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临床实践指南：耳鸣更新

Clinical Practice Guideline: Tinnitus Update.

指南共识耳科IF 2.9Q1

文献信息

PMID42861423
原文在 PubMed 查看原文 ↗
发表日期2026
作者Meredith E Adams
查看其他 20 位作者

John D Cramer；David E Tunkel；Victoria S Lee；James A Bourgeois；Adrien A Eshraghi；Marc A Fagelson；Kayla B White；Amy F Juliano；Helen Kim；Brianna Kuzbyt；Patrick A Lynch；Mia Miller；Kathryn Y Noonan；Pamela C Roehm；Scott R Schaffer；LaGuinn P Sherlock；Kristen K Steenerson；Margaret Wallhagen；Tara L Zaugg；Zarah Akrami

作者单位Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA.
查看其他 25 条单位信息

Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA.；Karmanos Cancer Institute, Detroit, Michigan, USA.；Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.；Department of Otolaryngology, College of Medicine, University of Illinois, Chicago, Illinois, USA.；Department of Psychiatry and Behavioral Sciences, University of California, Davis, Medical Center, Medical Center, Sacramento, California, USA.；Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA.；Center for Audiology and Speech-Language Pathology, ETSU Health, Elizabethton, Tennessee, USA.；Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.；Department of Radiology (A.F.J.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.；Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin, USA.；University of Miami Miller School of Medicine, Miami, Florida, USA.；American Tinnitus Association, Washington, District of Columbia, USA.；Cedars-Sinai Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, USA.；Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, USA.；Department of Otolaryngology-Head and Neck Surgery, St Luke's University Health Network, Easton, Pennsylvania, USA.；Division of Pediatric Otolaryngology, St Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.；Department of Otolaryngology-Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.；Department of Otorhinolaryngology-Head and, Neck Surgery Hospital University of Pennsylvania, Philadelphia, Pennsylvania, USA.；Hearing Conservation and Readiness Branch, Defense Centers for Public Health-Aberdeen, Maryland, USA.；Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.；Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA.；Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California, USA.；University of California, San Francisco, San Francisco, California, USA.；Department of Veterans Affairs, VISN 20, Portland, Oregon, USA.；American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA.

期刊Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
SCI 分区Q1
IF2.9
研究类型指南共识 · 临床
所属专科耳科

中文摘要

目的： 耳鸣是在没有外部声源的情况下感知到声音。美国有超过5000万人报告经历过耳鸣，估计成人患病率为10%至15%。本指南的重点是既令人困扰又持续存在（持续6个月或更长时间）的耳鸣，这通常会对患者的生活质量产生负面影响。指南的目标受众是任何参与管理耳鸣患者的临床医生，包括相关健康专业人员。目标患者人群仅限于患有持续性且令人困扰的耳鸣的成人（18岁及以上）。

目的： 本指南的目的是为管理耳鸣患者的临床医生提供并更新基于证据的建议。本指南为临床医生提供了一个逻辑框架，以改善患者护理并减轻持续性、令人困扰的耳鸣的个人和社会影响。它讨论了耳鸣患者的评估，包括诊断测试的选择和时机以及专科转诊，以识别潜在的可治疗病理。然后重点关注持续性耳鸣患者的治疗，并提出建议以指导耳鸣影响的测量，并确定最合适的干预措施，以改善耳鸣及相关合并症患者的症状和生活质量。

方法： 本指南使用美国耳鼻咽喉头颈外科学会基金会临床实践指南制定手册（第3版）发布的55页方案制定，该方案总结了当前数据评估、主题优先排序、关键行动声明（KASs）制定、价值判断应用及相关程序的方法学。指南小组由成人耳鼻喉科医生、听力学家、耳科医生/神经耳科医生、老年病学家、行为神经科学家、神经学家、放射学家、精神病学家、内科医生、执业护士、耳鼻喉科住院医师以及代表参与的国家专业组织的消费者倡导者组成。

行动声明： 指南更新小组对以下关键行动声明（KAS）提出了强烈建议：临床医生应区分令人困扰的耳鸣患者与非令人困扰的耳鸣患者（KAS 2）。临床医生应询问令人困扰的耳鸣患者的自伤风险（KAS 3）。临床医生不应专门为评估耳鸣而对耳鸣患者进行神经放射学成像，除非存在特定的令人担忧的特征（KAS 6）。指南更新小组对以下KAS提出了建议：临床医生应在耳鸣患者的初始评估中进行有针对性的病史采集和体格检查（KAS 1）。临床医生应对耳鸣患者进行全面的听力学评估（KAS 5）。临床医生应教育耳鸣患者关于耳鸣的自然史、影响和管理策略（KAS 7）。临床医生应为有听力困难且持续性、令人困扰的耳鸣患者推荐助听器评估（KAS 8）。临床医生应将符合听力学转诊标准的持续性、令人困扰的耳鸣患者转诊进行人工耳蜗评估（KAS 9）。临床医生应向持续性、令人困扰的耳鸣患者推荐认知行为疗法（CBT）（KAS 11）。临床医生或其指定人员应评估并记录持续性、令人困扰的耳鸣患者干预措施的结果（KAS 15）。指南更新小组对以下KAS提出了反对建议：临床医生不应常规推荐抗抑郁药、抗惊厥药、抗焦虑药或鼓室内药物用于治疗持续性、令人困扰的耳鸣的主要适应症（KAS 12）。临床医生不应推荐膳食补充剂用于持续性、令人困扰的耳鸣的主要适应症（KAS 13）。临床医生不应推荐重复经颅磁刺激（rTMS）用于治疗持续性、令人困扰的耳鸣患者（KAS 14A）。指南更新小组对以下KAS提供了选项：临床医生可以询问持续性、令人困扰的耳鸣患者的躯体感觉特征（KAS 4）。临床医生可以向持续性、令人困扰的耳鸣患者推荐声音丰富化（KAS 10）。临床医生可以向持续性、令人困扰的耳鸣患者提供双模式神经调控（KAS 14B）。

英文摘要

OBJECTIVE: Tinnitus is the perception of sound without an external source. More than 50 million people in the United States have reported experiencing tinnitus, resulting in an estimated prevalence of 10% to 15% in adults. The focus of this guideline is on tinnitus that is both bothersome and persistent (lasting 6 months or longer), which often negatively affects the patient's quality of life. The target audience for the guideline is any clinician, including allied health professionals, involved in managing patients with tinnitus. The target patient population is limited to adults (18 years and older) with tinnitus that is persistent and bothersome.
PURPOSE: The purpose of this guideline is to provide and update evidence-based recommendations for clinicians managing patients with tinnitus. This guideline provides clinicians with a logical framework to improve patient care and mitigate the personal and social effects of persistent, bothersome tinnitus. It discusses the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It then focuses on the treatment of patients with persistent tinnitus, with recommendations to guide the measurement of the effect of tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for people with tinnitus and associated comorbidities.
METHODS: This guideline was developed using the 55-page protocol published as the American Academy of Otolaryngology-Head and Neck Surgery Foundation's Clinical Practice Guideline Development Manual (3rd edition), which summarizes the methodology for assessments of current data, topic prioritization, development of key action statements (KASs), application of value judgments, and related procedures. The guideline group was represented by adult otolaryngologists, audiologists, otologists/neurotologists, a geriatrician, a behavioral neuroscientist, a neurologist, a radiologist, a psychiatrist, an internist, a nurse practitioner, an otolaryngology resident physician, and a consumer advocate who represented participating, national professional organizations.
ACTION STATEMENTS: The Guideline Update Group made strong recommendations for the following Key Action Statements (KAS): Clinicians should distinguish patients with bothersome tinnitus from patients with non-bothersome tinnitus (KAS 2). Clinicians should inquire about risks for self-harm in a patient with bothersome tinnitus (KAS 3). Clinicians should not obtain neuroradiologic imaging in patients with tinnitus specifically to evaluate the tinnitus unless specific concerning features are present (KAS 6). The Guideline Update Group made recommendations for the following KASs: Clinicians should perform a targeted history and physical examination at the initial evaluation of a patient with tinnitus (KAS 1). Clinicians should obtain a comprehensive audiological evaluation in patients with tinnitus (KAS 5). Clinicians should educate patients with tinnitus about the natural history and effects of, and management strategies for tinnitus (KAS 7). Clinicians should recommend a hearing aid evaluation for patients with hearing difficulties and persistent, bothersome tinnitus (KAS 8). Clinicians should refer patients with persistent, bothersome tinnitus for cochlear implant evaluation when they meet audiologic criteria for referral (KAS 9). Clinicians should recommend Cognitive Behavioral Therapy (CBT) to patients with persistent, bothersome tinnitus (KAS 11). Clinicians or their designee should assess and document outcomes of interventions in patients with persistent, bothersome tinnitus (KAS 15). The Guideline Update Group made recommendations against for the following KASs: Clinicians should not routinely recommend antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for a primary indication of treating persistent, bothersome tinnitus (KAS 12). Clinicians should not recommend dietary supplements for the primary indication of persistent, bothersome tinnitus (KAS 13). Clinicians should not recommend repetitive transcranial magnetic stimulation (rTMS) for the treatment of patients with persistent, bothersome tinnitus (KAS 14A). The Guideline Update Group offered options for the following KASs: Clinicians may inquire about somatosensory features in patients with persistent, bothersome tinnitus (KAS 4). Clinicians may recommend sound enrichment to patients with persistent, bothersome tinnitus (KAS 10). Clinicians may offer bimodal neuromodulation to patients with persistent, bothersome tinnitus (KAS 14B).