AAO-HNS GUIDELINES Bundle (free trial)

Table 2. Summary of Guideline Key Action Statements (KAS) Statement Action Strength of Rec 1. History and Physical Examination Clinicians should perform a targeted history and physical examination at the initial evaluation of a patient to identify conditions that if promptly identified and managed may relieve tinnitus. R-C 2a. Prompt Audiologic Examination Clinicians should obtain a prompt, comprehensive audiologic examination in patients with tinnitus that is unilateral, persistent (≥6 months), or associated with hearing difficulties. R-C 2b. Routine Audiologic Examination Clinicians may obtain an initial comprehensive audiologic examination in patients who present with tinnitus (regardless of laterality, duration, or perceived hearing status). O-C 3. Imaging Studies Clinicians should NOT obtain imaging studies of the head and neck in patients with tinnitus, specifically to evaluate the tinnitus, unless they have one or more of the following : tinnitus that localizes to one ear, pulsatile tinnitus, focal neurologic abnormalities, or asymmetric hearing loss. S-C Against 4. Bothersome Tinnitus Clinicians must distinguish patients with bothersome tinnitus from patients with non-bothersome tinnitus. S-B 5. Persistent Tinnitus Clinicians should distinguish patients with bothersome tinnitus of recent onset from those with persistent symptoms (≥6 months) to prioritize intervention and facilitate discussions about natural history and follow-up care. R-B 6. Management Strategies Clinicians should educate patients with persistent, bothersome tinnitus about management strategies. R-B 7. Hearing Aid Evaluation Clinicians should recommend a hearing aid evaluation for patients with hearing loss and persistent, bothersome tinnitus. R-C 8. Sound erapy Clinicians may recommend sound therapy to patients with persistent, bothersome tinnitus. O-B 9. Cognitive Behavior erapy Clinicians should recommend cognitive behavior therapy to patients with persistent, bothersome tinnitus. R-A 10. Medical erapy Clinicians should NOT routinely a recommend antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for a primary indication of treating persistent, bothersome tinnitus. R-B Against 11. Dietary Supplements Clinicians should NOT recommend ginkgo biloba, melatonin, zinc, or other dietary supplements for treating patients with persistent, bothersome tinnitus. R-C Against 12. Acupuncture No recommendation can be made regarding the effect of acupuncture in patients with persistent, bothersome tinnitus. N-C 13. Transcranial Magnetic Stimulation Clinicians should NOT recommend TMS for the routine a treatment of patients with persistent, bothersome tinnitus. R-B Against a e word "routinely" is used to avoid setting a legal precedent and to acknowledge there may be individual circumstances for which clinicians and patients may wish to deviate from the prescribed action in the statement.

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