AUDIOLOGY Tinnitus
- Executive Summary
Tinnitus: Adapted Egyptian Clinical Practice Guideline (CPG)
Scope: The main goal of this guideline is to establish
uniformity in the assessment and treatment of older children and adults with subjective
tinnitus, for proper diagnosis of the possible cause of tinnitus to direct for proper
treatment, and urgent referral if needed, and screening for the effects of tinnitus
for proper management to improve the quality of life of tinnitus patients. The statements
and flowchart of this guideline were adapted from the “Multidisciplinary European
Guideline for Tinnitus: Diagnostics, Assessment, and Treatment (MEGT), (Cima et
al.,2019
I. Diagnostics, assessments, and outcomes:
• Statement
1:
Ia. Minimum patient assessment:
2) A thorough physical assessment to exclude possible
treatable (physical/medical) causes of tinnitus (Strong recommendation for).
3) A comprehensive diagnostic investigation: (pure
tone audiometry, speech audiometry, sound tolerance assessment, evaluation of the
perceptional quality of tinnitus, tympanometry and acoustic reflex). (Strong recommendation
for).
• Statement 2:
Ib. Further assessment by investigations Further
assessment by AV investigations (ABR, OAE, VNG etc..) if clinically indicated or
referrals (radiological/laboratory etc..) in special cases (Strong Recommendation
for).
• Statement 3:
Ic. Consider Red Flags that need urgent referral
for Assessment/Management [1] (Strong Recommendation
for).
• Statement4:Id. Recommendation for Assessment by questionnaires,
to assess Tinnitus severity in terms of distress/impact (Strong Recommendation for).
II. Treatment options and referral pathways:
• Statement
5:
IIa. Drug/pharmacological treatment for (acute tinnitus)
(Strong Recommendation Against). But Drug/pharmacological treatment for acute sudden
hearing loss (Strong Recommendation for). Drugs for the treatment of chronic tinnitus
(Strong Recommendation Against). Drugs for the treatment of comorbidities associated
with tinnitus (anxiety, depression) may need drug treatment. (Conditional Recommendation
for).
• Statement
6:
IIb. Hearing loss interventions: i) Cochlear implantation
only for patients meeting the hearing loss criteria for candidacy (Strong Recommendation
for). ii) Hearing aids for the management of tinnitus and hearing loss (Conditional
Recommendation for) Combination hearing aids (including amplification and sound
generator in the same device) (Conditional Recommendation for).
• Statement
7:
IIc. Neurostimulation: Transcranial electrical (direct
or alternating current). Transcranial Vagus or Invasive neurostimulation treatments
(whether direct Vagus, cortical surface or deep brain neural stimulator) (Conditional
Recommendation against), or Acoustic CR® Neuromodulation: (Conditional Recommendation
for), or Repetitive transcranial magnetic stimulation (Conditional Recommendation
for).
• Statement 8:
IId. Cognitive Behavioural Therapy (CBT) (Strong
recommendation for).
• Statement 9:
IIe. Tinnitus Retraining Therapy (TRT) (Conditional
Recommendation for).
• Statement10 :
IIf. Sound therapy (including masking, music, environmental
sound) for acute relief purposes (Conditional Recommendation for). Sound therapy
for long-term use (Conditional recommendation against).
• Statement11:
IIg. Dietary and alternative therapies (Strong recommendation
Against).