Clinical Practice Guideline for the Diagnosis and Management of Tinnitus in Korea

Standardized, evidence-based guideline for tinnitus management is currently lacking in Korea. This guideline aims to provide evidence-based recommendations for the diagnosis and management of tinnitus in Korean adults, adapted to the Korean healthcare system. A multidisciplinary panel (eight otorhinolaryngologists, one neurologist, one psychiatrist, and one audiologist) conducted systematic literature searches up to 2025 using PubMed, Embase, Cochrane Library, KoreaMed, and KMBASE. Evidence quality was assessed using the GRADE methodology. Nine key clinical questions (KQs) were developed in PICO format, and recommendations were finalized through a modified Delphi process (≥80% agreement threshold). Imaging is recommended for the evaluation of patients with pulsatile tinnitus or asymmetric hearing loss (Grade B). Tinnitus retraining therapy (TRT) and cognitive behavioral therapy (CBT) are conditionally recommended for patients with tinnitus (Grade B). Hearing aids are conditionally recommended for patients with tinnitus and coexisting hearing loss (Grade B). Sound therapy is conditionally recommended to reduce tinnitus-related distress (Grade B). Neuromodulation (transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS)) is conditionally recommended as an adjunctive treatment (Grade B). Routine zinc and vitamin supplementation are strongly recommended against for tinnitus symptom improvement (Grade D†), whereas Ginkgo biloba may be considered for patients with subjective tinnitus (Grade B). Most available evidence was predominantly of low or very low certainty. This guideline provides the first comprehensive evidence-based framework for tinnitus management in Korea. Behavioral and rehabilitative interventions provided the strongest evidence for reducing tinnitus-related distress. Considerations of Korean National Health Insurance coverage, regional accessibility, and patient preferences were integrated throughout the guideline development process. The primary therapeutic goal is to reduce tinnitus-related distress and improve functional outcomes, thereby enhancing overall quality of life.