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Tinnitus

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Updated 2024 VA/DoD guidelines for the management of tinnitus.

Guidelines

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The following summarized guidelines for the evaluation and management of tinnitus are prepared by our editorial team based on guidelines from the United States Department of Defense (DoD/VA 2024), the American College of Radiology (ACR 2023), the American Cochlear Implant Alliance (ACI Alliance 2022), and the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2014).
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Diagnostic investigations

History and physical examination: as per AAO-HNSF 2014 guidelines, elicit a targeted history and perform a focused physical examination in the initial evaluation of patients with presumed primary tinnitus to identify conditions that, if promptly identified and managed, may relieve tinnitus.
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  • Audiologic examination

  • Diagnostic imaging

Medical management

Pharmacotherapy: as per AAO-HNSF 2014 guidelines, do not use antidepressants, anticonvulsants, anxiolytics, or intratympanic medications routinely in patients with persistent, bothersome tinnitus.
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Nonpharmacologic interventions

Hearing aids
As per DoD/VA 2024 guidelines:
Consider offering hearing aids for the management of tinnitus in adult patients with hearing loss.
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Insufficient evidence to recommend for or against contralateral routing of signal/sound hearing aids for the management of tinnitus in adult patients with single-sided deafness.
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  • Sound therapy

  • Auditory cognitive training

  • Psychotherapy

  • Technology-based interventions

  • Acupuncture

  • Manual therapy

  • Dietary supplements

Therapeutic procedures

Bone conduction implants: as per DoD/VA 2024 guidelines, insufficient evidence to recommend for or against implantable bone conduction devices for the management of tinnitus in adult patients with single-sided deafness.
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  • Cochlear implants

  • Neuromodulation

Patient education

General counseling: as per DoD/VA 2024 guidelines, consider offering educational counseling to reduce the functional impact of tinnitus.
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Follow-up and surveillance

Monitoring
As per DoD/VA 2024 guidelines:
Consider using validated subjective outcome measures (such as the Tinnitus Functional Index, Tinnitus Handicap Inventory) to monitor the effectiveness of tinnitus management.
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Avoid using psychoacoustic measures (such as minimum masking level, loudness matching) to monitor the effectiveness of tinnitus management.
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