Evaluation and Treatment of Tinnitus: Comparative Effectiveness: Comparative Effectiveness Review Number 122

Tinnitus is the perception of sound in the absence of an external auditory stimulus; as such, tinnitus is a symptom, not a disease. An estimated 16 percent of the American population (50 million people) experience tinnitus, with up to 16 million seeking medical help and 2 million being unable to lead a normal life. The prevalence of tinnitus increases with age and noise exposure. Additionally, tinnitus is an increasing problem in more recent birth cohorts. A variety of conditions and experiences can lead to tinnitus, but the exact physiology is still unknown. Patients are often described as presenting with symptoms of either objective or subjective tinnitus. Objective tinnitus is perceptible by patients and examiners. Subjective tinnitus is perceptible only by patients, yet is not due to a hallucination. Both forms of tinnitus may or may not be idiopathic. Some investigators have argued that tinnitus should be classified by origin, either as somatic or neurophysiologic. In this review, we will use the term subjective idiopathic tinnitus, rather than neurophysiologic tinnitus, because it is the term most commonly used in the current literature. Subjective idiopathic tinnitus is also the most commonly diagnosed type of tinnitus. Treatments for subjective idiopathic tinnitus are wide ranging in scope and may include medical/surgical treatments, sound treatments/technologies, and psychological/behavioral treatments. For the present review, treatment groups revolve around four main categories of intervention: pharmacological or food supplement, medical/surgical, sound technology, and psychological/behavioral. Standardized guidelines for the diagnosis and treatment of tinnitus do not exist in the United States. To help inform medical practice, this systematic review was undertaken to explore prognostic factors and strategies for the optimal management of tinnitus. Three Key Questions (KQs) governed the review: KQ1. In patients with symptoms of tinnitus (ringing in the ears, whooshing sounds, etc.), what is the comparative effectiveness of methods used to identify patients for further evaluation or treatment? KQ2. In adults with subjective idiopathic (nonpulsatile) tinnitus, what is the comparative effectiveness (and/or potential harms) of medical/surgical, sound treatment/technological, or psychological/behavioral interventions, including combinations of interventions? KQ3. For adults with subjective idiopathic tinnitus, what prognostic factors, patient characteristics, and/or symptom characteristics affect final treatment outcomes?