Open Access Open Access  Restricted Access Subscription Access

Equity and person-centeredness in provision of tinnitus services in UK National Health Service audiology departments

Derek James Hoare, Emily Broomhead, David Stockdale, Veronica Kennedy


Rationale, aim and objective: Chronic tinnitus is a prevalent condition broadly managed using individualised sound-based interventions, individualised or group education, counselling, or cognitive therapies. In the UK, therapy is largely delivered by audiologists or hearing therapists and, where available, clinical psychologists and physicians. Changes in the structure of the health service necessitate ongoing evaluation to monitor equity and person-centeredness of care. The purpose of the current evaluation was to describe provision and explore diversities in the services provided for tinnitus patients across the four countries of the UK and consider these relative to current commissioning and clinical practice guidelines. 

Method: A 37 item questionnaire was devised and distributed via email and social media to reach audiology departments in the UK and 147 valid responses were acquired during the 3 month period of the evaluation.  

Results: The structure and provision of tinnitus services varies widely across the four countries of the United Kingdom in terms of which clinicians provide the services. Outside of England there was no report of clinical psychology or audiovestibular physician involvement in services. There is also variability in access to psychological therapy or support (little training in CBT in Scotland and none in Northern Ireland), self-help groups (little involvement but interest from clinicians) and devices (e.g., one quarter of departments do not currently offer combination hearing aid devices for tinnitus). Clinicians are increasingly using validated questionnaires to evaluate the effectiveness of tinnitus management in their departments.

Conclusions: Training in and the provision of psychological support for tinnitus patients by audiologists is particularly a concern for Scotland and Northern Ireland and has implications for the person-centeredness of audiology services. Capacity and need for research in paediatric tinnitus, combination devices, non-ear level sound devices and audiologist-delivered psychological therapy, are noted.


Audiology, care provision, clinical management, equity, evidence-based healthcare, healthcare quality, person-centered healthcare, self-management, service commissioning, service evaluation, tinnitus

Full Text:



McCormack, A., Edmondson-Jones, M., Fortnum, H., Dawes, P., Middleton, H., Munro, K.J. & Moore, D.R. (2014). The prevalence of tinnitus and the relationship with neuroticism in a middle-aged UK population. Journal of Psychosomatic Research 76, 56-60.

Park, B., Choi, H.G., Lee, H-J., An, S-J., Kim, S.W., Lee, J.S., Hong, S.K. & Kim, H-J. (2014). Analysis of the prevalence of and risk factors for tinnitus in a young population. Otology and Neurotology 35, 1218-1222.

Cima, R.F.F., Crombez, G. & Vlaeyen, J.W.S. (2011). Catastrophizing and fear of tinnitus predict quality of life in patients with chronic tinnitus. Ear and Hearing 32, 634-641.

Zeman, F., Koller, M., Langguth, B. & Landgrebe, M. (2014). Which tinnitus-related aspects are relevant for quality of life and depression: results from a large international multicentre sample. Health and Quality of Life Outcomes 12, 7.

El-Shunnar, S.K., Hoare, D.J., Smith, S., Gander, P.E., Kang, S., Fackrell, K. & Hall, D.A. (2011). Primary care for tinnitus: practice and opinion among GPs in England. Journal of Evaluation in Clinical Practice 17, 684-692.

Yankaskas, K. (2013). Prelude: Noise-induced tinnitus and hearing loss in the military. Hearing Research 295, 3-8.

Hoare, D.J., Gander, P.E., Collins, L., Smith, S. & Hall, D.A. (2012). Management of tinnitus in English NHS Audiology Departments: an evaluation of current practice. Journal of Evaluation in Clinical Practice 18, 326-334.

Department of Health. (2009). Provision of services for adults with tinnitus. A good practice guide. Central Office of Information. London. Available at: (last accessed 14 January 2015).

Department of Health. (2011). Operational Guidance to the NHS: Extending patient choice of Provider. Department of Health. London. Available at: (last accessed 14 January 2015).

Tunkel, D.E., Bauer, C.A., Sun, G.H., Rosenfeld, R.M., Chandrasekhar, S.S., Cunningham, E.R. Jnr., Archer, S.M., Blakley, B.W., Carter, J.M., Granieri, E.C., Henry, J.A., Hollingsworth, D., Khan, F.A., Mitchell, S., Monfared, A., Newman, C.W., Omole, F.S., Phillips, C.D., Robinson, S.K., Taw, M.B., Tyler, R.S., Waquespack, R. & Whamond, E.J. (2014). Clinical practice guideline Tinnitus. Otolaryngology - Head and Neck Surgery 151, S1-S40.

Gander, P.E., Hoare, D.J., Collins, L., Smith, S. & Hall, D.A. (2011). Tinnitus referral pathways within the National Health Service in England: a survey of their perceived effectiveness among audiology staff. BMC Health Services Research 11, 162.

Hoare, D.J. & Hall, D.A. (2010). Clinical guidelines and practice: a commentary on the complexity of tinnitus management. Evaluation and the Health Professions 34, 421-428.

Department of Health. (2008). IAPT implementation plan: national guidelines for regional delivery. London. Available at: (last accessed 14 January 2015).

Sereda, M., Hoare, D.J., Smith, S., Nicholson, R. & Hall, D.A. (2015). Consensus on hearing-aid fitting candidature for mild hearing loss, with and without tinnitus: Delphi review. Ear and Hearing 36 (4) 417-429.

Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77-101.

Jastreboff, P.J. & Jastreboff, M.M. (2000). Tinnitus Retraining Therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients. Journal of the American Academy of Audiology 11, 162-177.

Lindstone , H.A. & Turoff, M. (1975). The Delphi Method. Techniques and Applications. Reading, MA: Addison-Wesley.

Shekhawat, G.S., Searchfield, G.D. & Stinear, C.M. (2013). Role of hearing aids in tinnitus intervention: a scoping review. Journal of the American Academy of Audiology 24, 747-762.

Hoare, D.J., Edmondson-Jones, M., Sereda, M., Akeroyd, M.A. & Hall, D. (2014). Amplification with hearing aids for patients with tinnitus and co-existing hearing loss. Cochrane Database of Systematic Reviews 1 CD 010151.

Landgrebe, M., Azevedo, A., Baguley, D., Bauer, C., Cacace, A., Coelho, C., Dornhoffer, J., Fiqueiredo, R., Flor, H., Hajak, G., van de Heyning, P., Hiller, W., Khedr, E., Kleinjung, T., Koller, M., Lainez, J.M., Londero, A., Martin, W.H., Menneneier, M., Piccirllo, J., De Ridder, D., Rupprecht, R., Searchfield, G., Vanneste, S., Zeman, F. & Langgucth, B. (2012). Methodological aspects of clinical trials in tinnitus: a proposal for an international standard. Journal of Psychosomatic Research 73, 112-121.

Newman, C.W., Jacobson, G.P. & Spitzer, J.B. (1996). Development of the Tinnitus Handicap Inventory. Archives of Otolaryngology, Head & Neck Surgery 122, 143-148.

Meikle, M.B., Henry, J.A., Griest, S.E., Stewart, B.J., Abrams, H.B., McArdle, R., Myers, P.J., Newman, C.W., Sandridge, S., Turk, D.C., Folmer, R.L., Frederick, E.J., House, J.W., Jacobson, G.P., Kinney, S.E., Martin, W.H., Nagler, S.M., Reich, G.E., Searchfield, G., Sweetow, R. & Vernon, J.A. (2012). The tinnitus functional index: development of a new clinical measure for chronic, intrusive tinnitus. Ear and Hearing 33, 153-176.

Hiller, W. & Goebel, G. (2004). Rapid assessment of tinnitus-related psychological distress using the Mini-TQ. International Journal of Audiology 43, 600-604.

Zigmond, A.S. & Snaith, R.P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 67, 361-370.

Garin O, Ayuso-Mateos, J.L., Almansa, J., Nieto, M., Chatterji, S., Vilagut, G., Alonso, J., Cieza, A., Svetskova, O., Burger, H., Racca, V., Francescutti, C., Vieta, E., Kostanjsek, N., Raggi, A., Leonadi, M., Ferrer, M & MHADIE consortium. (2010). Validation of the World Health Organization Disability Assessment Schedule, WHODAS-2 in patients with chronic diseases. Health and Quality of Life Outcomes 8, 51.

Evans, C., Mellor-Clark, J., Margison, F., Barkham, M., Audin K., Connell, J. & McGrath, G. (2000). CORE: clinical outcomes in routine evaluation. Journal of Mental Health 9, 247-255.

Weinman, J., Petrie, K.J., Moss-Morris, R. & Horne, R. (1996). The illness perception questionnaire: a new method for assessing the cognitive representation of illness. Psychology and Health 11, 431-445.

Khalfa, S., Dubal, S., Veuillet, E., Perez-Diaz, F., Jouvent, R. & Collet, L. (2002). Psychometric Normalization of a Hyperacusis Questionnaire. Journal of Oto-Rhino-Laryngology, Head and Neck Surgery 64, 436-442.

Martinez-Devesa, P., Perera, R., Theodoulou, M. & Waddell, A. (2010). Cognitive behavioural therapy for tinnitus. Cochrane Database of Systematic Reviews 9 CD005233.

Baguley, D., McFerran, D. & Hall, D. (2013). Tinnitus. The Lancet 382, 1600-1607.

English, K. & Archbold, S. (2014). Measuring the effectiveness of an audiological counseling program. International Journal of Audiology 53, 115-120.

Charnock, D. (1998). DISCERN Handbook Quality criteria for consumer health information on treatment choice. Abingdon: Radcliffe Medical Press Ltd.

Fackrell, K., Hoare, D.J., Smith, S., McCormack, A. & Hall, D.A. (2012). An evaluation of the content and quality of tinnitus information on websites preferred by General Practitioners. BMC Medical Informatics and Decision Making 12, 70.

Henry, J.A., Frederick, M., Sell, S., Griest, S. & Abrams, H. (2015). Validation of a Novel Combination Hearing Aid and Tinnitus Therapy Device. Ear and Hearing 36, 42-52.

Hoare, D.J., Fackrell, K., Barry, J. & Hall, D.A. (2014). Validation of the Tinnitus Functional Index in a UK research population. Proceedings of the 8th International TRI Tinnitus Conference. Auckland, NZ, 10-13 March 2014.

Chandra, N., Lee, A. & Searchfield, G. (2014). Validation of the Tinnitus Functional Index in New Zealand. Proceedings of the 8th International TRI Tinnitus Conference. Auckland, NZ, 10-13 March 2014.

Nyenhuis, N., Golm, D. & Kröner-Herwig, B. (2013). A systematic review and meta-analysis on the efficacy of self-help interventions in tinnitus. Cognitive Behaviour Therapy 42, 159-169.

Hall, D.A., Mohamad, N., Firkins, L., Fenton, M. & Stockdale, D. (2013). Identifying and prioritizing unmet research questions for people with tinnitus: the James Lind Alliance Tinnitus Priority Setting Partnership. Clinical Investigation 3, 21-28.



  • There are currently no refbacks.