Tinnitus Guideline Update Backs CBT, Not rTMS, Supplements or Routine Drug Therapy

An updated clinical practice guideline on tinnitus, published in Otolaryngology–Head and Neck Surgery, includes 16 key action statements (KASs) on the evaluation and management of adults with persistent, bothersome tinnitus.

The guideline focuses on tinnitus that is both bothersome and persistent, lasting 6 months or longer, in adults 18 years and older. According to the authors, more than 50 million people in the US have reported experiencing tinnitus, an estimated prevalence of 10% to 15% in adults. The guideline was developed using the American Academy of Otolaryngology–Head and Neck Surgery Foundation's Clinical Practice Guideline Development Manual (3rd edition). The update group included otolaryngologists, audiologists, otologists/neurotologists, a psychiatrist, a radiologist, a neurologist, and a consumer advocate, among others.

The Guideline Update Group made strong recommendations that clinicians distinguish patients with bothersome tinnitus from those with non-bothersome tinnitus and inquire about risks for self-harm in patients with bothersome tinnitus. The group also strongly recommended against neuroradiologic imaging specifically to evaluate tinnitus unless specific concerning features are present.

Recommendations include a targeted history and physical examination, a comprehensive audiological evaluation, patient education, and hearing aid evaluation for patients with hearing difficulties. The guideline also recommends cochlear implant evaluation referral when patients meet audiologic criteria, cognitive behavioral therapy (CBT), and assessment and documentation of intervention outcomes. The group recommended against routinely recommending antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for a primary indication of treating persistent, bothersome tinnitus. It also recommended against dietary supplements and repetitive transcranial magnetic stimulation (rTMS).

The guideline lists inquiry about somatosensory features, sound enrichment, and bimodal neuromodulation as options. According to the authors, the guideline is intended to give clinicians a logical framework to improve patient care and mitigate the personal and social effects of persistent, bothersome tinnitus.

Source: Adams ME, Cramer JD, Tunkel DE, et al. Clinical practice guideline: tinnitus update. Otolaryngol Head Neck Surg. 2026;175:S1-S62. doi:10.1002/ohn.70417