon H. Sun, Richard M. Rosenfeld, Sujana S. Chandrasekhar, Eugene R. Cunningham, Sanford M. Archer, Brian W. Blakley, John M. Carter, Evelyn C. Granieri, James A. Henry, Deena Hollingsworth, Fawad A. Khan, Scott Mitchell, Ashkan Monfared, Craig W. Newman, Folashade S. Omole, C. Douglas Phillips, Shannon K. Robinson, Malcolm B. TawRichard S. Tyler, Richard Waguespack, Elizabeth J. Whamond

Research output: Contribution to journalReview articlepeer-review

487 Citations (SciVal)


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.

Original languageEnglish
Pages (from-to)S1-S40
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number2
StatePublished - 2014

Bibliographical note

Funding Information:
Competing interests: David E. Tunkel, occasional consultant for Medtronic. Gordon H. Sun, employed by Partnership for Health Analytic Research, LLC and by UCLA Arthur Ashe Student Health & Wellness Center; received research grant from Blue Cross BlueShield of Michigan and an honorarium from BMJ Publishing Group. Sujana S. Chandrasekhar, consultant/advisor for Cochlear Corp and Med El Corp; received clinical research funding from Sonitus; shareholder and board member for Scientific Development & Research, Inc. Eugene R. Cunningham Jr, salaried employee of AAO-HNSF. James A. Henry, received research funding from Starkey Corp, ReSound Corp, and Phonak Corp. Craig W. Newman, research funding from Sanuthera, Inc. C. Douglas Phillips, stock options in Medsolutions. Richard S. Tyler, grants from Cochlear Corp and DSE Healthcare; consultant for SoundCure, Orusmedical, and Micro Transponder. Richard Waguespack, consultant for Blue Cross BlueShield of Alabama and for Speakers Bureau TEVA: Respiratory; research funding for a tinnitus treatment modality study at the University of Alabama at Birmingham.

Publisher Copyright:
© American Academy of Otolaryngology-Head and Neck Surgery Foundation 2014.


  • amplification
  • hearing aids
  • hearing loss
  • quality of life
  • sound therapy
  • tinnitus

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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