Tinnitus UK has just published a comprehensive and up to date analysis of this condition and its treatment in the NHS. The key figures are shown here but I recommend reading the whole paper (link here) for context and information.
This study found that although NICE guidance exists (link here) and is good quality, evidence-based stuff, it is often either not followed or is not timely. We know that patients will benefit from immediate reassurance from their GP, and that hearing aids and psychological interventions will improve the quality of life for so many people with moderate/severe tinnitus distress. However due to a lack of psychologists in the workforce, and referrals to ENT or other secondary services taking such a long time, it is no surprise that patients' experiences are neither good nor consistent.
My own tinnitus patients are reporting waiting around a year for an ENT appointment, only to be told "well I can't do anything for tinnitus", and/or not being prescribed hearing aids because their hearing loss "isn't bad enough". NICE guidelines clearly state the NHS should consider offering hearing aids to those in distress even if they are not yet having communication difficulties. Whether they do offer them is down to the individual audiologist/ENT doc. This strategy could be delivered for the majority by referral from GP to Audiology without ever putting stress on ENT services.
NICE guidelines suggest online cognitive behavioural therapy as a first line of psychological treatment. If you have not been offered this, there are apps such as MindEar which are created by psychologists and which patients can download to start receiving CBT help immediately. The guidelines also suggest peer support, such as my Facebook group, which is free.
To get the best from your GP, I recommend being clear about what you want and need from them. We know NHS resources are not bottomless, but if you are genuinely suffering, please ask for the available services. If you want to see Audiology and be assessed for hearing aids (or noise-generators if you have no hearing loss), ask for that referral. If you are in a cycle of negative self-talk about your tinnitus, you are the right person to have CBT. Ask for it. As long as you are mindful that resources are thin and appointments must be taken once booked, or cancelled if no longer required, you are entitled to the help that is there. Do not expect your GP to see inside your head, tell them if you are struggling. If appointments are difficult to come by, you can drop an email to the surgery outlining your issues and asking to be referred for CBT/aids.
GP's are gatekeepers of NHS funds. If you look like you're managing fine, you are unlikely to be proactively offered a service that costs £400.
If your audiologist is overworked and has been told off for prescribing hearing aids to those with mild loss during their last review, they need you to give them a reason so they can document their decision to prescribe that treatment.
ENT are specialist surgeons who in my experience know very little about tinnitus. Unless you have an underlying "red flag" medical condition, you do not need to press for a referral to them. CBT or hearing aids are delivered direct by the professionals who know most about them. Some audiologists in the NHS are now being trained to offer good quality information on tinnitus and how to overcome it. They can help you better than a surgeon who has nothing physical she/he can "fix".
Tinnitus UK have made a series of good, common sense recommendations, and they recognise, as do I, that the medical profession has all the tools (CBT, hearing aids) and information (NICE guidelines) now to do the job, they simply lack the central funding and will of commissioning bodies to implement it.
The first line of treatment for tinnitus distress should be information. Information, if it is good quality, will reduce tinnitus distress and set you on the path to habituation (having a condition but not being distressed by or hyper-aware of it). Tinnitus UK have free-to-access information online which is reliable and well written.
I offer direct support to tinnitus patients who are distressed by their condition. My two hour Active Habituation consultation is highly personalised for you to get to the bottom of the cause of your tinnitus (and often hearing) problem. We will discuss your triggers and give you techniques to improve your symptoms. More than that, we will work to cut though the minefield of information and help you understand what you need to do to successfully habituate to the signal. Millions of people are living with tinnitus yet it hardly bothers them at all. At the end of your session you will understand how to be one of them. Active Habituation is best delivered in person, but can be completed via Microsoft Teams video meeting. See here for details.
NHS or private, help is there. I am so pleased that we are moving in the right direction for those in tinnitus distress, and with a little rearranging of the furniture in the NHS, we will one day have a clear pathway for everyone. Until then I hope this article helps you to understand how to access help.
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