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Eur Arch Otorhinolaryngol. 2017 May;274(5):2079-2091. doi: 10.1007/s00405-016-4401-y. Epub 2016 Dec 19.

A multidisciplinary systematic review of the treatment for chronic idiopathic tinnitus.

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Department of Otolaryngology, Head and Neck Surgery, University of Tübingen, Elfriede-Aulhorn-Str. 5, 72076, Tübingen, Germany.
Otorhinolaryngology Centre, Kaiserslautern, Germany.
Department of Psychology, Georg-August University of Göttingen, Göttingen, Germany.
Mental Health Centre, Clinic for Psychosomatics and Psychotherapy, Medical University of Hannover, Hannover, Germany.
Department for Dental Prosthetics, Geriatric Dentistry and Function, Charité Hospital, Medical School Berlin, Berlin, Germany.
Tinnitus Clinic, Bad Arolsen Hospital, Arolsen, Germany.
Charité Hospital, Medical School Berlin, University Otorhinolaryngology Clinic, Berlin, Germany.
Department of Behavioural Medicine, Psychosomatics, Psychiatry and Psychotherapy, Schön Clinic in Roseneck, Prien am Chiemsee, Germany.
Clinic and Outpatient Clinic for Neurology, University Hospital of Hamburg-Eppendorf, Hamburg, Germany.
Social Paediatric Centre, Neuropaediatrics and Epileptology, University Paediatric Clinic, Erlangen, Germany.
Otorhinolaryngology Centre, Traunstein, Germany.
MedClin Bosenberg Clinics, Saint Wendel, Germany.
Department for Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.


The majority of tinnitus patients are affected by chronic idiopathic tinnitus, and almost 60 different treatment modalities have been reported. The present study is a multidisciplinary systematic analysis of the evidence for the different forms of treatment for chronic tinnitus. The results are used to form the basis of an S3 guideline. A systematic search was carried out in PubMed and the Cochrane Library. The basis for presenting the level of evidence was the evidence classification of the Oxford Centre of Evidence-based Medicine. Whenever available, randomised controlled trials were given preference for discussing therapeutic issues. All systematic reviews and meta-analyses were assessed for their methodological quality, and effect size was taken into account. As the need for patient counselling is self-evident, specific tinnitus counselling should be performed. Due to the high level of evidence, validated tinnitus-specific, cognitive behavioural therapy is strongly recommended. In addition, auditory therapeutic measures can be recommended for the treatment of concomitant hearing loss and comorbidities; those should also be treated with drugs whenever appropriate. In particular, depression should be treated, with pharmacological support if necessary. If needed, psychiatric treatment should also be given on a case-by-case basis. With simultaneous deafness or hearing loss bordering on deafness, a CI can also be indicated. For auditory therapeutic measures, transcranial magnetic or direct current stimulation and specific forms of acoustic stimulation (noiser/masker, retraining therapy, music, and coordinated reset) for the treatment of chronic tinnitus the currently available evidence is not yet sufficient for supporting their recommendation.


Cochlear implant; Cognitive behavioural therapy; Drug therapy; Retraining therapy; Tinnitus

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