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. 2023 Apr 24;12(9):3087.
doi: 10.3390/jcm12093087.

Tinnitus Guidelines and Their Evidence Base

Berthold Langguth  1   2 , Tobias Kleinjung  3 , Winfried Schlee  1   2   4 , Sven Vanneste  5   6   7 , Dirk De Ridder  8
Affiliations

Tinnitus Guidelines and Their Evidence Base

Berthold Langguth et al. J Clin Med. .

Abstract

Evidence-based medicine (EBM) is generally accepted as the gold standard for high-quality medicine and, thus, for managing patients with tinnitus. EBM integrates the best available scientific information with clinical experience and patient values to guide decision-making about clinical management. To help health care providers and clinicians, the available evidence is commonly translated into medical or clinical guidelines based on a consensus. These involve a systematic review of the literature and meta-analytic aggregation of research findings followed by the formulation of clinical recommendations. However, this approach also has limitations, which include a lack of consideration of individual patient characteristics, the susceptibility of guideline recommendations to material and immaterial conflicts of interest of guideline authors and long latencies till new knowledge is implemented in guidelines. A further important aspect in interpreting the existing literature is that the absence of evidence is not evidence of absence. These circumstances could result in the decoupling of recommendations and their supporting evidence, which becomes evident when guidelines from different countries differ in their recommendations. This opinion paper will discuss how these weaknesses can be addressed in tinnitus.

Keywords: decision support system; evidence; evidence-based medicine; living guideline; meta-analysis; tinnitus; treatment guidelines.

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Conflict of interest statement

B.L. received honoraria for consultancy and speakers’ fees from ANM, AstraZeneca, Autifony Therapeutics, Decibel Therapeutics, Desyncra, Gerson Lehmanns Group, Lundbeck, Merz, MagVenture, Medical Tribune, Neurolite, Neuromod, Novartis, Pfizer, Rovi, Schwabe, Sea Pharma, Servier, Sonova and Sound Therapeutics; research funding from the Tinnitus Research Initiative, Bayhost, the German Research Foundation, the German Bundesministerium für Bildung und Forschung, the American Tinnitus Association, AstraZeneca, cerbomed, Neuromod and the European Commission under the Horizon 2020 Research and Innovation Programme; funding for equipment from MagVenture and Deymed Diagnostic; and travel and accommodation payments from Eli Lilly, Lundbeck, Servier, and Pfizer. He owns shares in Sea Pharma. None of the funding sources is in relation to this article. T.K. received funding for research projects from the Swiss National Science Foundation, Zurich Hearing Foundation, the Horizon 2020 program of the European Commission, the Tinnitus Research Initiative and Cochlear®. He obtained honoraria for lectures from Schwabe Pharma AG. None of the funding sources is in relation to this article. W.S. received funding from the European Commission under the Horizon 2020 Research and Innovation Programme. He obtained honoraria from G. Pohl-Boskamp GmbH & Co. KG and Schwabe Pharma AG and is a stakeholder of the Lenox uG, which aims to translate scientific knowledge into e-health applications. None of the funding sources is in relation to this article. S.V. is receiving funding from the national institute of Health, Department of defines, Enterprise Ireland, science foundation Ireland and the Alzheimer Association. He is a scientific advisor for Neuromod and Capri Medical and is a stakeholder of Brai3n BVBA. None of the funding sources is in relation to this article. D.D.R. is on the speakers’ bureau, advisory board and consultant for Abbott, Qey, Elexo and Neurosoft bio, but none related to the topic of this manuscript.

Figures

Figure 1
Figure 1
The number of hits for “randomized controlled trials tinnitus” in Pubmed (assessed 1 December 2022).
Figure 2
Figure 2
Schematic illustration of the procedure to determine the level of certainty (modified from [6]).
Figure 3
Figure 3
The weekly flow of evidence, recommendations, and approval (from [92]).
See this image and copyright information in PMC

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