Management of tinnitus in English NHS audiology departments: an evaluation of current practice

Abstract

Rationale, aim and objective: In 2009, the UK Department of Health formalized recommended National Health Service practices for the management of tinnitus from primary care onwards. It is timely therefore to evaluate the perceived practicality, utility and impact of those guidelines in the context of current practice.

Methods: We surveyed current practice by posting a 36-item questionnaire to all audiology and hearing therapy staff that we were able to identify as being involved in tinnitus patient care in England.

Results: In total, 138 out of 351 clinicians responded (39% response rate). The findings indicate a consensus opinion that management should be tailored to individual symptom profiles but that there is little standardization of assessment procedures or tools in use.

Conclusions: While the lack of standardized practice might provide flexibility to meet local demand, it has drawbacks. It makes it difficult to ascertain key standards of best practice, it complicates the process of clinical audit, it implies unequal patient access to care, and it limits the implementation of translational research outcomes. We recommend that core elements of practice should be standardized, including use of a validated tinnitus questionnaires and an agreed pathway for decision making to better understand the rationale for management strategies offered.

Figure 1

Histogram showing the use of different procedures for tinnitus diagnostic and outcome assessments. Responses indicate personal use of each procedure and not necessarily departmental level use. Responses are given as a percentage of total respondents (±95% confidence intervals).

Figure 2

Histogram showing the use of different types of questionnaire in diagnostic (light bars) and outcome (dark bars) assessment stages. Responses are given as the number of respondents (±95% confidence intervals) who indicated that they use each questionnaire. THI, Tinnitus Handicap Inventory; Own, a self-styled questionnaire; HADS, Hospital Anxiety and Depression Scale; GHABP, Glasgow Hearing Aid Benefit Profile; HQ, Hyperacusis Questionnaire; GHTQ, Goebel-Hiller Tinnitus Questionnaire; TEQ, Tinnitus Effect Questionnaire; Beck Q, Beck Anxiety Inventory and Beck Depression Inventory; COSI, Client Oriented Scale of Improvement.

Figure 3

Management strategies employed in audiological departments. ‘Habituation therapies’ refers to any form of therapy that combines counselling and sound enrichment to promote habituation to tinnitus. ‘Other psychological support’ includes relaxation training or therapy, and acceptance and commitment therapy. Responses are given as a percentage of total respondents (±95% confidence intervals).

Figure 4

Histogram showing the reported factors that influence the choice of tinnitus management strategy. Responses are given as the number of respondents (±95% confidence intervals) who identified each factor.