Tinnitus services in the United Kingdom: a survey of patient experiences

Abstract

Background: Tinnitus service provision in the United Kingdom has been investigated from the healthcare provider's perspective demonstrating considerable regional variation particularly regarding availability of psychological treatments. An audiological-based tinnitus service, however, was reportedly available for all tinnitus patients in the UK. The aim of the current study was to define and evaluate nationwide tinnitus healthcare services from the patients' viewpoint.

Methods: Secondary analyses were performed on data from a 33-item questionnaire provided by the British Tinnitus Association. The questionnaire had been distributed via email and social media.

Results: Responses from 937 participants who had or had previously experienced tinnitus were analysed. All but one person had at some time consulted their GP. About one in five received medication in primary care. The majority were referred to secondary care, generally an ENT surgeon or audiovestibular physician; some were referred directly to audiological services. In secondary care the majority underwent audiometric testing and over half underwent MRI scanning. Drugs were prescribed less frequently in secondary care. About one third of patients were referred onwards from diagnostic services in secondary care to receive therapeutic interventions for tinnitus. Therapy was generally delivered by an audiologist or hearing therapist. Just under two fifths of people discharged from secondary care returned to their GP, with most returning within one year. Over a third of this group were re-referred to secondary care. Few patients saw a psychologist (2.6%) though some psychological treatments were delivered by appropriately trained audiologists. Negative counselling from healthcare professionals in both primary and secondary care settings was reported.

Conclusions: Although the UK has developed a national service for patients with tinnitus many people find it difficult to access, being blocked at the primary care level or after secondary care diagnostic services. Many of those discharged from secondary care return to their GP within a short space of time and are re-referred to secondary care creating an unsatisfactory and expensive revolving-door pattern of healthcare. Despite psychological treatment modalities having the best evidence base for successful tinnitus management, only a minority of tinnitus patients ever get to meet a psychologist.

Keywords: Audiology; Primary care; Psychology; Revolving door; Secondary care; Tinnitus.

Fig. 1

The age distribution of survey respondents (n = 873)

Fig. 2

Time between onset of tinnitus and the patient first seeking an appointment with their GP (n = 931)

Fig. 3

The number of visits to the GP prior to referral to secondary care (n = 680)

Fig. 4

The number of ENT/Audiovestibular Medicine appointments attended per respondent (n = 249)

Fig. 5

The number of audiology department appointments attended per respondent (n = 405)

Fig. 6

The duration of audiology department therapeutic appointments (n = 405)

Fig. 7

The time taken from discharge from hospital to seeking a repeat appointment with the GP (n = 286)