Article record

耳鸣临床实践指南更新执行摘要

Executive Summary of the Clinical Practice Guideline on Tinnitus Update.

指南共识耳科IF 2.9Q1

文献信息

PMID	42861486
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.；Kermanos 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, Sacramento, 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
IF	2.9
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，这种耳鸣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。本指南的目标受众是任何参与管理耳鸣患者的临床医生。耳鸣患者可能由各种医疗保健提供者进行评估，包括初级保健临床医生、专科临床医生以及相关健康专业人员，包括听力学家和临床心理学家。目标患者人群仅限于患有持续且令人困扰的耳鸣的成人（18岁及以上）。大多数耳鸣患者伴有相关的听力损失，例如继发于衰老（老年性耳聋）、噪声暴露（噪声性听力损失）或声创伤的感音神经性听力损失（SNHL）。耳鸣也可能是众多听觉和非听觉系统疾病的症状，从中耳疾病如耳硬化症和咽鼓管功能障碍，到内耳和听神经病变如梅尼埃病和前庭神经鞘瘤。可引起耳鸣的非听觉系统疾病包括血管异常、肌阵挛和颅内高压。指南更新组（GUG）强调需要进行全面的临床评估，以识别这些可能可治疗且有时严重的疾病。然而，具有除感音神经性听力损失以外的可识别病因诊断的患者被排除在本指南之外，因为他们几乎被排除在所有耳鸣管理的随机对照试验之外，使得无法将这些试验结果推广到这些患者。尽管如此，临床医生应个体化决定是否将本指南的建议应用于这些疾病患者。该指南还强调需要区分主观性、客观性和搏动性耳鸣，以进一步指导患者评估和管理。客观性耳鸣和搏动性耳鸣的综合管理不在本指南范围内。搏动性耳鸣是在没有外部声源的情况下感知到节律性声音，可能是脉搏同步的，通常但不总是与血管原因有关，或脉搏非同步的，通常与机械原因如腭部或中耳肌阵挛有关。1此外，本指南不适用于短暂性耳噪声，即突然感知到单侧音调或铃声，持续少于5分钟，可能伴有听力损失或耳闷感，因为它通常不需要临床管理。2该指南还排除了与复杂听幻觉或与精神病或癫痫发作相关的幻觉有关的耳鸣患者。这是对为耳鸣评估和管理开发的基于证据的临床指南的更新。本更新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、令人困扰的耳鸣的个人和社会影响。指南的第一部分侧重于耳鸣患者的临床评估，包括病史、体格检查以及诊断测试和专科转诊的选择和时机，以识别潜在的可治疗病理并降低自伤风险。指南的其余部分侧重于持续、令人困扰的耳鸣患者的评估和治疗，建议评估和测量其影响，并确定最合适的干预措施以改善症状和生活质量。

行动声明： 指南更新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）。临床医生不应仅为了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和持续、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、令人困扰的耳鸣患者转诊进行人工耳蜗植入评估（KAS 9）。临床医生应向持续、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、令人困扰的耳鸣患者干预措施的结果（KAS 15）。指南更新组对以下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、令人困扰的耳鸣的主要指征（KAS 12）。临床医生不应推荐膳食补充剂用于持续、令人困扰的耳鸣的主要指征（KAS 13）。临床医生不应推荐重复经颅磁刺激（rTMS）用于治疗持续、令人困扰的耳鸣患者（KAS 14A）。指南更新组对以下KAS提供了选项：临床医生可以询问持续、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、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、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. The target audience for this guideline is any clinician involved in managing patients with tinnitus. People with tinnitus may be evaluated by a variety of health care providers, including primary care clinicians, specialty clinicians, and allied health professionals including audiologists and clinical psychologists. The target patient population is limited to adults (18 years and older) with tinnitus that is persistent and bothersome. Most people with tinnitus have associated hearing loss, such as sensorineural hearing loss (SNHL) secondary to aging (presbycusis), noise exposure (noise-induced hearing loss), or acoustic trauma. Tinnitus can also be a symptom of numerous auditory and non-auditory system disorders, ranging from middle ear diseases, such as otosclerosis and eustachian tube dysfunction, to inner ear and auditory nerve pathologies such as Ménière's disease and vestibular schwannoma. Nonauditory system disorders that can cause tinnitus include vascular anomalies, myoclonus, and intracranial hypertension. The Guideline Update Group (GUG) placed emphasis on the need for thorough clinical evaluation to identify these potentially treatable and sometimes serious disorders. However, patients with identifiable causative diagnoses other than sensorineural hearing loss are excluded from this guideline as they are excluded from nearly all randomized controlled trials of tinnitus management, making it impossible to generalize trial results to these patients. Nevertheless, clinicians should decide whether to apply the recommendations of this guideline to patients with these conditions on an individualized basis. The guideline also underscores the need to distinguish between subjective, objective, and pulsatile tinnitus to further direct patient evaluation and management. Comprehensive management of objective tinnitus and pulsatile tinnitus is not within the scope of this guideline. Pulsatile tinnitus is the perception of a rhythmic sound in the absence of an external source that may be pulse-synchronous, which is often but not always related to vascular causes, or pulse-asynchronous, which is typically associated with mechanical causes such as palatal or middle ear myoclonus.1 Further, the guideline does not apply to transient ear noise, which is the sudden perception of a tonal or ringing sound in 1 ear, lasting fewer than 5 minutes, that may be accompanied by a sense of hearing loss or aural fullness, as it does not typically require clinical management.2 The guideline also excludes patients with tinnitus related to complex auditory hallucinations or hallucinations related to psychotic or seizure disorders. This is an update to an evidence-based clinical guideline developed for the evaluation and management of tinnitus. This updated guideline provides clinicians with a logical framework to improve patient care and mitigate the personal and social effects of persistent, bothersome tinnitus. The first part of the guideline is focused on the clinical evaluation of patients with tinnitus, including the history, physical exam, and selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology and reduce the risk of self-harm. The remainder of the guideline is focused on the evaluation and treatment of patients with persistent, bothersome tinnitus, with recommendations to evaluate and measure its effects as well as to determine the most appropriate interventions to improve symptoms and quality of life.
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 nonbothersome 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).