Cima et al. - 2018 - A multidisciplinary european guideline for tinnitus

Authors: R. F. F. Cima (Maastricht University, Netherlands), B. Mazurek (Charité—Universitätsmedizin Berlin, Germany), H. Haider (Hospital Cuf Infante Santo, Portugal), D. Kikidis (University of Athens, Greece), A. Lapira (Malta University, Malta), A. Noreña (Aix-Marseille Université, France), D. J. Hoare (University of Nottingham, UK).
Contributors: A. Agius, A. Londero, A. Clarke, etc.

General Introduction - Motivation for the guideline. - Aim of the guideline. - Delineation and intended users of the guideline. - Main classifications for subjective tinnitus. - Epidemiology and pathophysiology of tinnitus. - Mechanisms of tinnitus awareness and distress. - Theoretical models of tinnitus.
Methods - Introduction to the guideline development process. - Preparatory work leading to the guideline formation. - Consultation rounds and consensus building.
Diagnostics, Assessments, and Outcomes - Introduction to diagnostic criteria. - Minimum patient assessments and further assessment options. - Use of assessment questionnaires.
Treatment Options and Referral Pathways - Available treatments and evidence base for each. - Referral options and treatment criteria.
Patient Information and Support - Importance of confirming knowledge and dispelling myths. - Types of information that should be provided to patients. - Resources for further support.

1.1 Motivation for the guideline - Tinnitus is the perception of sound without external stimulus; can be distressing for some individuals. - Objective vs. subjective tinnitus. - Need for standardized assessment and treatment due to the complex nature of tinnitus and diverse patient profiles.
1.2 Aim of the guideline - Establish uniformity in assessment and treatment of adult patients with subjective tinnitus. - Optimize referral trajectories, minimize over- and under-treatment. - Support shared decision-making in clinical practice.
1.3 Intended users - Health professionals (ENT doctors, audiologists, psychologists, etc.) and stakeholders including researchers and patients.
1.5 Main classifications for subjective tinnitus - Acute (

3.1 Introduction - Numerous factors contribute to tinnitus onset; a comprehensive assessment is critical.
3.2 Minimum patient assessment - Fundamental patient history should include onset, modulation, severity, and impact assessments (using validated questionnaires).
3.4 Assessment by questionnaires - Recommended assessments include Tinnitus Handicap Inventory (THI), Tinnitus Questionnaire (TQ), and more to evaluate severity/distress.

4.1 Available treatments - Cognitive Behavioral Therapy (CBT) is highly recommended. - Medication options are limited; strong recommendation against drug treatments specifically for tinnitus.
4.2 Referral options - Referral for psychological or audiological assessment based on screening results.

5.1 Confirming knowledge and dispelling myths - Educating patients about tinnitus, treatment strategies, and dispelling common misconceptions (e.g., tinnitus leading to deafness).
5.2 Information provided to patients - Key information includes treatment options, coping strategies, and understanding of tinnitus.
5.3 Further information - Support from national charities, professional organizations, and helplines.

Appendix A: Management of Pulsatile Tinnitus
Appendix B: Development of the guideline implementation plan
Appendix C & D: Further details on somatosensory tinnitus and related quality-of-life instruments.

Importance of interdisciplinary approaches involving audiologists, psychologists, and ENT specialists.
Emphasis on educating patients about the expected outcomes and available coping mechanisms, ensuring ongoing communication and support throughout their treatment journey.