Clinical practice guidelines for diagnosis and treatment of chronic tinnitus in Japan
Introduction
Tinnitus is present in 10%–15% of the population. Clinically problematic tinnitus accounts for about 20%; that is, 2%–3% of the population. In Japan, approximately 3 million tinnitus patients experienced tinnitus onset accompanied by strong pain and were referred to otolaryngology. However, guidelines that systematically summarized the tinnitus practice in Japan have not been prepared. It is likely that medical treatments for patients with refractory tinnitus are unsatisfactory. As a result, quality of life (QOL) is decreased and patients may begin to “shop” for a different doctor; thus, this is an urgent issue.
With the following guidelines, we are seeking to (1) standardize methods for evidence-based diagnosis of tinnitus (diagnosis / treatment) and (2) to improve each patient's QOL. These guidelines are for patients who complain of chronic tinnitus. This tinnitus is non-pulsatile and lasts longer than 3 months.
Tinnitus practice was previously published by the United States, Germany, Denmark, the Netherlands, and Sweden, among other countries [1].
These guidelines also refer to previously reported guidelines, recent literature reports, and Japanese research reports.
The objectives of this study were as follows:
- 1)
Standardization of evidence-based tinnitus medical treatment (diagnosis and treatment)
- 2)
Improvement in the QOL of tinnitus patients
We also aimed to address two main clinical issues. Clinical issue 1: In Japan, “standardization of tinnitus evaluation” is necessary; however, “standard tinnitus test methods 1993” was published in 1993, more than 20 years previously. Pitch-match inspection and representation of the loudness balance test should be revised. Further, standardization of tinnitus distress and QOL evaluation in patients with tinnitus are urgent issues.
Clinical issue 2: We need to develop evidence-based treatment guidelines for chronic tinnitus. In recent years, cognitive behavioral and sound therapies have been found to be effective for reducing distress in tinnitus patients. Currently, different medical treatments are performed at the discretion of each doctor at each medical institution, and differences between the areas of facilities for treating tinnitus are also identified. Evidence-based standardization of tinnitus clinical practice guidelines is an important issue for improving the level of tinnitus medical examinations in Japan.
The guidelines were developed by subcommittee members, edited by the Japan Audiological Society, and authorized by the Oto-Rhino-Laryngological Society of Japan.
Section snippets
Methods
1. Users
The main enforcers of these guidelines are otolaryngologists who diagnose and treat patients.
2. Subjects
The subjects for whom these guidelines are created are patients with non-pulsatile tinnitus that has persisted for > 3 months after onset, excluding pulsatile tinnitus.
3. Systematic Review of the Diagnosis and Treatment of Tinnitus
We used the Cochrane Library, the medical journal Web, and PubMed for the literature search, and the search was performed in March 2017 under the following
Pre-release review
Before these guidelines were released for general use, they were reviewed with reference to the Conference on Guideline Standardization (COGS) proposals concerning their publication format [4] and the Appraisal of Guidelines for Research & Evaluation (AGREE) appraisal instrument for content assessment [5].
Before publication of the 2019 edition of the guidelines, opinions were solicited from the otolaryngologists and patients with tinnitus, and corrections were made as necessary.
Acknowledgement
This guideline was supported by AMED grant (2016−2019).
Disclosure Statement
All the authors are required to declare any financial support or relationship that may pose a conflict of interest. We have been granted by national goverment (AMED grant) as mentioned above.
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2023, Handbook of Cognitive Behavioral Therapy by Disorder: Case Studies and Application for AdultsThe efficacy of acoustic therapy versus oral medication for chronic tinnitus: A meta-analysis
2021, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :It is often difficult to achieve the desired effect without knowing the cause of tinnitus. While giving physical treatment, it is also necessary for tinnitus patients to pay attention to psychological therapy [16,47]. Tinnitus Retraining Therapy (TRT) uses a combination of sound therapy and directive psychological counseling to assist in overcoming the bothersome effects of tinnitus, thus making the patient no longer aware of their tinnitus [48–50].
Efficacy of pharmacologic treatment in tinnitus patients without specific or treatable origin: A network meta-analysis of randomised controlled trials
2021, eClinicalMedicineCitation Excerpt :No language restriction was used. In addition, manual searches were performed for potentially eligible articles selected from the reference lists of review articles, clinical guidelines, and pairwise meta-analyses [1,8,9,13,19–23]. The definition of “tinnitus without specific or treatable origin” followed the definition of primary tinnitus addressed in the important guideline by Tunkel, D.E. (2014) [22].
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