![]() Patients should be referred to cognitive behavior therapy for chronic, bothersome primary tinnitus. Patient-oriented recommendation from the American Academy of Otolaryngology–Head and Neck Surgery and European guidelines based on observational studies with significant benefit over harm Imaging should be avoided unless tinnitus is unilateral, pulsatile, associated with asymmetric hearing loss, or with focal neurologic abnormalities. Patients should be referred within four weeks for audiologic examination if tinnitus is chronic, bothersome, unilateral, or associated with hearing changes. Guideline recommendation based on observational studies Guideline recommendation based on limited-quality studies of patient-oriented outcomesĪ focused history and physical examination should be performed to identify tinnitus characteristics and examination findings that direct differential diagnosis, further evaluation, and treatment options. Patients with primary tinnitus that is not bothersome do not require further intervention. 5, 7 Guidelines recommend a standard approach to history and physical examination that can begin the process of determining the etiology of the tinnitus, followed by audiometric testing and imaging, laboratory studies, and other testing as appropriate. 5, 6 Vascular and neuromuscular etiologies are the more common causes of secondary tinnitus. Secondary tinnitus results from sound generated by a source near the ear or referred to the ear, and is rare, accounting for less than 1% of tinnitus cases. 4 The etiology of primary tinnitus is often unclear, but most cases are associated with sensorineural hearing loss (SNHL). 1 – 3 At least 20% of people diagnosed with tinnitus will seek clinical intervention. Tinnitus is a common problem among adults in the United States, with an estimated prevalence of 10% to 15% and peak incidence between 60 and 69 years of age. Tinnitus is a symptom, not a disease, and although it is typically not associated with a dangerous condition, it can significantly affect quality of life. ![]() Tinnitus is the perception of sound in the absence of an objective internal or external source. Providing information about the natural progression of tinnitus and being familiar with the causes that warrant additional evaluation, imaging, and specialist involvement are essential to comprehensive care. Avoidance of noise exposure may help prevent the development or progression of tinnitus. Melatonin, antidepressants, and cognitive training may help with sleep disturbance, mood disorders, and cognitive impairments, respectively. Sound therapy and tinnitus retraining therapy are treatment options, but evidence is inconclusive. Cognitive behavior therapy is the only treatment that has been shown to improve quality of life in patients with tinnitus. Neuroimaging is not part of the standard workup unless the tinnitus is asymmetric or unilateral, pulsatile, associated with focal neurologic abnormalities, or associated with asymmetric hearing loss. A comprehensive audiologic evaluation should be performed for patients who experience unilateral tinnitus, tinnitus that has been present for six months or longer, or that is accompanied by hearing problems. Less common but potentially dangerous causes such as vascular tumors and vestibular schwannoma should be ruled out. A standard workup begins with a targeted history and physical examination to identify treatable causes and associated symptoms that may improve with treatment. Most cases of tinnitus are benign and idiopathic and are strongly associated with sensorineural hearing loss. ![]() Tinnitus is the sensation of hearing a sound in the absence of an internal or external source and is a common problem encountered in primary care.
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