临床实践指南：耳鸣更新。
完整摘要 · 中文译文
目的：耳鸣是在没有外部声源的情况下对声音的感知。美国有超过5000万人报告曾经历过耳鸣，估计在成人中的患病率为10%至15%。本指南的重点是既令人困扰又持续存在（持续6个月或更长）的耳鸣，这种耳鸣常对患者的生活质量产生负面影响。本指南的目标受众是任何参与管理耳鸣患者的临床医生，包括专职医疗人员。目标患者人群仅限于患有持续且令人困扰的耳鸣的成人（18岁及以上）。 目的：本指南的目的是为管理耳鸣患者的临床医生提供并更新循证建议。本指南为临床医生提供了一个逻辑框架，以改善患者护理并减轻持续、令人困扰的耳鸣对个人和社会的影响。它讨论了耳鸣患者的评估，包括诊断性检查和专科转诊的选择与时机，以识别潜在的可治疗的潜在病理。然后重点讨论持续耳鸣患者的治疗，提供建议以指导耳鸣效果的测量，并确定最合适的干预措施，以改善耳鸣患者及其相关合并症患者的症状和生活质量。 方法：本指南依据美国耳鼻咽喉头颈外科学基金会发布的《临床实践指南制定手册》（第3版）中概述的55页方案制定，该方案总结了当前数据评估、主题优先级排序、关键行动声明（KASs）制定、价值判断应用及相关程序的方法。指南制定小组由成人耳鼻咽喉科医师、听力学家、耳科医师/神经耳科医师、老年医学医师、行为神经科学家、神经科医师、放射科医师、精神科医师、内科医师、执业护师、耳鼻咽喉科住院医师以及一名代表参与的全国性专业组织的消费者代表组成。 行动声明：指南更新小组对以下关键行动声明（KAS）提出了强推荐：临床医生应将有困扰性耳鸣的患者与无困扰性耳鸣的患者区分开来（KAS 2）。临床医生应询问有困扰性耳鸣患者的自我伤害风险（KAS 3）。除非存在特定的令人担忧的特征，否则临床医生不应为了评估耳鸣本身而对耳鸣患者进行神经影像学检查（KAS 6）。指南更新小组对以下关键行动声明提出了推荐：临床医生应在耳鸣患者的初次评估中进行针对性的病史采集和体格检查（KAS 1）。临床医生应对耳鸣患者进行全面的听力学评估（KAS 5）。临床医生应教育耳鸣患者了解耳鸣的自然病程、影响及管理策略（KAS 7）。临床医生应建议有听力困难和持续性、困扰性耳鸣的患者进行助听器评估（KAS 8）。临床医生应将符合听力学转诊标准的持续性、困扰性耳鸣患者转诊进行人工耳蜗植入评估（KAS 9）。临床医生应向持续性、困扰性耳鸣患者推荐认知行为疗法（CBT）（KAS 11）。临床医生或其指定人员应评估并记录持续性、困扰性耳鸣患者干预措施的结果（KAS 15）。指南更新小组对以下关键行动声明提出了反对建议：临床医 临床医生不应常规推荐抗抑郁药、抗惊厥药、抗焦虑药或鼓室内注射药物作为治疗持续性、困扰性耳鸣的主要适应症（KAS 12）。临床医生不应推荐膳食补充剂作为持续性、困扰性耳鸣的主要适应症（KAS 13）。临床医生不应推荐重复经颅磁刺激（rTMS）治疗持续性、困扰性耳鸣患者（KAS 14A）。指南更新工作组对以下KAS提供了选项：临床医生可询问持续性、困扰性耳鸣患者的感觉运动特征（KAS 4）。临床医生可向持续性、困扰性耳鸣患者推荐声音丰富化治疗（KAS 10）。临床医生可向持续性、困扰性耳鸣患者提供双模态神经调控治疗（KAS 14B）。
完整摘要 · 英文原文
OBJECTIVE: Tinnitus is the perception of sound without an external source. More than 50 million people in the United States have reported experiencing tinnitus, resulting in an estimated prevalence of 10% to 15% in adults. The focus of this guideline is on tinnitus that is both bothersome and persistent (lasting 6 months or longer), which often negatively affects the patient's quality of life. The target audience for the guideline is any clinician, including allied health professionals, involved in managing patients with tinnitus. The target patient population is limited to adults (18 years and older) with tinnitus that is persistent and bothersome. PURPOSE: The purpose of this guideline is to provide and update evidence-based 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 discusses the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It then focuses on the treatment of patients with persistent tinnitus, with recommendations to guide the measurement of the effect of tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for people with tinnitus and associated comorbidities. METHODS: This guideline was developed using the 55-page protocol published as the American Academy of Otolaryngology-Head and Neck Surgery Foundation's Clinical Practice Guideline Development Manual (3rd edition), which summarizes the methodology for assessments of current data, topic prioritization, development of key action statements (KASs), application of value judgments, and related procedures. The guideline group was represented by adult otolaryngologists, audiologists, otologists/neurotologists, a geriatrician, a behavioral neuroscientist, a neurologist, a radiologist, a psychiatrist, an internist, a nurse practitioner, an otolaryngology resident physician, and a consumer advocate who represented participating, national professional organizations. ACTION STATEMENTS: The Guideline Update Group made strong recommendations for the following Key Action Statements (KAS): Clinicians should distinguish patients with bothersome tinnitus from patients with non-bothersome tinnitus (KAS 2). Clinicians should inquire about risks for self-harm in a patient with bothersome tinnitus (KAS 3). Clinicians should not obtain neuroradiologic imaging in patients with tinnitus specifically to evaluate the tinnitus unless specific concerning features are present (KAS 6). The Guideline Update Group made recommendations for the following KASs: Clinicians should perform a targeted history and physical examination at the initial evaluation of a patient with tinnitus (KAS 1). Clinicians should obtain a comprehensive audiological evaluation in patients with tinnitus (KAS 5). Clinicians should educate patients with tinnitus about the natural history and effects of, and management strategies for tinnitus (KAS 7). Clinicians should recommend a hearing aid evaluation for patients with hearing difficulties and persistent, bothersome tinnitus (KAS 8). Clinicians should refer patients with persistent, bothersome tinnitus for cochlear implant evaluation when they meet audiologic criteria for referral (KAS 9). Clinicians should recommend Cognitive Behavioral Therapy (CBT) to patients with persistent, bothersome tinnitus (KAS 11). Clinicians or their designee should assess and document outcomes of interventions in patients with persistent, bothersome tinnitus (KAS 15). The Guideline Update Group made recommendations against for the following KASs: Clinicians should not routinely recommend antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for a primary indication of treating persistent, bothersome tinnitus (KAS 12). Clinicians should not recommend dietary supplements for the primary indication of persistent, bothersome tinnitus (KAS 13). Clinicians should not recommend repetitive transcranial magnetic stimulation (rTMS) for the treatment of patients with persistent, bothersome tinnitus (KAS 14A). The Guideline Update Group offered options for the following KASs: Clinicians may inquire about somatosensory features in patients with persistent, bothersome tinnitus (KAS 4). Clinicians may recommend sound enrichment to patients with persistent, bothersome tinnitus (KAS 10). Clinicians may offer bimodal neuromodulation to patients with persistent, bothersome tinnitus (KAS 14B).