Adult tinnitus and hyperacusis services

Tinnitus is a common symptom with a reported prevalence of 36% (opens PDF, 372KB) of the adult population, with 7% experiencing sleep disturbance attributable to tinnitus and a high number complaining of problems with concentration. In a small proportion of people (0.5–1% of the adult population) tinnitus is chronically disabling and a good outcome may be achieved only in the long term with highly specialised care. Tinnitus may be associated with a range of medical and otological conditions which require appropriate investigations and management.

There is strong evidence that only one-third of people with tinnitus receive an assessment and there is likely to be a large pool of unmet need locally (Davis A, Hearing in adults, London: Whurr, 1995). GPs need to be made aware of the potential for the positive treatment of tinnitus and be encouraged to refer patients for appropriate assessment, investigations, diagnosis and management.

Service delivery: A well-trained primary care team can provide initial advice, exclude associated symptoms requiring referral to secondary or tertiary care and give the necessary treatment. This team should include specifically trained primary care professionals with an appropriate documented level of competency such as a GP with special interest in audiology/ENT. The initial assessment can also be carried out by a specifically trained audiologist, according to BAA guidelines (opens PDF, 52.94KB), in a community-based audiology service. If tinnitus persists and provokes mild to moderate distress despite reassurance from the GP, or is associated with reported or suspected bilateral hearing loss, the patient could be referred to the local community-based audiology service. This service provides assessment and support.

Patients with distressing tinnitus and those who require a full clinical audiological assessment could be referred directly by the GP to the secondary or tertiary level specialist centre. Clear guidelines (opens PDF, 377KB) and criteria for referral to more specialist services, with audiovestibular physicians and ENT specialists, are a necessity.

Workforce: Specialist and supra-specialist services consist of a multiprofessional team including an audiovestibular physician, audiologists, hearing therapists or audiologists with hearing rehabilitation skills, clinical psychologist, cognitive behavioural therapist, speech and language therapists and psychiatrist.

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