g logo nice orange

Overview

  • This Guidelines summary covers support and information for people with tinnitus and referring people with tinnitus
  • This summary only covers recommendations for primary care. Please see the full guideline for complete recommendations on assessment, investigation, and management
  • For adults with tinnitus and hearing loss, this guideline should be read together with the NICE guideline on hearing loss in adults

Support and information for people with tinnitus

Tinnitus support

At all stages of care:

  • Discuss with the person with tinnitus, and their family members or carers if appropriate, their experience of tinnitus, including its impact and any concerns
  • Based on any identified needs, agree a management plan with the person, taking into account their preferences. The plan should include information about tinnitus and opportunities for discussion about different management options
  • Discuss with the person the results of any recent assessments and their impact on the management plan
  • With consent from the person or their parent or carer, as appropriate, share the management plan with relevant health, education and social care professionals

For people with long-standing tinnitus who have delayed accessing care, aim to find out the reason for the delay and why they are accessing care now. This could involve, for example, asking questions about lifestyle factors or changes in health

Information

  • Reassure the person with tinnitus, at first point of contact with a healthcare professional, that:
    • tinnitus is a common condition
    • it may resolve by itself
    • although it is commonly associated with hearing loss, it is not commonly associated with other underlying physical problems
    • there are a variety of management strategies that help many people live well with tinnitus
  • Give information about tinnitus at all stages of care. The content should be tailored to the individual needs of the person, and their family members or carers if appropriate, and include information about:
    • what tinnitus is, what might have caused it, what might happen in the future
    • what can make tinnitus worse (for example, stress or exposure to loud noise)
    • safe listening practices (for example, noise protection)
    • the impact of tinnitus (for example, it can affect sleep)
    • investigations (see full guideline)
    • self-help and coping strategies (for example, self-help books and relaxation strategies)
    • management options (see full guideline)
    • local and national support groups
    • other sources of information
  • When providing information:
    • ensure it is available in appropriate formats such as verbal consultation, written information, leaflets and online in line with the NICE guideline on patient experience
    • take into account accessibility requirements for children, and people with hearing loss, cognitive impairment or visual impairment

Referring people with tinnitus

  • Refer immediately to a crisis mental health management team for assessment people who have tinnitus associated with a high risk of suicide. If needed, provide a safe place while waiting for the assessment
  • Refer immediately, in line with the NICE guideline on suspected neurological conditions, people with tinnitus associated with:
  • Refer people to be seen within 24 hours, in line with the NICE guideline on hearing loss in adults, if they have tinnitus and have hearing loss that has developed suddenly (over a period of 3 days or less) in the past 30 days
  • Recognise that assessment and management of the person’s tinnitus may still need to continue following an immediate referral
  • Refer people to be seen within 2 weeks for assessment and management if they have tinnitus associated with either of the following:
    • distress affecting mental wellbeing (for example, distress that prevents them carrying out their usual daily activities) even after receiving tinnitus support at first point of contact with a healthcare professional. Refer in line with local pathways
    • hearing loss that developed suddenly more than 30 days ago or rapidly worsening hearing loss (over a period of 4 to 90 days). Refer in line with the NICE guideline on hearing loss in adults
  • Refer people for tinnitus assessment and management in line with local pathways if they have any of the following:
    • tinnitus that bothers them despite having received tinnitus support at first point of contact with a healthcare professional
    • persistent objective tinnitus
    • tinnitus associated with unilateral or asymmetric hearing loss
  • Consider referring people for tinnitus assessment and management in line with local pathways if they have any of the following, in line with the NICE guideline on hearing loss in adults:
    • persistent pulsatile tinnitus
    • persistent unilateral tinnitus

© NICE 2020. Tinnitus: assessment and management. Available from: www.nice.org.uk/guidance/NG155. All rights reserved. Subject to Notice of rights.

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.

First published: March 2020.