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Tinnitus

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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 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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Guidelines

1.Diagnostic investigations

History and physical examination: 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

2.Medical management

Pharmacotherapy: do not use antidepressants, anticonvulsants, anxiolytics, or intratympanic medications routinely in patients with persistent, bothersome tinnitus.
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3.Nonpharmacologic interventions

Hearing aid: obtain hearing aid evaluation in patients with hearing loss and persistent, bothersome tinnitus.
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  • Sound therapy

  • CBT

  • Dietary supplements

  • Acupuncture

4.Therapeutic procedures

Transcranial magnetic stimulation: do not offer transcranial magnetic stimulation routinely in patients with persistent, bothersome tinnitus.
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  • Cochlear implants

5.Patient education

General counseling: educate patients with persistent, bothersome tinnitus about management strategies.
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