Patient handout

Chronic bothersome tinnitus (AAO-HNSF 2014 CPG — CBT first-line; AGAINST routine pharmacotherapy)

PRODUCTION

1. Your condition

This handout is for chronic bothersome tinnitus (aao-hnsf 2014 cpg — cbt first-line; against routine pharmacotherapy). Your care team identified this based on: persistent subjective tinnitus ≥6 months (ringing, buzzing, hissing, roaring) — chronic-tinnitus entry per aao-hnsf 2014 (tunkel ohns pmid 25273878).

Other reasons your team may use this plan: tinnitus reported as bothersome — affecting concentration, sleep, mood, or quality of life; the aao-hnsf 2014 management focus is the bothersome subset (tunkel pmid 25273878); pulsatile / objective tinnitus (heard by examiner) — mandates imaging (mra/mrv) and ent/neuro-otology referral; vascular causes (dural avf, glomus tumour, venous sinus stenosis, dehiscent jugular bulb); unilateral tinnitus with asymmetric sensorineural hearing loss — vestibular schwannoma until proven otherwise; mri iac (tunkel pmid 25273878).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
patient_education_natural_history_and_management_strategies	—	—	—	AAO-HNSF 2014 Tunkel (PMID 25273878) — STRONG recommendation to educate patients with persistent, bothersome tinnitus about management strategies; sets realistic expectations and reduces anxiety-driven amplification
distinguish_bothersome_from_non_bothersome_THI_TFI	—	—	—	AAO-HNSF 2014 Tunkel (PMID 25273878) — STRONG recommendation to distinguish bothersome from non-bothersome; only bothersome chronic tinnitus warrants intervention beyond reassurance

Plan: Chronic bothersome primary tinnitus — non-pharmacologic ladder (AAO-HNSF 2014 CPG); AGAINST routine pharmacotherapy

3. When to call your provider

Contact your care team if any of the following happen:

New unilateral or asymmetric SNHL → MRI IAC + neuro-otology referral
New pulsatile / objective tinnitus → MRA/MRV head + ENT referral
Sudden severe hearing loss → ent.sudden-sensorineural-hearing-loss.core.v1 within steroid window
Focal neuro / severe headache / papilloedema → urgent neurology / neurosurg
Severe psychiatric distress, suicidal ideation → urgent mental-health referral

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

UNILATERAL persistent tinnitus with documented asymmetric sensorineural hearing loss — vestibular schwannoma until proven otherwise (AAO-HNSF 2014 Tunkel PMID 25273878 — strong recommendation against routine imaging EXCEPT this scenario)
Pulsatile or objective tinnitus (heard by examiner with stethoscope) — vascular cause (dural AV fistula, glomus tumour, venous sinus stenosis, dehiscent jugular bulb, carotid stenosis) (Tunkel PMID 25273878)
Sudden onset tinnitus (≤72 h) with sudden severe sensorineural hearing loss — sudden SNHL is a time-critical otologic emergency with a steroid window of ~2 weeks (Tunkel PMID 25273878)(life-threatening)
Severe bothersome tinnitus (high THI / TFI) with comorbid severe depression and suicidal ideation — rare but documented

5. Follow-up

Longitudinal chronic-disease arc: 3-6 monthly stable; sooner for sleep / mood / suicidal-ideation flares. Maintain hearing protection (concert/work). Reassess audiometry annually if hearing loss; sooner if change. Re-screen for ototoxic medication updates at every visit (DM aminoglycosides, oncology platinum, vancomycin courses). Re-counsel that AAO-HNSF 2014 is AGAINST routine pharmacotherapy — many patients will be offered gabapentin / sertraline by other clinicians and ask for it; reinforce evidence

6. Sources

Guideline: AAO-HNSF Clinical Practice Guideline: Tinnitus — Tunkel et al, Otolaryngol Head Neck Surg 2014 (PMID 25273878 full; PMID 25274374 Executive Summary). Current US authority; no 2021-2026 society replacement at the time of authoring. CBT evidence: Cima et al, Lancet 2012 (PMID 22633033). Internet-CBT: Beukes et al, Int J Audiol 2018 (PMID 30295113). Bimodal stimulation emerging: Conlon et al, Sci Transl Med 2020 (PMID 33028707). All PMIDs live-PubMed-verified 2026-05-26.