Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Recommended management strategies for patients with chronic tinnitus in primary care include:
- Provide information and reassurance: Explain that tinnitus is common, may resolve spontaneously, is often associated with hearing loss but rarely with serious underlying physical problems, and that various management strategies can help people live well with tinnitus NICE CKS,NICE NG155.
- Assess and manage hearing loss: Offer hearing aids to patients with tinnitus who have hearing loss affecting communication, or consider hearing aids if hearing loss is present but communication is not affected. Do not offer hearing aids if there is no hearing loss NICE CKS,NICE NG155,NICE CKS.
- Treat underlying causes: Address any treatable causes such as impacted earwax, otitis media or externa, or temporomandibular joint dysfunction NICE CKS.
- Review medications: Consider stopping or changing drugs that may be causing or worsening tinnitus NICE CKS.
- Sound therapy: Advise patients to use continuous, low-level background sounds (e.g., quiet music, water sounds, fans) to distract from tinnitus. Refer to audiology and hearing therapy services for tailored sound therapy advice NICE CKS,NICE NG155.
- Psychological therapies for tinnitus-related distress: For patients with significant emotional or social impact, consider a stepped approach starting with digital tinnitus-related cognitive behavioural therapy (CBT), then group-based psychological interventions (including mindfulness-based cognitive therapy, acceptance and commitment therapy, or CBT), and finally individual CBT if needed NICE CKS,NICE NG155.
- Referral: Refer patients who cannot be adequately managed in primary care or who have unilateral/asymmetric hearing loss or tinnitus, or other concerning features, for specialist assessment NICE CKS,NICE NG155.
- Do not offer: Medication or complementary therapies (e.g., dietary supplements, herbal medicines, acupuncture) for tinnitus treatment, as they are not recommended and may cause harm NICE CKS.