What happens after you first go to the doctor with tinnitus in the NHS? What tests are done and how is tinnitus diagnosed? How long will you be waiting for an appointment?
In this article we'll take you through the typical pathway for tinnitus treatment on the NHS. We'll go from start to finish, right from when you first start experiencing tinnitus, up until you receive NHS treatment for tinnitus.
How are NHS Tinnitus Treatments Decided?
The National Institute for Health and Care Excellence (NICE) is an organisation that creates guidance for different NHS treatment pathways.
These are updated regularly, accounting for new medical findings and discoveries.
This guide will be based on the latest NICE guidelines (which were updated in March 2020), and the pathways they recommended for people with tinnitus.
The GP visit
As with most symptoms or health-related problem we have, the first step is to present to your GP.
You'll need to have a consultation with them first before you can see a specialist in secondary care (hospitals or specialist clinics).
They'll assess each of your symptoms, determining their severity and how effectively they can be managed in primary care, or whether a referral to a specialist is needed.
This is the same for tinnitus.
Is an urgent referral needed?
There are certain situations in which an urgent referral to different speciality services are warranted.
These referral conditions are quite specific and have their own individual pathways.
If you have any of the following you will be referred on an urgent pathway:
- Tinnitus in only one ear
- Sudden onset pulsatile tinnitus
- Any nervous system symptom (such as facial weakness)
- Vertigo
- Sudden hearing loss
- Recent head injury
You can read more about what causes tinnitus in our complete guide.
GP management
Your GP should provide you with information on the condition.
They will usually start by explaining to you that tinnitus is a common condition that can sometimes resolve by itself.
They will provide you with tips on how to make your tinnitus more manageable; from safe listening practices to self-help strategies.
They might explain that if the tinnitus does not resolve on its own there are investigations and management options that can be explored at later stages.
A list of the available support and will also be offered.
We've created a guide for available tinnitus help.
At the end of your consultation, you and your GP should have identified your needs and agreed on a management plan at this stage based on your preferences after exploring all options available.
They may schedule in for a follow up visit to have another discussion about your tinnitus at a future date.
If your tinnitus is severe and having a big impact on your life, your GP could refer you non urgently to see a specialist.
Specialist Assessment
Investigations
For different tinnitus causes, there are different assessment tools used.
If there is a suspicion of a problem in the middle ear, tympanometry might be performed. Tympanometry is a test that looks for middle ear conditions by creating variations of air pressures in the canal.
This is not an invasive test and should not cause any pain and side effects. The test will be carried out by a trained audiologist or ENT doctor. They will insert a small probe, resembling an earphone into each ear and the device will push air into each ear canal.
Scans
MRI and CT scans are sometimes offered based on the type of tinnitus a person presents with.
These are types of specialised scans that creates a 3D image of what is going on inside the body.
An MRI of the inner ear canal is normally offered if you have:
- tinnitus on one side (unilateral tinnitus)
- pulsatile tinnitus
- nerve symptoms (such as changes to vision or facial weakness)
- head and neck associated symptoms (such as a swelling or lump)
An MRI will generate an accurate representation of the structure of the inner ear and the nerves surrounding the ears and brain.
This can help reveal a growth or tumour that might be situated near the ear or nerves causing the tinnitus. This might sound alarming, but these causes are very rare and these tests are carried out to exclude types of conditions.
The Treatment Management Plan
After all the relevant assessments and tests are carried out a management plan will be created by the specialist.
This will include treatments to help you better manage your tinnitus.
The tinnitus treatments we will discuss today are those recommended by the NICE guidelines, and that are offered on the NHS.
These may include one of the following:
- An amplification device (or hearing aid)
- Psychological therapies
- Self management advice
You can read an in depth review of the available tinnitus treatments in our complete guide.
Amplification devices (hearing aids)
If you have hearing loss alongside your tinnitus, you may be offered an amplification devices.
These are normally hearing aids, but in cases of severe hearing loss can be cochlear implants.
The amplification devices are usually fitted by an audiologist or ENT specialist.
These are often effective as sound therapy for tinnitus, and can provide effective tinnitus relief.
Psychological therapies
Psychological therapies form the mainstay of tinnitus treatment on the NHS.
These are offered through specialist tinnitus services.
During the first session, your therapist will start by assessing the severity of your tinnitus using a questionnaire that assesses the impact of tinnitus on your life. The commonly used is called the Tinnitus Functional Index.
The Tinnitus Functional Index
This is an assessment tool used to determine the extent at which tinnitus affects an individual.
It looks at the following impacts your tinnitus may be having on your life:
- The effect of tinnitus on sleep
- The effect of tinnitus on quality of life
- How tinnitus affects home, social, leisure, work and school
- The effect of tinnitus on mental health
The Therapy
The main psychological therapy offered is usually CBT for tinnitus (cognitive behavioural therapy), or tinnitus retraining therapy (TRT).
This will largely depend on where you live.
You can be offered different forms of CBT: digital, group-based or individual.
In most cases, you will be recommended individual therapy which will last around 30-60 minutes for 2-6 sessions.
In each session, you will go through a different step of your therapy journey and will have a different learning objective. The therapist will take you through different exercises during the session and will also give you some additional exercises to practice at home.
Other psychological therapies outside CBT include attention refocusing and relaxation training as stress has been linked to individuals struggling to cope with their tinnitus.
How long will I wait for NHS treatment for tinnitus?
You may be waiting for 6 months to see a therapist.
This is because tinnitus is a very common condition, there are many people waiting to see a specialist for treatment.
Due to the COVID-19 pandemic waiting lists are longer than ever.
However, the Oto app allows you to access all the tinnitus therapies described above, and more, directly from your smartphone.
Oto brings together therapies such as CBT, tinnitus targeted mindfulness and sound therapy into a progressive tinnitus management programme.
At Oto, we aim to revolutionise tinnitus treatment by bringing therapies directly to your smartphone using a simple mobile app. We are a dedicated team of doctors, scientists and tinnitus experts, and have decades of experience in managing tinnitus.
You can try Oto for free for a week.
Join Oto
The Oto app offers expert guidance to reduce tinnitus intrusion through a variety of resources:
- CBT techniques
- A library of various audio landscapes such as urban, binaural, ASMR, 3D, sleep, nature, household, and coloured
- Meditation and breathing exercises
- Sleep support including sleep stories, mindfulness for sleep, and sleep preparation
- Guided stretches for the neck, shoulders, back, jaw, and arms
Check out Oto's Tinnitus Support Group, a supportive community for individuals with tinnitus or related conditions to receive regular tips and tricks from the expert team at Oto!
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