Different Teams, Same Conclusions? A Systematic Review of Existing Clinical Guidelines for the Assessment and Treatment of Tinnitus in Adults

Abstract

Background: Though clinical guidelines for assessment and treatment of chronic subjective tinnitus do exist, a comprehensive review of those guidelines has not been performed. The objective of this review was to identify current clinical guidelines, and compare their recommendations for the assessment and treatment of subjective tinnitus in adults.Method: We systematically searched a range of sources for clinical guidelines (as defined by the Institute of Medicine, United States) for the assessment and/or treatment of subjective tinnitus in adults. No restrictions on language or year of publication were applied to guidelines.Results: Clinical guidelines from Denmark, Germany, Sweden, The Netherlands, and the United States were included in the review. There was a high level of consistency across the guidelines with regard to recommendations for audiometric assessment, physical examination, use of a validated questionnaire(s) to assess tinnitus related distress, and referral to a psychologist when required. Cognitive behavioral treatment for tinnitus related distress, use of hearing aids in instances of hearing loss and recommendations against the use of medicines were consistent across the included guidelines. Differences between the guidelines centered on the use of imaging in assessment procedures and sound therapy as a form of treatment for tinnitus distress respectively.Conclusion: Given the level of commonality across tinnitus guidelines from different countries the development of a European guideline for the assessment and treatment of subjective tinnitus in adults seems feasible. This guideline would have the potential to benefit the large number of clinicians in countries where clinical guidelines do not yet exist, and would support standardization of treatment for patients across Europe.

A multidisciplinary European guideline for tinnitus: diagnostics, assessment, and treatment

“…The tinnitus assessments (diagnostics and measures), processes and treatment options recommended by the respective guidelines were compared and summarised. Methods are described in brief here and are reported in full by Fuller et al [79].…”

“…The content and structure of these sections were informed by multiple sources in two steps. First, the authors reviewed diagnostics and assessments that are currently used across Europe [15], and the recommended diagnostics and assessments included in existing national clinical practice guidelines (USA, Denmark, Sweden, Germany, and The Netherlands; Fuller et al [79]). An initial proposal was thereafter agreed by consensus of the authors based onknowledge ofcurrentuse inclinical practice specifically for tinnitus, and therefore of the need to provide endorsement of those procedures considered safe and clinically useful (and exclude those that were considered not).…”

One-Year Results for Patients with Unilateral Hearing Loss and Accompanying Severe Tinnitus and Hyperacusis Treated with a Cochlear Implant

“…Techniques such as cognitive behavioural therapy help to alter the noxious response to tinnitus [Cima et al, 2014]. Where patients have a hearing loss, hearing aid fitting is recommended, or if the hearing loss is severe to profound, a cochlear implant (CI) is indicated [Fuller et al, 2017;Zenner et al, 2017]. The prevalence of tinnitus in patients with severe to profound bilateral hearing loss being considered for cochlear implantation is high.…”

“…However, for some people their tinnitus is persistent, debilitating, and has a negative impact on their quality of life and speech comprehension, even when present in only one ear [Van de Heyning et al, 2008;Fuiji et al, 2011;Vielsmeier et al, 2016;Weidt et al, 2016]. Tinnitus treatment and assessment is complex with no commonly agreed management pathway and presents an ever-increasing burden on health care services [Martinez et al, 2015;Fuller et al, 2017].…”

Do dietary factors significantly influence tinnitus?

“…22 The lack of efficacy is unanimously confirmed by several systematic reviews and existing clinical guidelines for the treatment of tinnitus: dietary supplements or herbs do not improve the symptoms of people with tinnitus and can cause serious side effects, especially if taken along with conventional medications (eg blood thinners, antibiotics). 4,6,7,23,24 Dietary supplements may increase or decrease the effectiveness of medication and alter the results of blood or urine tests. According to Cochrane reviews, supplementation with ginkgo biloba or zinc does not relieve tinnitus symptoms and is no more effective than placebo (adverse effects such as gastrointestinal disturbances, headache or allergic reactions may occur).…”