➡️Introduction

Tinnitus is the perception of sound without an external source. The estimated prevalence is 10% to 15% in adults.^1,2 About 20% of adults who experience tinnitus will require clinical intervention.³ Not a disease in and of itself, tinnitus is actually a symptom that can be associated with multiple causes and aggravating co-factors. Tinnitus is relatively common, but in rare cases, it can be a symptom of serious diseases such as vascular tumours or vestibular schwannoma (VS). Tinnitus can be persistent, bothersome, and costly. The prevalence of tinnitus was estimated in the National Health Interview Survey conducted in the United States in 1994 by asking whether individuals experienced “ringing, roaring, or buzzing in the ears that lasted for at least three months.” Such tinnitus was present in 1.6% of adults ages 18 to 44, 4.6% of adults ages 45 to 64, and 9.0% of adults 60 and older.⁴ In the Beaver Dam offspring study of more than 3000 adults between the ages of 21 and 84 years studied between 2005 and 2008, 10.6% reported tinnitus of at least moderate severity or causing difficulty falling asleep.⁵ Tinnitus can also have a large economic effect. For example, tinnitus was the most prevalent service-connected disability for U.S. military veterans receiving compensation at the end of fiscal year 2012, resulting in nearly 1 million veterans receiving disability awards.⁶

Tinnitus can occur on one or both sides of the head and can be perceived as coming from within or outside the head. Tinnitus most often occurs in the setting of concomitant sensorineural hearing loss (SNHL), particularly among patients with bothersome tinnitus and no obvious ear pathology. The quality of tinnitus can also vary, with ringing, buzzing, clicking, pulsations, and other noises described by tinnitus patients. In addition, the effects of tinnitus on health-related quality of life (QOL) vary widely, with most patients less severely affected but some experiencing anxiety, depression, and extreme life changes. Patients who have tinnitus accompanied by severe anxiety or depression require prompt identification and intervention, as suicide has been reported in tinnitus patients⁷ who have coexisting psychiatric illnesses. Most tinnitus is subjective, perceived only by the patient. In contrast, others can perceive objective tinnitus as rare and is not the focus of this guideline.

➡️Scope: The scope of the guideline is the diagnosis and management of bothersome and persistent (lasting 6 months or longer), often with a negative effect on the patient’s QOL.

➡️Target audience: The target audience is any clinician, including non-physicians, involved in managing these patients. Patients with tinnitus will often be evaluated by various healthcare providers, including primary care clinicians, speciality physicians, and non-physician providers such as audiologists and mental health professionals. The target patient population is limited to adults (18 years and older) with primary tinnitus that is persistent and bothersome.