Tinnitus: assessment and management

The NICE draft guidance consultation for Tinnitus assessment and management is now open for all stakeholders to comment. The consultation for review and comment closes on Friday 1 November 2019 at 5pm. If you haven’t already registered as a stakeholder, you can also do this on the NICE website, where you can register as an organisation or individual.

In the draft guidance, the National Institute for Health and Care Excellence (NICE) calls for more research on a range of therapies that could help people with tinnitus. An appraisal committee singled out the lack of high-quality evidence on the clinical and cost-effectiveness of neuromodulation therapies, which meant it was unable to recommend their use on the NHS.

Dr Paul Chrisp, director of the Centre for Guidelines at NICE, said: “The type and severity of tinnitus varies from person to person, and there is no single approach that works for everyone. Further research on treatments such as neuromodulation would allow us to make recommendations on a greater range of options that could potentially benefit people with tinnitus.”

Other recommendations for research included gathering evidence on the combined use of tinnitus support with sound therapy, methods for assessing tinnitus in primary care, and the clinical and cost-effectiveness of psychological therapies for children and young people.

Tinnitus Management Plans

The draft guidelines advise healthcare professionals to discuss the patient’s experience of tinnitus, and develop a management plan to help their symptoms based on their needs and preferences. This could include psychological therapies, such as cognitive behavioural therapy (CBT) in cases of tinnitus-related distress.

For people with tinnitus-related hearing loss, hearing aids should be recommended.

Patients should be referred for assessment and management within 24 hours in cases where tinnitus was associated with:

• A high risk of suicide
• Sudden onset of significant neurological symptoms or signs, such as facial weakness
• Sudden hearing loss over a period of 3 days or less in the past 30 days

People should be referred within 2 weeks for assessment and management in cases where tinnitus was associated with:

• Distress affecting their mental well-being
• Acute uncontrolled vestibular symptoms, such as vertigo
• Sudden hearing loss over a period of 3 days or less, more than 30 days ago, or rapidly progressing hearing loss over a period of 4 to 90 days

Guidance: ‘An Important Step’

Tracey Moore, chair of the guideline committee said in a statement: “Around 1 in 10 adults has tinnitus in the UK and it’s incredibly important that they receive the appropriate support. This new draft guideline will help healthcare professionals do just that, by ensuring people are appropriately assessed and offered management strategies that are most likely to help.”

Francesca Oliver, an audiology expert at Action on Hearing Loss, said: “Tinnitus can have a negative impact on many aspects of someone’s life including their well-being, mental health and relationships. So we very much welcome the launch of the consultation on a guideline for this condition.

“We’re glad to see hearing aids mentioned as a viable course of action for those with tinnitus and hearing loss – they are a hugely cost-effective treatment that can help many people with tinnitus. We also welcome the suggestion that more research needs to be done into other treatments, as this currently receives very little funding.

“We see this guidance as an important step towards providing a tinnitus care pathway, which will help clinicians and commissioners, but most importantly those living with tinnitus in the UK.”

Provide your comments on the draft guidance here