Algorithm for the Diagnostic and Therapeutic Management of Tinnitus

Abstract

1. Tinnitus can be a symptom of a wide range of different underlying pathologies and accompanied by many different comorbidities, indicating the need for comprehensive multidisciplinary diagnostic assessment. 2. Basic diagnostics should include a detailed case history, assessment of tinnitus severity, clinical ear examination, and audiological measurement of hearing function. For a considerable number of patients, these first diagnostic steps in combination with counseling will be sufficient. 3. Further diagnostic steps are indicated if the findings of basic diagnostics point to acute tinnitus onset, a potentially dangerous underlying condition (e.g., carotid dissection), a possible causal treatment option, or relevant subjective impairment. 4. Further diagnostic management should be guided by clinical features. There is increasing evidence that phenomenologic and etiologic aspects determine the pathophysiology and the clinical course of tinnitus. In a hierarchical diagnostic algorithm, the first differentiation should be between pulsatile vs. non-pulsatile tinnitus. In case of non-pulsatile tinnitus, differentiation between acute tinnitus with hearing loss, paroxysmal tinnitus, and chronic tinnitus is recommended. Further diagnostic procedures of constant non-pulsatile tinnitus will depend on concomitant symptoms and etiological conditions. 5. All diagnostic and therapeutic steps should be accompanied by empathic and insightful counseling. 6. The ultimate treatment goal is the complete relief from tinnitus. If causally oriented treatment options are available, these should be preferred. However, in many cases, only symptomatic therapies can be offered, and then the treatment goal in clinical practice will be defined as the best possible reduction of unpleasant hearing sensations and accompanying symptoms, that is, to improve quality of life.