Management Of Tinnitus Research Articles

Management of adult patients with tinnitus: Preparedness, perspectives and practices of audiologists.

BackgroundAudiologists, globally, are generally challenged when assessing and creating intervention plans to help patients suffering from tinnitus. Tinnitus is very common among individuals and may significantly affect one’s quality of life, especially if not addressed by health care professionals. In South Africa, there seems to be limited published studies regarding the current practices of tinnitus management by audiologists. This is mainly because of limited training and a lack of guidelines and strategies for the management of tinnitus. In particular, some participants reported being unfamiliar on how to approach the identification of tinnitus and difficulty is also encountered when counselling tinnitus patients.AimThe aim of this study was to describe the preparedness, perspectives and practices of audiologists who manage adult patients with tinnitus.MethodTwo hundred and forty-three registered Health Professions Council of South Africa (HPCSA) participants were involved in the study by responding to an electronic questionnaire survey. Data were collected online from Survey Monkey and were exported to Statistical Packages for the Social Sciences (SPSS) (Version 23) for statistical analysis. Data were analysed using descriptive and inferential statistics. Closed-ended questions were analysed within a quantitative framework and thematic analysis for open-ended questions that were descriptively quantified.ResultsThe results of the study are presented according to the objectives. Approximately 44% of participants (44.3%) disagreed that the undergraduate university training had sufficiently prepared them to manage adult patients with tinnitus. Very few (12.3%) had the opportunity to attend specialist training on how to assess patients with tinnitus. Similarly, only 11.6% received any specialist training with regard to tinnitus intervention. With regard to its overall management, 49.4% felt adequately informed in the assessment of patients with tinnitus, while a further 39.2% rated their experience as being limited with regard to tinnitus intervention. There is no statistical significance relationship between participants’ years of experience and tinnitus intervention (p = 0.075). Most participants did not follow any standard guidelines for its management. Some participants (26.8%) reported that further education and training are required in the overall management of patients with tinnitus, while a further 17.7% required training in all areas of tinnitus.ConclusionThe feedback relating to the study suggests that overall management of tinnitus seems to be a challenge among South African audiologists, irrespective of their years of experience. Audiologists in the study perceived that tinnitus services are limited mainly because of a lack of or limited knowledge, training and guidelines, these being affected by contextual restraints.

Incorporating Tinnitus Management Services into Your Audiology Practice

Incorporating Tinnitus Management Services into Your Audiology Practice

Tinnitus and the Brain: A Review of Functional and Anatomical Magnetic Resonance Imaging Studies

Purpose The tinnitus patient population is inherently heterogeneous. Although tinnitus often co-occurs with hearing loss and is more frequent among elderly people, it affects all age groups with varying hearing sensitivity. In addition, tinnitus severity and patients' reaction to tinnitus vary across individuals. Regardless of the metrics used to measure tinnitus handicap, on one end of the severity spectrum are the patients who have managed to habituate to their tinnitus; at the other end are those who are extremely bothered by tinnitus, and often have a confluence of related comorbidities of mood disorders. Understanding the neural correlates of tinnitus while accounting for such variations could benefit clinicians, helping them modify and objectively monitor tinnitus management strategies. Brain imaging, specifically magnetic resonance imaging, is an excellent tool to study the functional and structural properties of the neural networks involved in tinnitus and tinnitus severity. Method In this article, we review studies that employ magnetic resonance imaging-based neuroimaging techniques including resting-state functional connectivity, voxel-based morphometry, and diffusion tensor imaging to investigate underlying functional and structural neural correlates of tinnitus to address overarching dimensions of a person's reaction to tinnitus, namely, audition, emotion, and attention. Results We discuss findings from brain imaging studies in the context of theories and models proposed for tinnitus generation and persistence. Conclusion These studies have revealed tinnitus-related alteration in the auditory, emotion, and attention neural networks. Future research is required to better understand these changes in the neural circuitry based on tinnitus comorbidities and severity, and to refine existing theoretical models.

Multidisciplinary Tinnitus Care

Tinnitus (ringing in the ears) is highly prevalent, and yet standards of clinical care for tinnitus do not exist. Consequently, tinnitus clinical care is haphazard, leaving individuals seeking help for their tinnitus at a disadvantage. These individuals need accurate information about the realities of tinnitus management, which should be made available by health care providers. This report reviews the key concerns related to clinical care for tinnitus and provides recommendations for all health care practitioners to provide their patients with useful and cost-effective information. A toolkit of resources is provided to facilitate the process of dispensing this information.

Understanding User Reactions and Interactions With an Internet-Based Intervention for Tinnitus Self-Management: Mixed-Methods Evaluation.

Purpose Internet-based interventions have the potential to reduce the disparity in access to psychological therapy that people with tinnitus currently experience. One example is the Tinnitus E-Programme, which, although freely available online, has not yet been formally evaluated. The purpose of this study was to evaluate past, current, and new users' reactions and interactions with the Tinnitus E-Programme. Method Study 1 used an online survey to gather past and current users' reactions to, and interactions with, the intervention (n = 27). Study 2 used interviews and a relaxation log to assess how new users implemented the skills they learned into their everyday lives (n = 13). Results Generally, users expressed positive views on the intervention content and design features. Users particularly valued the education about tinnitus and its management and the relaxation skills training, and use of these components was high. In contrast, user reactions to self-monitoring tools, an online support forum, and therapist support were mixed, and use was lower. Implementation was limited by instances of poor usability and accessibility, user engagement, and adherence to relaxation goals. Users' perceptions of the intervention's credibility and relevance and beliefs regarding a negative impact on their tinnitus influenced engagement. Users in both studies identified several benefits gained, including functional and emotional management, self-efficacy for managing and coping with tinnitus, understanding tinnitus and its management, social support, and acceptance of tinnitus. Conclusion Findings suggest that the intervention was acceptable to its target group but also highlighted some areas for improvement. These findings will be used to inform further optimization work.

Systematic Assessment of Self-help Tools for the Management of Chronic Tinnitus

Systematic Assessment of Self-help Tools for the Management of Chronic Tinnitus

Functional Near-Infrared Spectroscopy to Probe tDCS-Induced Cortical Functioning Changes in Tinnitus

There are limited treatment options for successful management of tinnitus, which is highly prevalent worldwide. The pathogenetic role of auditory cortex activation changes in tinnitus has been reported by various functional studies that suggest that the emerging neuromodulation techniques may pave way toward better treatment response. The current case report depicts the use of functional near-infrared spectroscopy (fNIRS) based on the assessment of improvement in auditory cortex functioning in chronic tinnitus by transcranial direct current stimulation (tDCS).

Why Is There No Cure for Tinnitus?

Tinnitus is unusual for such a common symptom in that there are few treatment options and those that are available are aimed at reducing the impact rather than specifically addressing the tinnitus percept. In particular, there is no drug recommended specifically for the management of tinnitus. Whilst some of the currently available interventions are effective at improving quality of life and reducing tinnitus-associated psychological distress, most show little if any effect on the primary symptom of subjective tinnitus loudness. Studies of the delivery of tinnitus services have demonstrated considerable end-user dissatisfaction and a marked disconnect between the aims of healthcare providers and those of tinnitus patients: patients want their tinnitus loudness reduced and would prefer a pharmacological solution over other modalities. Several studies have shown that tinnitus confers a significant financial burden on healthcare systems and an even greater economic impact on society as a whole. Market research has demonstrated a strong commercial opportunity for an effective pharmacological treatment for tinnitus, but the amount of tinnitus research and financial investment is small compared to other chronic health conditions. There is no single reason for this situation, but rather a series of impediments: tinnitus prevalence is unclear with published figures varying from 5.1 to 42.7%; there is a lack of a clear tinnitus definition and there are multiple subtypes of tinnitus, potentially requiring different treatments; there is a dearth of biomarkers and objective measures for tinnitus; treatment research is associated with a very large placebo effect; the pathophysiology of tinnitus is unclear; animal models are available but research in animals frequently fails to correlate with human studies; there is no clear definition of what constitutes meaningful change or “cure”; the pharmaceutical industry cannot see a clear pathway to distribute their products as many tinnitus clinicians are non-prescribing audiologists. To try and clarify this situation, highlight important areas for research and prevent wasteful duplication of effort, the British Tinnitus Association (BTA) has developed a Map of Tinnitus. This is a repository of evidence-based tinnitus knowledge, designed to be free to access, intuitive, easy to use, adaptable and expandable.

A Comprehensive Evaluation of Tinnitus Apps.

Purpose The use of mobile phones is on the rise worldwide. Many people who experience tinnitus often turn to the Internet and applications (apps) on their smartphones to acquire information on tinnitus and solutions to "cure" tinnitus. The aim of this study was to evaluate and summarize features offered by tinnitus-related apps on different mobile platforms. Method This study was conducted on 3 mobile platforms-Apple iOS, Google Android, and Windows. The key word tinnitus was searched, and all free and paid apps were downloaded. Relevant apps were reviewed in-depth and then classified into 4 categories based on their functionality-"tinnitus education, awareness, and prevention," "tinnitus assessment and measurement," "tinnitus management," and "misinformation." Results All mobile platforms yielded both free and paid tinnitus apps, allowing individuals to learn more about tinnitus, assess and measure their own tinnitus, gain access to different sounds to help manage their tinnitus, and find strategies to better cope with their tinnitus. The Google Android platform revealed the most number of tinnitus apps. The "tinnitus management" category consistently outperformed the other categories-containing the most number of apps and the most number of features. A small proportion of misinformation apps were detected across platforms. There were no significant differences in the total number of features between free and paid apps (except on the Windows platform). A cost-feature analysis revealed that more expensive apps did not necessarily offer more number of features. Conclusions This study reveals that a variety of tinnitus-related apps-both free and paid-are available on different mobile platforms. Clinicians should be aware that patients with tinnitus often rely on apps for additional help and should be prepared to direct them to valid apps. Implications for end users are discussed as well. Supplemental Material https://doi.org/10.23641/asha.8956775.

Intratympanic dexamethasone as an adjuvant to oral imipramine hydrochloride (Tofranil, a TCA) 25 mg twice daily in management of idiopathic unilateral subjective tinnitus

BackgroundIn this report, we summarize our clinical experience with intratympanic (IT) dexamethasone treatment for control of idiopathic unilateral tinnitus when used as an adjunct treatment with Tricyclic antidepressant (TCA) imipramine hydrochloride 25mg twice daily for 1 month.ObjectivesTo assess the clinical benefit of adding dexamethasone by IT route to the tricyclic antidepressant imipramine hydrochloride in the management of idiopathic unilateral subjective tinnitus.Study designA prospective randomized clinical trial was conducted.ResultsResults from this study showed significant subjective improvement of patients with unilateral subjective tinnitus when comparing the two arms of the study, both to pretreatment assessment and between the two arms, giving significant advantage to the group treated with combination of intratympanic dexamethasone with imipramine hydrochloride 25mg twice daily for 2 weeks using tinnitus handicap inventory questionnaire, subjective tinnitus loudness as measured by a visual analog scale, and tinnitus awareness score.ConclusionIntratympanic dexamethasone injection in combination with TCA imipramine maleate could be subjectively beneficial when compared with imipramine hydrochloride alone.

Clinical Efficacy of Tinnitus Retraining Therapy Based on Tinnitus Questionnaire Score and Visual Analogue Scale Score in Patients with Subjective Tinnitus.

Tinnitus is the annoying sensation of sound perception without acoustic stimulus. Tinnitus retraining therapy (TRT) is the habituation therapy used for the management of chronic subjective tinnitus. The objective of the study is to describe TRT and to evaluate its efficacy in patients with subjective tinnitus. In total, 58 patients with tinnitus who did not respond to medications were enrolled in the TRT program. TRT included counseling as described in the neurophysiological model of tinnitus and sound therapy (aided or unaided) for six months. The tinnitus severity grade (TSG) 1-5, based on a validated tinnitus questionnaire score (TQS), and the visual analogue scale (VAS) score were documented before and after therapy. Before TRT, 53 patients (91.3%) exhibited TSG 3-5, and the average VAS score was 6.7±2.1. After TRT for two months, 49 patients (84.4%) showed TSG 1-3, and the average VAS score was 3.2±2.4. After six months of TRT, most of the patients found remarkable improvement in the symptoms, and 51 patients (87.9%) exhibited TSG 1-2, and the average VAS score was 2.1±2.6. Statistically significant difference was found in TSG and VAS score before and after TRT. Statistically significant correlation was observed between TSG and VAS score. TRT is an useful approach for amelioration of tinnitus. TQS is a very effective, cheap, and easy method to help otologists to grade the patients as per the severity of symptoms.

Pediatric Ototoxicity: Current Trends and Management.

Medical interventions to combat serious infection or malignancies carry significant morbidities, including ototoxicity. While these lifesaving drugs are often necessary to preserve life, the impact on quality of life for survivors is increasingly concerning for families and healthcare providers. Of primary importance for medical prescribers are appropriately sensitive ototoxicity grading scales and audiological monitoring protocols for surveillance for hearing loss. The intent of grading scales is to help communicate complicated audiological information to non-audiologist healthcare providers (such as oncologists) to help them make good decisions with regards to chemotherapy dosing. Appropriate audiological monitoring helps reduce the time delay between the adventitious onset of hearing loss and the diagnosis and intervention. Finally, pediatric ototoxicity grading and monitoring protocols help ensure timely access to adequate hearing habilitation, verification and validation of the management of permanent medication-induced hearing loss and tinnitus in children.

Progressive Tinnitus Management at Two Veterans Affairs Medical Centers: Clinical Implementation With Modified Protocols.

Purpose This is a description of the clinical implementation and outcomes of progressive tinnitus management (PTM) at 2 Veterans Affairs (VA) medical centers: Both programs modified the protocol originally described by PTM developers. Method Modifications at both sites were classified according to an evidence-based framework set forth by Stirman, Miller, Toder, and Calloway (2013) . The Iowa City VA PTM program clinicians made 2 modifications and the Asheville, North Carolina, VA PTM program clinicians made 6 modifications to the standard PTM protocol. Pre-post outcome measures were analyzed for 20 veterans who completed the Iowa City program and for 200 veterans who completed the Asheville program. Results Veterans who completed the Iowa City program showed a statistically significant decrease in the average Tinnitus Handicap Inventory score ( Newman, Jacobson, & Spitzer, 1996 ). Veterans who completed the Asheville PTM program showed a statistically significant decrease in the average Tinnitus Functional Index (TFI) score. Outcomes in Asheville were compared to outcomes of a clinical trial of PTM conducted by the developers of PTM. The clinical work in Asheville resulted in a greater mean reduction on the TFI and a larger effect size using the TFI as compared to the results of the PTM clinical trial. Conclusions Clinician-directed modifications to PTM that are made to address the unique needs and circumstances of an individual clinic have potential to result in positive outcomes for patients. Clinicians providing care for patients with tinnitus using PTM who modify the protocol to meet the needs of their local setting are encouraged to collect and report the outcomes of their modifications to improve understanding of the impact of various types of modifications to PTM and other evidence-based practices.

The effectiveness and safety of mindfulness-based interventions for posttraumatic stress disorder - a systematic review and meta-analysis

Following the British Medical Research Council recommendations for pilot trials, this study aims to increase experience with a complex integrative medicine (IM) intervention in a randomized controlled design to assess the feasibility for studying this intervention in a larger trial. Specific objectives are to: 1) assess the feasibility of implementing this IM approach to improve dysfunction from tinnitus in a large clinical trial; 2) evaluate patient satisfaction with this complex intervention; and 3) obtain preliminary clinical efficacy data using the planned procedures and measures.This NIDCD-funded pilot study targets retention of 40 participants with significant tinnitus-related dysfunction, recruited from a conventional otolaryngology clinic. To maximize experience with the intervention, enrolled participants are randomized in a 3:1 ratio to IM + a commonly applied sound-based and educational therapy (SBE) or to SBE alone. The 6-month IM treatment includes the same SBE, modeled after the Veteran’s Affairs Progressive Tinnitus Management approach, as well as 3 cognitive behavioral psychotherapy sessions, an 8-week Mindfulness Based Stress Reduction course, 5 acupuncture sessions, and 9 telephonic health coaching sessions. Enrollment, retention, patient satisfaction and lessons learned by the trial team will determine the feasibility of using this complex IM intervention in a large trial. Baseline, post-treatment, and 3-months follow-up measures and trial procedures planned for the larger trial are also piloted, with change in tinnitus-dysfunction over the intervention slated to provide preliminary clinical efficacy data.This pilot protocol will inform decisions regarding the feasibility of using this complex IM intervention in a large clinical trial. The larger trial would potentially offer patients an IM treatment to amplify conventional SBE for those who are unable to habituate to tinnitus.

Integrative medicine for significant dysfunction from tinnitus: Treatment rationale and protocol for a randomized clinical pilot trial

ObjectivesFollowing the British Medical Research Council recommendations for pilot trials, this study aims to increase experience with a complex integrative medicine (IM) intervention in a randomized controlled design to assess the feasibility for studying this intervention in a larger trial. Specific objectives are to: 1) assess the feasibility of implementing this IM approach to improve dysfunction from tinnitus in a large clinical trial; 2) evaluate patient satisfaction with this complex intervention; and 3) obtain preliminary clinical efficacy data using the planned procedures and measures. Design & methodsThis NIDCD-funded pilot study targets retention of 40 participants with significant tinnitus-related dysfunction, recruited from a conventional otolaryngology clinic. To maximize experience with the intervention, enrolled participants are randomized in a 3:1 ratio to IM + a commonly applied sound-based and educational therapy (SBE) or to SBE alone. The 6-month IM treatment includes the same SBE, modeled after the Veteran’s Affairs Progressive Tinnitus Management approach, as well as 3 cognitive behavioral psychotherapy sessions, an 8-week Mindfulness Based Stress Reduction course, 5 acupuncture sessions, and 9 telephonic health coaching sessions. Enrollment, retention, patient satisfaction and lessons learned by the trial team will determine the feasibility of using this complex IM intervention in a large trial. Baseline, post-treatment, and 3-months follow-up measures and trial procedures planned for the larger trial are also piloted, with change in tinnitus-dysfunction over the intervention slated to provide preliminary clinical efficacy data. DiscussionThis pilot protocol will inform decisions regarding the feasibility of using this complex IM intervention in a large clinical trial. The larger trial would potentially offer patients an IM treatment to amplify conventional SBE for those who are unable to habituate to tinnitus.

Is tinnitus a major concern in individuals with auditory neuropathy spectrum disorder? - Questionnaire based study.

ObjectiveOur study attempted to determine if tinnitus is a major concern in individuals with auditory neuropathy spectrum disorder (ANSD). The study also attempted to determine if pure tone average (PTA), speech identification scores (SIS), or reported duration of hearing loss could predict the tinnitus severity and functional handicap in adults with ANSD.MethodsTinnitus functional index (TFI) and tinnitus severity index (TSI) were administered on all the 40 participants diagnosed with ANSD.ResultsThe mean TFI score was 44.3, which suggested moderate degree of tinnitus related functional impairment. The mean TSI score was found to be 33.3, which suggested moderate degree of severity in individuals with ANSD. The study also showed that tinnitus causes functional impairment that leading to sleep disturbances, emotional problems, and affecting the quality of life. There was no significant correlation (P > 0.05) between PTA, SIS, reported onset of hearing loss and scores of TFI or TSI.ConclusionTinnitus in individuals with ANSD should also be given priority during assessment and provide appropriate tinnitus management.

Telephone-Based Progressive Tinnitus Management for Persons With and Without Traumatic Brain Injury: A Randomized Controlled Trial.

This randomized controlled trial evaluated the efficacy of delivering coping skills education from Progressive Tinnitus Management (PTM) by telephone (Tele-PTM). The trial followed a previous pilot study that showed positive results for Tele-PTM. Participants included individuals with bothersome tinnitus (N = 205) located anywhere within the United States. A special emphasis was given to including individuals who had experienced one or more traumatic brain injuries (TBIs). Participants were randomized to either Tele-PTM intervention or 6-month wait-list control (WLC). The Tele-PTM intervention involved five telephone appointments-two led by an audiologist (teaching how to use therapeutic sound) and three by a psychologist (teaching coping skills derived from cognitive-behavioral therapy). It was hypothesized that Tele-PTM would be more effective than WLC in reducing functional effects of tinnitus as measured with the Tinnitus Functional Index. Additional outcome measures included the Self-Efficacy for Managing Reactions to Tinnitus questionnaire and the Hospital Anxiety and Depression Scale. The effect of Tele-PTM on outcomes was estimated using linear mixed models. Overall results showed convincingly that the Tele-PTM group had significantly better outcomes than the WLC group. These results were consistent across all outcome measures, indicating not only a reduction of tinnitus functional distress but also increased self-efficacy. Improvements in measures of anxiety and depression were also observed. Tele-PTM participants in all TBI categories showed significant improvement. Results provide strong support for use of Tele-PTM methodology for persons with bothersome tinnitus, regardless of whether the person also has TBI symptoms. The effect size for Tele-PTM was high for the primary outcome measure, the Tinnitus Functional Index, and all other outcome measures showed significant improvement. Combined with our previous pilot study, the Tele-PTM method is validated for potential nationwide provision of tinnitus services.

Retrospective Assessment of the Efficacy of Modified Progressive Tinnitus Management Skills Education in a Military Medical Treatment Facility.

The number-one service-connected disability is tinnitus. Tinnitus currently has no cure, but the functional impact of tinnitus has been shown to be mitigated by Progressive Tinnitus Management (PTM), a multi-level management approach. The duration of PTM Level 3 skills education (PTM-SE) and the inclusion of mental health providers have been identified as barriers to implementation of PTM-SE in Department of Defense (DOD) medical treatment facilities. The goal of this study was to determine if a version of PTM-SE modified for use in DOD medical treatment facilities resulted in positive changes in tinnitus-related outcomes. A retrospective study was conducted by examining the medical records of patients who attended modified PTM-SE appointments. The study was approved by the Walter Reed National Military Medical Center Institutional Review Board. The study sample included 130 patients who completed modified PTM-SE between January 2015 and June 2016. Primary outcome measures were tinnitus awareness and tinnitus annoyance; secondary outcome measures were effect on life and self-perceived coping ability. Outcome measures were analyzed with nonparametric statistics and logistic regression. Modified PTM-SE resulted in clinically significant improvements in the primary outcome measures (awareness, p < 0.0001; annoyance, p < 0.0001). The proportion of patients who indicated an improvement in coping with tinnitus was similar to other published data with similar modifications to PTM-SE. The evidence supports the assumption that PTM is a flexible program of tinnitus management that even when modified to be suitable for use in a DOD medical treatment facility provides meaningful reductions in tinnitus awareness and annoyance and improves tinnitus coping ability among military beneficiaries. These findings should encourage audiologists to modify PTM to work within their military medical treatment facility.

Mobile Apps for Management of Tinnitus: Users' Survey, Quality Assessment, and Content Analysis.

BackgroundTinnitus is the perception of a sound without any outside source. It affects 6 million people in the United Kingdom. Sound therapy is a core component of many tinnitus management programs. Potential mechanisms of benefit include making tinnitus less noticeable, habituation, distracting attention from tinnitus, relaxation, and promoting neuroplastic changes within the brain. In recent years, there has been a substantial increase in the use of mobile technology. This provided an additional medium through which people with tinnitus can access different tinnitus management options, including sound therapy.ObjectiveThe aim of this study was to (1) generate the list of apps that people use for management of their tinnitus, (2) explore reasons for app use and nonuse, (3) perform quality assessment of the most cited apps, and (4) perform content analysis to explore and describe options and management techniques available in the most cited apps.MethodsA Web-based survey consisting of 33 open and closed questions captured (1) demographic information, information about tinnitus, and hearing loss and (2) mobile app–specific information about the motivation to use an app, the apps which respondents used for tinnitus, important factors when choosing an app, devices used to access apps, and reasons for not using apps. The quality of the most cited apps was assessed using the Mobile Apps Rating Scale (MARS). Content and features of the most cited apps were analyzed.ResultsData from 643 respondents were analyzed. The majority of respondents (482/643, 75.0%) had never used an app for management of tinnitus mainly because of lack of awareness (381/643, 59.3%). The list of the 55 apps that people use for their tinnitus was generated. These included apps that were developed specifically for the management of tinnitus; however, the majority of cited apps were developed for other problems (eg, sleep, depression or anxiety, and relaxation). Quality assessment of the 18 most popular apps using MARS resulted in a range of mean scores from 1.6 to 4.2 (out of 5). In line with the current model of tinnitus management, sound was the main focus of the majority of the apps. Other components included relaxation exercises, elements of cognitive behavioral therapy, information and education, and hypnosis.ConclusionsPeople used apps for the management of their tinnitus; however, this was done mostly as a self-help option, without conjunction with management provided by hearing health care professionals. Further research should consider the place for apps in tinnitus management (stand-alone self-management intervention vs part of the management by a hearing professional). As the content of the apps varies with respect to sound options, information, and management strategies, it seems that the choice of the best management app should be guided by individual patient’s needs and preferences.

Tinnitus Perspectives among Israeli Ear, Nose and Throat Physicians: A Nationwide Survey.

To study the compliance of ear, nose, and throat (ENT) physicians to the American Association Otolaryngology-Head - Neck Surgery (AAO-HNS) clinical practice guidelines (CPG) for tinnitus and to identify the disparity of both diagnosis and management options in the absence of a local protocol for the management of adult tinnitus. A voluntary and anonymous questionnaire was emailed in a Google spread-out sheet format to all practicing ENT physicians across the country (n=370). Overall, 126 ENT physicians responded to the questionnaire (34% of the physicians to whom the questionnaire was sent). Medical history focuses on tinnitus characteristics and otological signs, and symptoms are often queried (80%-98%). Physicians routinely perform an otoscopic examination, whereas other relevant possible physical findings, such as temporomandibular joint disorders or neck trauma, are less frequently examined. Treating physicians have the most frequent recourse to sound therapy and cognitive behavioral therapy in accordance with AAO-HNS CPG. The publication of the AAO-HNS CPG for tinnitus is important, permitting a common approach for the diagnosis and management of primary tinnitus (PT). A diagnosis and management scheme that takes into consideration both the AAO-HNS CPG for tinnitus as well as physician diagnosis and management paradigms is suggested.