Tinnitus involves the percept of a sound or sounds in the ear or head without an external source. Tinnitus is a common auditory symptom, which may result in serious burden particularly when there are comorbidities. Tinnitus is a complex condition with a multifactorial origin. Tinnitus can present in many forms. Tinnitus can be any sound, but it is typically ringing, buzzing, hissing, or tonal. Some patients experience multiple sounds. For some the sound is persistent in quality and for others it changes. It can be constant or intermittent, and heard in one or both ears or inside the head. The sound can be perceived as either pulsatile or non-pulsatile. Pulsatile tinnitus can be either vascular or non-vascular. Tinnitus may be objective or subjective. It is necessary that clinicians identify all relevant tinnitus-related factors during tinnitus assessment. Treatment should be proposed based on an assessment that accounts for tinnitus as part of a complex system with intricate interactions between its constituent factors. A classification protocol should identify tinnitus clinically relevant patient profiles and offer a rational path to individualized treatment. Consensus on clinically relevant patient profiles, standard treatment, assessment, and referral trajectories has not been reached thus far. Additionally, inconsistent results in tinnitus studies, in experimental research, clinical trials, observational and cross-sectional research, represent a barrier to efficient standards in health care for tinnitus.

The scope of this guideline is the establishment of 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.

ENT and Audio-Vestibular Medicine Physicians, to be used to make and inform clinical decisions regarding management of older children and adults with subjective tinnitus and/or appropriate referral.