LM111 - Overview of the 2024 VA/DOD Clinical Practice Guideline for Tinnitus

Abstract:
Evidence-based practice is essential to providing high quality hearing healthcare. Given that about 10% of the general population experiences tinnitus, audiologists regularly encounter patients reporting tinnitus. Tinnitus is even more prevalent in the military. The Veterans Affairs and the Department of Defense recently published a comprehensive clinical practice guideline for adults with bothersome tinnitus. Evaluation of the evidence that was retrieved to answer 20 key questions resulted in 25 recommendations, encompassing interventions provided by audiologists, behavioral/mental health, dentists, and physical therapists. An overview of the CPG development process, and the final recommendations, will be presented in this session.

Summary:
Tinnitus is the number one Veteran Affairs (VA) service-connected disability (VA Benefits Report, 2023). Department of Defense (DOD) Service members report tinnitus at a high rate as well. Evidence-based care for tinnitus is needed in the VA and DOD. The most recent clinical practice guideline for tinnitus was developed in 2014 (Tunkel et al., 2014); therefore, a new guideline was warranted. The VA/DOD Clinical Practice Guideline (CPG) for Tinnitus team was comprised of a Work Group (WG) of individuals with the following areas of expertise: audiology, neurotology, nursing, pharmacy, psychology, sociology, and speech and hearing science; 4 agencies contracted by the VA to conduct evidence retrieval and grading, and to guide the CPG development process; and VA and DOD evidence-based practice leadership Twenty key questions were developed by the WG. Evidence was retrieved to answer the key questions and this formed the basis of the recommendations. Recommendations were developed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, patient preferences, and clinical expertise. Options for identifying the strength of a given recommendation can be strong for, strong against, weak for, or weak against. In some instances there is insufficient evidence on which to base a recommendation for or against a given intervention. The recommendations developed by the WG encompass 11 topics: (1) Monitoring, (2) Education and Self-Management, (3) Amplification Devices, (4) Sound-based Intervention Alone, (5) Behavioral Intervention Alone, (6) Combined Sound-based and Behavioral Intervention, (7) Neuromodulation/Neurostimulation, (8) Manual Therapy, (9) Complementary and Integrative Health, (10) Herbals/Nutraceuticals, and (11) Pharmacotherapy. Ten weak for, four weak against, and 11 insufficient evidence recommendations were developed by the WG. These recommendations apply to audiology, otolaryngology, mental/behavioral health, dental, and physical therapy providers. In addition to the 25 recommendations, an algorithm was developed to provide a clinical pathway framework. Module A details a suggested pathway for patients presenting with a complaint of tinnitus. The pathway includes a referral to audiology, if appropriate. Module B provides guidance for helping patients to manage their tinnitus and improve their quality of life. The interventions mentioned in the algorithm are derived from the evidence-based recommendations in the CPG. Additional appendices in the CPG include: (1) Routine Care, (2) Medication-related Considerations in Managing Patients with Bothersome Tinnitus, (3) Devices, (4) Quick Guide to Questionnaires and Assessment Instruments in Clinical Practice, and (5) Education. Additionally, a Tinnitus Provider Summary, Tinnitus Reference Card, and Tinnitus Patient Summary was developed.

Brief Summary of Clinical Takeaways:
The clinical takeaway for this session is that the 2024 VA/DOD Clinical Practice Guideline for Tinnitus can be a valuable resource to facilitate delivery of high quality evidence-based hearing healthcare to patients presenting with a complaint of bothersome tinnitus.