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More than 50\u00a0million people in the United States have reported experiencing tinnitus, resulting in an estimated prevalence of 10% to 15% in adults. Despite the high prevalence of tinnitus and its potential significant effect on quality of life, there are no evidence\u2010based, multidisciplinary clinical practice guidelines to assist clinicians with management. The focus of this guideline is on tinnitus that is both bothersome and persistent (lasting 6\u00a0months or longer), which often negatively affects the patient's quality of life. The target audience for the guideline is any clinician, including nonphysicians, involved in managing patients with tinnitus. The target patient population is limited to adults (18 years and older) with primary tinnitus that is persistent and bothersome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose of this guideline is to provide evidence\u2010based recommendations for clinicians managing patients with tinnitus. This guideline provides clinicians with a logical framework to improve patient care and mitigate the personal and social effects of persistent, bothersome tinnitus. It will discuss the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary tinnitus, with recommendations to guide the evaluation and measurement of the effect of tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Action Statements<\/jats:title><jats:p>The development group made a <jats:italic>strong recommendation<\/jats:italic> that clinicians distinguish patients with bothersome tinnitus from patients with nonbothersome tinnitus. The development group made a <jats:italic>strong recommendation against<\/jats:italic> obtaining imaging studies of the head and neck in patients with tinnitus, specifically to evaluate tinnitus that does not localize to 1 ear, is nonpulsatile, and is not associated with focal neurologic abnormalities or an asymmetric hearing loss. The panel made the following <jats:italic>recommendations<\/jats:italic>: Clinicians should (a) perform a targeted history and physical examination at the initial evaluation of a patient with presumed primary tinnitus to identify conditions that if promptly identified and managed may relieve tinnitus; (b) obtain a prompt, comprehensive audiologic examination in patients with tinnitus that is unilateral, persistent (\u2265 6\u00a0months), or associated with hearing difficulties; (c) distinguish patients with bothersome tinnitus of recent onset from those with persistent symptoms (\u2265 6\u00a0months) to prioritize intervention and facilitate discussions about natural history and follow\u2010up care; (d) educate patients with persistent, bothersome tinnitus about management strategies; (e) recommend a hearing aid evaluation for patients who have persistent, bothersome tinnitus associated with documented hearing loss; and (f) recommend cognitive behavioral therapy to patients with persistent, bothersome tinnitus. The panel <jats:italic>recommended against<\/jats:italic> (a) antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for the routine treatment of patients with persistent, bothersome tinnitus; (b) Ginkgo biloba, melatonin, zinc, or other dietary supplements for treating patients with persistent, bothersome tinnitus; and (c) transcranial magnetic stimulation for the routine treatment of patients with persistent, bothersome tinnitus. The development group provided the following <jats:italic>options<\/jats:italic>: Clinicians may (a) obtain an initial comprehensive audiologic examination in patients who present with tinnitus (regardless of laterality, duration, or perceived hearing status); and (b) recommend sound therapy to patients with persistent, bothersome tinnitus. The development group provided <jats:italic>no recommendation<\/jats:italic> regarding the effect of acupuncture in patients with persistent, bothersome tinnitus.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599814545325","type":"journal-article","created":{"date-parts":[[2014,10,1]],"date-time":"2014-10-01T14:36:33Z","timestamp":1412174193000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":403,"title":["Clinical Practice Guideline: Tinnitus"],"prefix":"10.1002","volume":"151","author":[{"given":"David E.","family":"Tunkel","sequence":"first","affiliation":[{"name":"Otolaryngology\u2013Head and Neck Surgery Johns Hopkins Outpatient Center Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol A.","family":"Bauer","sequence":"additional","affiliation":[{"name":"Division of Otolaryngology\u2013Head and Neck Surgery Southern Illinois University School of Medicine Springfield Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon H.","family":"Sun","sequence":"additional","affiliation":[{"name":"Partnership for Health Analytic Research, LLC Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard M.","family":"Rosenfeld","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology State University of New York at Downstate Medical Center Brooklyn New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sujana S.","family":"Chandrasekhar","sequence":"additional","affiliation":[{"name":"New York Otology New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Eugene R.","family":"Cunningham","sequence":"additional","affiliation":[{"name":"Department of Research and Quality Improvement American Academy of Otolaryngology\u2014Head and Neck Surgery Foundation Alexandria Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanford M.","family":"Archer","sequence":"additional","affiliation":[{"name":"Divisions of Rhinology &amp; Sinus Surgery and Facial Plastic &amp; Reconstructive Surgery University of Kentucky Lexington Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian W.","family":"Blakley","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology University of Manitoba Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Carter","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Tulane University New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn C.","family":"Granieri","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine and Aging Columbia University New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Henry","sequence":"additional","affiliation":[{"name":"National Center for Rehabilitative Auditory Research Portland VA Medical Center Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deena","family":"Hollingsworth","sequence":"additional","affiliation":[{"name":"ENT Specialists of Northern Virginia Falls Church Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fawad A.","family":"Khan","sequence":"additional","affiliation":[{"name":"Ochsner Health System Kenner Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Mitchell &amp; Cavallo, P.C. 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