Management of Tinnitus

Publication Date: July 10, 2024
Last Updated: July 11, 2024

Monitoring

We suggest using validated subjective outcome measures (e.g., Tinnitus Functional Index, Tinnitus Handicap Inventory) to monitor the effectiveness of tinnitus management. (Weak for)
315659
We suggest against psychoacoustic measures (e.g., minimum masking level, loudness matching) to monitor the effectiveness of tinnitus management. (Weak against)
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Education and Self-Management

We suggest educational counseling to reduce the functional impact of tinnitus. (Weak for)
315659
There is insufficient evidence to recommend for or against the use of web-based or app-based selfmanagement for tinnitus (Neither for or against)
315659

There is insufficient evidence to recommend for or against the use of computer-based games, training programs, or both for tinnitus self-care.

(Neither for or against)
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Amplification Devices

Non-surgical

We suggest hearing aids for tinnitus management in adults with hearing loss (see narrative for discussion of patients without hearing loss). (Weak for)
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There is insufficient evidence to recommend for or against contralateral routing of signal/sound (CROS) hearing aids for tinnitus management in adults with single-sided deafness. (Neither for or against)
315659

Surgical

We suggest cochlear implantation for tinnitus management in adults who meet candidacy requirements. (Weak for)
315659

There is insufficient evidence to recommend for or against implantable bone conduction devices (BCD) for tinnitus management in adults with single-sided deafness.

(Neither for or against)
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We suggest cochlear implants over implantable bone conduction devices (BCD) or contralateral routing of signal/sound (CROS) hearing aids for tinnitus management in adults with single-sided deafness who meet candidacy requirements. (Weak for)
315659

Sound-Based Intervention Alone

There is insufficient evidence to recommend for or against auditory cognitive training (e.g., frequency discrimination training, auditory attention training) for the reduction of tinnitus distress and functional impact. (Neither for or against)
315659
We suggest the therapeutic use of sound for tinnitus self-care. (Weak for)
315659
There is insufficient evidence to recommend for or against sound therapy with altered music (e.g., notched music therapy, spectrally altered music) to reduce the impact of tinnitus. (Neither for or against)
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Behavioral Intervention Alone

We suggest cognitive behavioral therapy (CBT) by a trained provider for adults with bothersome tinnitus.

(Weak for)
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There is insufficient evidence to recommend for or against the following psychological interventions by a trained provider for adults with bothersome tinnitus (unranked).
  • Acceptance and Commitment Therapy (ACT)
  • Mindfulness-based therapies
  • Mindfulness-Based Stress Reduction (MBSR)
(Neither for or against)
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Combined SoundBased and Behavioral Intervention

We suggest sound therapy combined with cognitive behavioral therapy (CBT) for tinnitus management by a multidisciplinary team. (Weak for)
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We suggest sound enrichment with ongoing directed tinnitus education by an audiologist. (Weak for)
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Neuromodulation/ Neurostimulation

There is insufficient evidence to recommend for or against repetitive transcranial magnetic stimulation (rTMS) for tinnitus management. (Neither for or against)
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There is insufficient evidence to recommend for or against transcutaneous electric nerve stimulation (TENS) for tinnitus management. (Neither for or against)
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There is insufficient evidence to recommend for or against transcranial direct current stimulation (tDCS) for tinnitus management.

(Neither for or against)
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We suggest against low-level laser therapy for tinnitus management. (Weak against)
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Manual Therapy

We suggest a multidisciplinary approach for the assessment and treatment of patients with bothersome tinnitus and temporomandibular disorder (TMD), cervical spine dysfunction, or both to reduce the functional impact of tinnitus. (Weak for)
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Complementary and Integrative Health

There is insufficient evidence to recommend for or against acupuncture for tinnitus management. (Neither for or against)
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Herbals, Nutraceuticals, Supplements

We suggest against the use of ginkgo biloba, dietary or herbal supplements, or nutraceuticals for tinnitus management. (Weak against)
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Pharmacotherapy

We suggest against the use of anticonvulsants, antidepressants, antiemetics, antithrombotics, betahistine, intratympanic corticosteroid injections, or n-methyl d-aspartic acid (NMDA) receptor antagonists for tinnitus management.

(Weak against)
315659

Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Management of Tinnitus

Authoring Organization

Veterans Health Administration / Department of Defense

Publication Month/Year

July 10, 2024

Last Updated Month/Year

July 15, 2024

Document Type

Guideline

Country of Publication

US

Document Objectives

The guideline describes the critical decision points in Tinnitus and provides clear and comprehensive evidence based recommendations incorporating current information and practices for practitioners throughout the DoD and VA Health Care systems. The guideline is intended to improve patient outcomes and local management of patients who have tinnitus.

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Audiologist, nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D014012 - Tinnitus

Keywords

tinnitus

Supplemental Methodology Resources

Data Supplement