A Multi-Integrated Approach to Tinnitus Phenotype-Guided Otolaryngological, Dental, and Physiotherapeutic Care

Abstract

Background: Tinnitus is a heterogeneous percept that becomes a disorder when it is accompanied by clinically meaningful distress or functional impairment. Hearing loss is a major contributor, while temporomandibular, cervical, sleep, psychological, and contextual factors can shape symptom expression. This heterogeneity supports coordinated assessment, but it does not by itself prove that an integrated care pathway improves outcomes. Objective: To narratively synthesize evidence relevant to phenotype-guided tinnitus care and to propose a clinical–organizational framework for coordinating otolaryngological and audiological care, dental and temporomandibular management, physiotherapeutic rehabilitation, and complementary behavioral and sleep interventions. Methods: A structured narrative review was developed with reference to SANRA. PubMed/MEDLINE, the Cochrane Library, major guideline repositories, and targeted citation searches were examined for English-language evidence from January 2014 to 12 August 2026, with seminal earlier publications retained. Guidelines, systematic reviews, randomized trials, and clinically informative observational studies were prioritized. Owing to substantial heterogeneity, findings were synthesized thematically rather than pooled. Results: The evidence separates into three levels. Guideline-supported or relatively strong evidence underpins diagnostic assessment, education, cognitive behavioral therapy, and hearing rehabilitation when indicated. Temporomandibular and cervical interventions have more limited, phenotype-specific evidence from small and heterogeneous studies. No comparative study has validated the proposed integrated framework as a complete treatment package. We therefore present coordination, phenotype-gated referral, shared outcomes, and explicit adaptation or stop rules as a hypothesis-generating organizational model. Conclusions: The proposed framework should be regarded as a hypothesis-generating organizational model rather than a validated treatment package. Its individual components retain their own levels of evidence, and prospective studies should compare the coordinated framework with usual or standard care using both clinical and health-economic outcomes.