What official guidance do ENT specialists give for managing tinnitus symptoms?

1. Diagnosis: rule out red flags, don’t image reflexively

Official guidance instructs clinicians to take a focused history and physical to identify treatable or urgent causes—sudden sensorineural hearing loss, pulsatile tinnitus, unilateral tinnitus, persistent symptoms, otalgia, or otorrhea warrant prompt specialist assessment—while discouraging routine head/neck imaging for typical tinnitus without red flags (AAO‑HNS; systematic reviews) ^{[1] [3]}. ENT and audiology evaluation, including comprehensive audiometry, is recommended when tinnitus is unilateral, associated with hearing difficulty, or persistent ≥6 months; audiology can triage hearing‑related therapies and further referral ^{[5] [7]}.

2. Treat the identifiable causes first

ENT guidance stresses that when tinnitus is secondary to a specific, treatable condition, addressing that condition may reduce or eliminate the symptom: impacted cerumen removal, treating middle‑ear infection, medical or surgical management of vascular lesions that produce pulsatile tinnitus, or targeted therapy for sudden hearing loss are standard initial steps (ENT clinic guidance; University of Miami; academic summaries) ^{[7] [8] [3]}. Clinicians will also review medications that can cause tinnitus and collaborate to modify offending drugs when appropriate (clinical summaries) ^[9].

3. Audiologic rehabilitation and sound‑based approaches

When no reversible medical cause is found, official recommendations prioritize audiologic management: hearing aids for concurrent hearing loss, sound therapy (use of background or mask­ing sounds) to reduce perceived loudness and distraction, and individualized management plans developed by audiologists and ENTs—these approaches are central to Progressive Tinnitus Management models used in clinics ^{[5] [3] [10]}. Sound enrichment and “good aural hygiene,” including hearing protection and noise avoidance to prevent progression, are repeatedly advised ^{[3] [4]}.

4. Psychological care: CBT is evidence‑based for distress

Guidelines explicitly recommend educating patients about tinnitus’ natural history and offering cognitive behavioral therapy (CBT) to those with persistent, bothersome tinnitus because CBT reduces tinnitus‑related distress even when it does not eliminate the sound (AAO‑HNS evidence summary; evidence maps) ^{[5] [2]}. A stepped approach is suggested: digital or group CBT resources, then individual therapy when needed, and clinicians are reminded to screen for comorbid anxiety and depression ^[3].

5. Medications and supplements: limited roles, some targeted uses

Official guidance and reviews caution against routine use of antidepressants, anticonvulsants, or anxiolytics specifically for tinnitus, although treating coexisting depression or anxiety can reduce annoyance ^{[6] [5]}. Melatonin has some evidence for improving sleep and secondary tinnitus distress and may be considered for sleep problems, but guidelines do not endorse a pharmacologic “cure” for primary tinnitus ^[6]. Claims for vitamins or unproven supplements are not supported by high‑quality evidence and are not recommended as routine therapy (AAFP summary) ^[4].

6. When to refer and the patient role

ENT guidance and tinnitus organizations advise that primary care can manage many cases but should refer for ENT/audiology when red flags, persistent or unilateral tinnitus, or significant functional impact occur; patients are encouraged to seek clinicians who follow established practice guidelines and to educate themselves using reputable sources (AAO‑HNS; American Tinnitus Association) ^{[5] [11]}. Clinics emphasize individualized plans and note that while no universal cure exists for primary tinnitus, multiple evidence‑based strategies can reduce distress and improve quality of life (ENT health resources) ^{[8] [10]}.