CHRONIC TINNITUS: AN UPDATE ON PATHOPHYSIOLOGY, CLINICAL ASSESSMENT AND THERAPEUTIC EVIDENCE

Abstract

Tinnitus is the perception of sound without an external sound source and affects about 14% of adults worldwide, with a relevant impact on sleep, concentration, mood and quality of life. This study aimed to synthesize the current evidence on the epidemiology, pathophysiology, clinical assessment and treatment of chronic tinnitus in adults. This is a narrative review, structured according to the SANRA scale, with searches in the PubMed, SciELO and Cochrane Library databases, prioritizing clinical practice guidelines, systematic reviews and large studies. Hearing loss is the main risk factor, and the most accepted pathophysiological model involves maladaptive plasticity of the central nervous system after reduced cochlear input. Assessment is based on clinical history, audiometry and validated questionnaires, with imaging reserved for atypical presentations. Cognitive behavioral therapy has the most consistent evidence for reducing tinnitus impact, and sound amplification is indicated when hearing loss is present. Antidepressants, anticonvulsants, betahistine and Ginkgo biloba have not shown benefit, and neuromodulation techniques remain experimental. Management should be multiprofessional and centered on counseling, avoiding treatments without scientific support.