Publication Date: October 1, 2014
Last Updated: September 2, 2022

Table 2. Summary of Guideline Key Action Statements (KAS)

1. History and Physical Examination

Clinicians should perform a targeted history and physical examination at the initial evaluation of a patient to identify conditions that if promptly identified and managed may relieve tinnitus. ( C , R )

2a. Prompt Audiologic Examination

Clinicians should obtain a prompt, comprehensive audiologic examination in patients with tinnitus that is unilateral, persistent (≥6 months), or associated with hearing difficulties. ( C , R )

2b. Routine Audiologic Examination

Clinicians may obtain an initial comprehensive audiologic examination in patients who present with tinnitus (regardless of laterality, duration, or perceived hearing status). ( C , O )

3. Imaging Studies

Clinicians should NOT obtain imaging studies of the head and neck in patients with tinnitus, specifically to evaluate the tinnitus, unless they have one or more of the following: tinnitus that localizes to one ear, pulsatile tinnitus, focal neurologic abnormalities, or asymmetric hearing loss. ( C , S )

4. Bothersome Tinnitus

Clinicians must distinguish patients with bothersome tinnitus from patients with non-bothersome tinnitus. ( B , S )

5. Persistent Tinnitus

Clinicians should distinguish patients with bothersome tinnitus of recent onset from those with persistent symptoms (≥6 months) to prioritize intervention and facilitate discussions about natural history and follow-up care. ( B , R )

6. Management Strategies

Clinicians should educate patients with persistent, bothersome tinnitus about management strategies. ( B , R )

7. Hearing Aid Evaluation

Clinicians should recommend a hearing aid evaluation for patients with hearing loss and persistent, bothersome tinnitus. ( C , R )

8. Sound Therapy

Clinicians may recommend sound therapy to patients with persistent, bothersome tinnitus. ( B , O )

9. Cognitive Behavior Therapy

Clinicians should recommend cognitive behavior therapy to patients with persistent, bothersome tinnitus. ( A , R )

10. Medical Therapy

Clinicians should NOT routinelya recommend antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for
a primary indication of treating persistent, bothersome tinnitus. ( B , R )

11. Dietary Supplements

Clinicians should NOT recommend ginkgo biloba, melatonin, zinc, or other dietary supplements for treating patients with persistent, bothersome tinnitus. ( C , R )

12. Acupuncture

No recommendation can be made regarding the effect of acupuncture in patients with persistent, bothersome tinnitus. ( C , N)

13. Transcranial Magnetic Stimulation

Clinicians should NOT recommend TMS for the routinea treatment of patients with persistent, bothersome tinnitus. ( B , R )

a The word “routinely” is used to avoid setting a legal precedent and to acknowledge there may be individual circumstances for which clinicians and patients may wish to deviate from the prescribed action in the statement.

Recommendation Grading





Authoring Organization

Publication Month/Year

October 1, 2014

Last Updated Month/Year

July 26, 2023

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


Document Objectives

The purpose of this guideline is to provide evidence-based recommendations for clinicians managing patients with tinnitus.

Target Patient Population

Adults (18 years and older) with primary tinnitus that is persistent and bothersome

Target Provider Population

Any clinician, including nonphysicians, involved in managing these patients

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings


Intended Users

Physician, physical therapist, audiologist, nurse, nurse practitioner, physician assistant


Diagnosis, Prevention, Management

Diseases/Conditions (MeSH)

D014012 - Tinnitus


hearing loss, tinnitus, sound therapy, amplification, hearing aids

Source Citation

Tunkel DE, Bauer CA, Sun GH, et al. Clinical Practice Guideline: Tinnitus. Otolaryngology–Head and Neck Surgery. 2014;151(2_suppl):S1-S40. doi:10.1177/0194599814545325