I said I'd try and answer some of the questions on here relating to the guidelines. As well as the guidelines (not yet published) highlighted above, other countries do have guidelines already in place, the US ones are the most referenced;
https://journals.sagepub.com/doi/full/10.1177/0194599814545325?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed
Guidelines should be evidence based. Meaning they make recommendations, and the strength of the recommendation should be based on the weight of evidence available. Some guidelines will be more liberal with that interpretation then others. NICE will be very restrictive, whereas the BSA guidelines will be a little more flexible, but will still need to prove the statements with evidence. So with that in mind;
Why are they against Neuromodulation and Vagus Nerve stimulation, or even sound therapy? They only advocate CBT?
The guidelines are not against Neuromodulation, VNS or sound therapy. They make no recommendation because there is not a sufficient evidence base that they either
Do or
Do Not work. So currently see the white box as areas that require more evidence to be recommended within practice guidelines. The reason the therapies in the 'No Recommendation,' box appear is because they were highlighted as currently available or emerging treatments/therapies that were worth of consideration within the guideline. Others will have different lists, depending on when the guidelines were produced or what is available locally.
Why are they against supplementation?
I am by no means saying it will cure tinnitus, but many people have reduced their tinnitus when they fix a mineral or vitamin imbalances. There have also been studies done showing the beneficial effect that certain supplements have on the auditory system when exposed to loud noises or ototoxic medication.
Just a complete stab in the dark here, but maybe they think deficiencies are best corrected in our diet maybe?
For example, get your magnesium from spinach or kale.
I know a lot of studies are against some supplements in pill form because they don't show much effect. However, this really does depend upon what the supplement is and what you are taking it for.
By the way, I take supplements.
Because there is evidence (and quite a lot of it) they do not work for tinnitus. If you have a deficiency then treating this may be sensible BUT you are treating the deficiency, not the tinnitus. Zinc and B12 are the ones most commonly referenced here. The guidelines are for treating tinnitus, not for treating a vitamin (or other deficiency), in the same way they are not a guideline for hearing loss (which may also cause tinnitus). So the guideline is against taking a supplement solely for tinnitus (as are the US guidelines), based on current evidence.
Pardon if I didn't understand this correctly, but from the looks of it, they are disregarding and/or discouraging therapies or attempts at actually curing or treating the condition in a way that results in a decrease in tinnitus volume.
Practice guidelines are (and should) be based on evidence and at the moment this is where the evidence leads such a document. All of the practice guidelines are 'live' documents, they will be updated to account for future evidence, so they will change as new practice and research emerges. BUT they can only make recommendations for and against based on the current evidence, and often will only consider high quality RCT's and systematic reviews - so the highest level of evidence.
So...
There is a valid point in some of the comments on supplements. Guidelines are developed for what makes a difference on a population wide level, due to them being developed based on RCTs, etc. This doesn't account for what works for some individuals, as they get lost in the numbers often. Nor do they take account of patient preference. So things that work for some or may be reported in the forum as useful may be missed due to the data that is used to write these. There are similar frustrations often for clinician who believe important elements of care get overlooked in the need for high level evidence.
But...
They are useful. They promote the need for tinnitus care and management to be taken seriously. They provide a blueprint for services to follow. They raise the profile of tinnitus - by having the guidelines it raises the bar and gives people with tinnitus some sort of comparator to see if the care received meets the local guideline. It also raises awareness of the research gaps where more research is needed into current treatments to prove efficacy (the No Recommendation box in this case). They are a live document and will be updated in the future based on new evidence, so are overall helpful to have in place.
Please don't shoot the messenger! Just trying to give some context I thought may be useful.
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