A new tinnitus guideline recommends use of therapeutic sounds, cognitive behavioural therapy, and hearing aids or cochlear implants as needed for treatment.
It also recommends using validated subjective outcome measures as opposed to psychoacoustic measures to monitor the effectiveness of tinnitus management.
But it advises against using herbals, nutraceuticals, supplements, and pharmacotherapy for relief of tinnitus symptoms.
The Clinical Practice Guideline for Management of Tinnitus Recommendations from the US Department of Veterans Affairs/US Department of Defense Work Group was published in JAMA Otolaryngology Head & Neck Surgery on 20 March 2025.
The guideline, which updated a version from 2014, was based on a systematic review of clinical and epidemiological evidence published from 1 January 2013 to 7 April 2023.
The guideline made 25 recommendations including using:
- Validated subjective outcome measures (eg the Tinnitus Functional Index) to monitor the effectiveness of tinnitus management but not psychoacoustic measurements (eg, minimum masking level, pitch, or loudness matching).
- Educational counselling to reduce the functional impact of tinnitus.
- Hearing aids for adults with hearing loss and cochlear implants for adults who meet candidacy requirements. The group suggested cochlear implants vs implantable bone conduction devices (BCDs), or contralateral routing of signal/sound (CROS) hearing aids for tinnitus management in adults with single-sided deafness (SSD) who meet candidacy requirements.
- Therapeutic use of sound for tinnitus self-care, but combined sound-based and behavioural interventions were associated with reductions in tinnitus effect compared with sound therapy alone.
- Cognitive behavioral therapy (CBT) for tinnitus management which focuses on improving thoughts, feelings, and behaviours associated with tinnitus.
- A multidisciplinary approach for evaluating and treating patients with bothersome tinnitus and temporomandibular disorder (TMD), cervical spine dysfunction, or both.
The guideline stated there was insufficient evidence to make a recommendation for or against:
- neuromodulation or neurostimulation.
- acupuncture for tinnitus management.
- neuromodulation or neurostimulation.
The guideline was against using:
- ginkgo biloba, dietary or herbal supplements, or nutraceuticals.
- anticonvulsants, antidepressants, antiemetics, antithrombotics, betahistine, intratympanic corticosteroid injections, or N-methyl d-aspartic acid receptor antagonists for tinnitus management.
“The full guideline offers patients and clinicians a comprehensive overview of evidence-based education and self-management, treatment options, and recommended outcome measures that could be used to monitor effectiveness and associations with other health outcomes with the overarching goal to improve patient health and well-being,” the researchers wrote.
They said the strength of most of the evidence was weak, with many interventions lacking sufficient data for them to recommend either for or against.
More studies were needed, they said, including to evaluate pre-treatment and post-treatment effects of tinnitus, compare the efficacy of web-based or app-based training as standalone tinnitus care with clinician-guided tinnitus care combined with self-management, and to focus on internet-based therapies.
More reading
Scientists develop new facial expression scoring system to measure tinnitus severity
Tinnitus experts spread the word: Myriam Westcott, Grant Searchfield and Mini Gupta
