The need to differentiate “bothersome” from “nonbothersome” tinnitus is the first step in assessing and managing people with primary persistent tinnitus.
This is one of 13 recommendations provided in recent clinical practice guidelines on tinnitus [PDF] by the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS). The guidelines focus on primary persistent tinnitus, defined as tinnitus that is idiopathic and may or may not be associated with concomitant sensorineural hearing loss (SNHL) that lasts six months or longer.
Not covered in the guidelines is secondary tinnitus, which is defined as tinnitus that is associated with a specific underlying cause or organic condition that can be identified.
“Although tinnitus affects about 10% to 15% of adults in the U.S., only about 20% of people who experience tinnitus have bothersome tinnitus,” said Sujana S. Chandrasekhar, MD of the AAO-HNS. “That is, tinnitus that so affects their quality of life that treatment is required.”
For these patients, the guidelines recommend interventions that include education and counseling, hearing aid evaluation, cognitive behavioral therapy, and the option for sound therapy. Interventions recommended against include routine psychiatric or other treatments, dietary supplements, or transcranial magnetic stimulation.
“This guideline helps the clinician systematically address the problem, obtain enough data to alleviate fears of an as-yet-undiscovered problem causing tinnitus, and work with the patient to help them manage their tinnitus and improve their quality of life,” she said.
Dr. Chandrasekhar also highlighted the importance of not overusing imaging to diagnose tinnitus, emphasizing that the practice guidelines strongly recommend against routine imaging studies of the head and neck in patients with tinnitus.
Among the gaps that remain in the evidence on the diagnosis and management of tinnitus is the utility of acupuncture, she said, as well as the need for a better classification of tinnitus and establishment of validated questionnaires.