Tinnitus guideline update shifts focus toward individualized care, away from drugs

Clinical takeaway: For adults with persistent, bothersome tinnitus, clinicians should prioritize targeted evaluation, hearing assessment, and evidence-based nonpharmacologic therapies such as cognitive behavioral therapy (CBT). The guideline also advises against routinely using medications, dietary supplements, or most device-based interventions solely to treat tinnitus.

The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has released an updated clinical practice guideline for adults with persistent, bothersome tinnitus, reinforcing a personalized approach that targets symptom burden, associated hearing loss, and quality-of-life effects rather than tinnitus loudness alone.

The guideline applies to adults aged 18 years and older with bothersome tinnitus lasting at least 6 months. It highlights the importance of distinguishing bothersome from nonbothersome tinnitus early in the evaluation, as management recommendations are directed toward patients whose symptoms meaningfully impair daily functioning.

Several recommendations focus on identifying underlying conditions while avoiding unnecessary testing. Clinicians should perform a targeted history and physical examination, obtain a comprehensive audiologic evaluation, and assess patients with bothersome tinnitus for risk of self-harm. The guideline strongly recommends against routine neuroradiologic imaging unless specific concerning clinical features are present.

Management recommendations emphasize education and hearing-related interventions. Patients should receive counseling about the natural history of tinnitus and available management strategies. Those with hearing difficulties should be referred for hearing aid evaluation, while patients meeting audiologic criteria should be considered for cochlear implant evaluation.

Among symptom-directed treatments, CBT remains the only intervention specifically recommended for persistent, bothersome tinnitus. Sound enrichment may be offered as an option, and clinicians may consider bimodal neuromodulation, a newer approach that combines auditory stimulation with stimulation of another sensory pathway.

The update also provides clear guidance on therapies that should generally be avoided. Clinicians are advised not to routinely recommend antidepressants, anticonvulsants, anxiolytics, or intratympanic medications when the primary goal is tinnitus treatment. Dietary supplements are likewise not recommended, and the guideline advises against repetitive transcranial magnetic stimulation (rTMS).

The guideline further encourages clinicians to assess treatment outcomes over time and to consider whether somatosensory factors may contribute to symptoms in selected patients.

Emphasizing the need for individualized care, the authors noted that tinnitus can arise from multiple auditory and nonauditory causes and that management should be tailored to a patient's symptoms, comorbidities, hearing status, and treatment goals.

“There’s no single approach that works for everyone,” said Meredith E. Adams, MD, MS, chair of the guideline update group, underscoring the emphasis on individualized care.

What's changed

• Added a strong recommendation to assess patients with bothersome tinnitus for risk of self-harm.
• Added an option for clinicians to consider bimodal neuromodulation in selected patients.
• Added a recommendation to consider cochlear implant evaluation for patients who meet audiologic referral criteria.
• Expanded emphasis on documenting treatment outcomes and monitoring response to interventions.
• Reaffirmed recommendations against routine use of antidepressants, anticonvulsants, anxiolytics, intratympanic medications, dietary supplements, and rTMS for primary tinnitus treatment.

Source: Adams ME, et al. (2026 Oct 12) Otolaryngol Head Neck Surg. Clinical Practice Guideline: Tinnitus Update