Tinnitus: Assessment and Management
National Institute for Health and Care Excellence. (2020).
London (United Kingdom): National Institute for Health and Care Excellence, 1-40.
This guideline provides recommendations regarding the assessment, investigation, and management of tinnitus in individuals. The target audience includes health care and social care professionals, commissioners of health and social care services, and people with tinnitus and their families and caregivers.
National Institute for Health and Care Excellence (United Kingdom)
<p>This document was reviewed with the following:</p><ul> <li>National Institute for Health and Care Excellence. (2020). <em>Evidence Review - March 2020</em>. Retrieved from <a href="https://www.nice.org.uk/guidance/ng155/evidence/evidence-review-march-2020-255229407258?tab=evidence" title="https://www.nice.org.uk/guidance/ng155/evidence/evidence-review-march-2020-255229407258?tab=evidence">www.nice.org.uk</a></li></ul>
For individuals with tinnitus and hearing loss whose ability to communicate has been affected, consider offering an amplification device to manage symptoms.
Individuals with tinnitus symptoms should be immediately referred to appropriate healthcare providers for severe mental health concerns (e.g., suicidal), sudden onset of other neurological concerns (e.g., facial weakness, vertigo, suspected stroke), or sudden hearing loss. Referrals should be made within two weeks of assessment for chronic mental health concerns or tinnitus associated with worsening hearing loss or asymmetrical hearing loss. Additional referrals may be considered for persistent pulsatile or persistent unilateral tinnitus symptoms.
For those with tinnitus, education and counseling should be provided to individuals and their families or caregivers. The individual's concerns and preferences should be reviewed and matched to appropriate tinnitus management options. Educational content should be accessible and personalized to the needs of the individual and may include information about tinnitus, its causes, potential impact of symptoms, compensatory strategies, safe listening practices, management options, and available support groups.
When assessing an individual with tinnitus, conduct an audiological assessment and consider tympanometry when causes of conductive hearing loss may be contributing to symptoms. Only perform otoacoustic emissions testing if other symptoms or audiological concerns are present. Questionnaires, such as the Tinnitus Functional Index or age- or ability-appropriate tools, should be used to assess impact of tinnitus symptoms on quality of life. Do not conduct acoustic reflex testing or uncomfortable loudness/loudness discomfort levels in individuals with tinnitus.
