What are the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) guidelines for assessment and management of chronic tinnitus?

Updated: Feb 27, 2020
  • Author: Aaron G Benson, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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In 2014, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) released the first evidence-based clinical guidelines for the assessment and management of chronic tinnitus. The major recommendations include the following [24] :

  • Conditions that if promptly managed may relieve tinnitus should be identified during the initial evaluation of a patient with presumed primary tinnitus
  • Patients with tinnitus that is unilateral and associated with hearing difficulties or that persists for 6 months or more should undergo a comprehensive audiologic examination. 
  • Imaging studies of the head and neck are not recommended specifically to evaluate tinnitus unless one or more of the following is present: tinnitus that localizes to 1 ear, pulsatile tinnitus, focal neurologic abnormalities, and/or asymmetrical hearing loss
  • Distinguish patients with bothersome tinnitus from those with nonbothersome tinnitus; educate patients with persistent, bothersome tinnitus about management strategies
  • Patients with hearing loss and persistent, bothersome tinnitus should be offered a hearing aid evaluation, sound therapy, and cognitive behavior therapy
  • Antidepressants, anticonvulsants, anxiolytics, or intratympanic medications should not be offered as a primary treatment for persistent, bothersome tinnitus
  • Ginkgo biloba, melatonin, zinc, or other dietary supplements or transcranial magnetic stimulation should not be recommended for treating patients with persistent, bothersome tinnitus

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