Analysis and comparison of clinical practice guidelines regarding treatment recommendations for chronic tinnitus in adults: a systematic review

OBJECTIVES: To determine if, and to what extent, published clinical practice guidelines for the treatment of chronic tinnitus vary in their recommendations. DESIGN: Systematic review of guidelines. DATA SOURCES: PubMed, EMBASE and GIN electronic databases were searched in March 2022 and the search was updated in June 2023. ELIGIBILITY CRITERIA: We included clinical practice guidelines that gave recommendations on the treatment of tinnitus. No language restrictions were applied. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted the data and used the AGREE checklist to report on reporting. RESULTS: A total of 10 guidelines were identified and included, published between 2011 and 2021. Recommendations for 13 types of tinnitus treatments were compared. Large differences in guideline development and methodology were found. Seven of the 10 guidelines included a systematic search of the literature to identify the available evidence. Six of the 10 guidelines used a framework for the development of the guideline. Reporting was poor in multiple guidelines. Counselling and cognitive behavioural therapy were the only treatments that were recommended for treating tinnitus associated distress by all guidelines that reported on these topics. Tinnitus retraining therapy, sound therapy, hearing aids and cochlear implantation were not unanimously recommended either due to the lack of evidence, a high risk of bias or judgement of no beneficial effect of the specific treatment. CONCLUSIONS: There were notable differences with respect to whether guidelines considered the available evidence sufficient enough to make a recommendation. Notably, we identified substantial differences in the rigour of guideline design and development. Reporting was poor in many guidelines. Future guidelines could benefit from the use of reporting tools to improve reporting and transparency and the inclusion of guideline experts and patients to improve the quality of clinical practice guidelines on tinnitus.