Tinnitus Stepped-Care: A Model for Standardizing Clinical Services for Tinnitus.

Clinical services for tinnitus have expanded greatly since the "masking" method was introduced by Jack Vernon in the 1970s. According to PubMed, the number of peer-reviewed publications has increased dramatically since that time (seven with "tinnitus" in the title in 1975; 477 in 2023). With so much research and overall interest, it might be expected that tinnitus services have improved accordingly. In reality, there are many variations of treatment, but no one method has been shown to be more effective than any other. This diversity of methods is evident when researching "tinnitus" on the internet and considering the many different ways clinicians offer tinnitus services. Some offer an evidence-based method but may not have the competency to ensure fidelity. Further is the proliferation of commercial methods that can cost thousands of dollars. In this article, I propose a framework for providing tinnitus clinical services called Tinnitus Stepped-Care. This framework does not promote specific procedures for tinnitus assessment and treatment, but rather suggests guiding principles that are essential in each of six progressive steps of tinnitus clinical care. It is further proposed to test the stepped-care model in the (currently under development) Tinnitus Learning Health Network (TLHN). The TLHN would consist of a network of clinicians, patients, and researchers from around the world who collaborate in establishing "best tinnitus practices." Collaboration would involve using and sharing data for the ongoing monitoring of a large, diverse, well-described patient population, and using quality improvement science to test and monitor outcomes over time, to determine the most effective treatments for different subgroups of tinnitus patients.