Tinnitus treatment on the NHS: what can the NHS offer you? The Oto Guide 2020

Fatema M Dawoodbhoy
Oto Health Intern | 5th Year Medical Student
December 2, 2020

What happens after you first go to the doctor with tinnitus in the NHS? What tests are done and how is tinnitus diagnosed?

Welcome back to the Oto guide to tinnitus. In our 3rd post, we will take you on a journey from start to finish from when you are diagnosed. I'm going to explain how tinnitus treatment works within the NHS, and a typical pathway that someone diagnosed with tinnitus might go on, from start to finish. In the first 2 guides, we explored the causes and treatments of tinnitus but now let’s go through what the NHS offers as part of their tinnitus management pathway.

Our guide to the causes of tinnitus can be found here, and tinnitus treatments here.

The National Institute for Health and Care Excellence (NICE) is an organisation that creates guidelines 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, updated March 2020, and the pathways they recommended for people with tinnitus.

The GP visit

A visit to the GP is normally the first step on the tinnitus treatment on the NHS pathway
A visit to the GP is normally the first step on the tinnitus treatment on the NHS pathway

As with any symptoms or health-related problem we have, the first step is to present to your GP. GPs are the gatekeepers of the NHS. 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  and determine their severity and how effectively they can be managed in primary care, or whether they need a referral. This is the same for tinnitus. When you present to the GP with that “ringing or buzzing” sound in your ears, they’ll start off by providing you with information on everything about the symptom.

GPs will usually start by explaining to you that tinnitus is a common condition that may resolve by itself if there is not permament underlying cause. They will also provide you with tips on how to make your tinnitus more manageable; from safe listening practices to self-help strategies. The GP will also 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 for tinnitus will also be offered.

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 might even schedule in for a follow up visit to have another discussion about your tinnitus at a future date. This is also when your GP decides whether to refer you to secondary care based on the severity and type of your tinnitus and associated symptoms.

Time to refer

So now you have seen your GP and they have decided based on the symptoms you are presenting with and the type of tinnitus you have, there may be a need for a referral to see a specialist. What determines which pathway I get referred to? 

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. I have summarised the relevant points below: 

  • If you have nervous system symptoms (such a changes to vision or muscle weakness) you will be referred to a specialist pathway specific to neurological conditions that could be resulting in your tinnitus
  • If you have experienced sudden hearing loss, your GP will refer you to a specialist hearing loss pathway. 
  • If you have existing hearing loss or the GP is concerned about your mental health, you will be referred onto a 2-week tinnitus pathway. 
  • If you have any form of pulsatile tinnitus (more info on that in our causes of tinnitus blog), you will be referred to your local tinnitus pathway for assessment and formulation of a management plan.

Assessment

Investigations 

An MRI can be used to investigate tinnitus in the NHS
An MRI scan can be used to investigate tinnitus in the NHS

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 an test that looks for middle ear conditions by creating variations of air pressures in the canal. There is nothing to worry about here. 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. 

MRIs and CT scans are offered based on the type of tinnitus a person presents with. For pulsatile tinnitus, MRI of the inner ear canal is offered to those with neurological otological or head and neck associated symptoms. A CT scan might be alternatively offered if an MRI is not suitable. An MRI is a type of imaging scan that creates a detailed image of the anatomy inside the body. 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. However, I know this might sound scary but do not be alarmed as these causes are very rare and these tests are carried out to exclude these rarer causes. 

Treatments

So now, after all the relevant assessments and tests are carried out and results are gathered, along with the expert knowledge from the specialist in each pathway, a management plan including treatments will be formulated to help you better manage your tinnitus.

If you are looking for a more detailed informative guide on the different treatments for tinnitus available, head over to the second edition of the Oto Guide 2020 - Tinnitus treatments. These tinnitus treatments we will discuss are the ones recommended by the NICE guidelines and do not encompass all the treatments there are. 

Amplification devices 

Amplification devices can be used to treat tinnitus on the NHS
Amplification devices can be used to treat tinnitus on the NHS

Amplification devices (such as cochlear implants or hearing aids) are only offered to those with hearing loss. The amplification devices are usually fitted by an audiologist or ENT specialist to help those with hearing loss improve their communication. These often can work as a mask for people with tinnitus, and subsequently improve their symptoms.

Psychological therapies 

Psychological therapies form the mainstay of tinnitus treatment on the NHS. At the moment, psychological therapies are offered through specialist tinnitus services in the UK. During the first session, your therapist will start by assessing the severity of your tinnitus using a Tinnitus Functional Index. There are other available measures  but the Tinnitus Functional Index is the most common assessment form. 

Tinnitus Functional Index 

Tinnitus NHS Insomnia Index

The Tinnitus Functional Index is an assessment tool used to determine the extent at which tinnitus affects an individual. If the patient presenting with tinnitus is a patient or a young person, a visual analogue scale or another measure might be used to ensure it is age and ability appropriate. 

The Tinnitus Functional Index will look 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

 CBT forms the core of psychological therapy offered as tinnitus treatment on the NHS
CBT forms the core of psychological therapy offered as tinnitus treatment on the NHS

The main psychological therapy offered is CBT (cognitive behavioural therapy). You can be offered different forms of CBT: digital, group-based or individual. In most cases, you will be recommended individual CBT therapy which will last around 30-60 minutes for about 3-6 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 does Oto fit in?

Understanding treatment pathways offered on the NHS can be difficult. I hope that this blog has given you a clearer understanding of the Tinnitus NHS treatment pathway. 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.

How does Oto work?

Oto brings together all the known effective therapies in tinnitus management into a progressive programme of cognitive behavioural therapy (CBT), targeted mindfulness, relaxation therapy and education. Work through Oto’s therapy modules whilst filling in a hearing health log to see how your tinnitus improves over time. 

Oto allows you to access tinnitus therapy from the comfort of your own home, for a fraction of the cost of private therapy. No more long waiting lists, no more driving to appointments.

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NB. To download Oto on iOS, you’ll need to first download Apple’s TestFlight app. This will allow you to join our testing programme. 

References

  1. NICE. Tinnitus - NICE Pathways. [Online] pathways.nice.org.uk. Available from: https://pathways.nice.org.uk/pathways/tinnitus#content=view-node%3Anodes-management [Accessed: 11th October 2020]
  2. Oto. What causes tinnitus? The Oto Health Guide 2020. [Online] www.otohealth.ai. Available from: https://www.otohealth.ai/post/what-causes-tinnitus-the-oto-health-guide
  3. Oto. Tinnitus Treatments: The Oto Health Guide 2020. [Online] www.otohealth.ai. Available from: https://www.otohealth.ai/post/tinnitus-treatments-the-oto-health-guide-2020 [Accessed: 19th October 2020]
  4. ‌Royal College of GPs https://www.rcgp.org.uk/
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