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Comprehensive guidance on tinnitus treatment hampered by lack of evidence

Further research, particularly on neuromodulation therapies, needed says NICE

Caroline White

Friday, 20 September 2019

Comprehensive recommendations on the most effective treatments for tinnitus are being hampered by the absence of good quality evidence, says the National Institute for Health and Care Excellence (NICE) in draft guidance on the assessment and management of the condition published today.

Further research is needed, particularly on neuromodulation therapies, which aim to reduce symptoms by targeting the nerves in the head or neck, it says.

Better quality evidence would enable recommendations to be made on a wider range of treatments that could help the one in 10 adults affected by the condition.

The guidance advises healthcare professionals to develop a management plan with patients to explore different approaches to ease their symptoms, based on their needs and preferences. 

Psychological therapies, such as cognitive behavioural therapy (CBT), are recommended for people with tinnitus-related distress, says NICE, while hearing aids should be provided for people with tinnitus-related hearing loss.

In the absence of compelling evidence on the clinical and cost-effectiveness and safety of neuromodulation, NICE has recommended further research in this area.

Dr Paul Chrisp, director of the Centre for Guidelines at NICE, said: “The type and severity of tinnitus varies from person to person, and there is no single approach that works for everyone.”

Further research on treatments such as neuromodulation would mean a wider range of treatments could be recommended, he added.

Other recommendations for research include gathering evidence on the combined use of tinnitus support with sound therapy, which aims to use different sounds to reduce tinnitus awareness, and the clinical and cost effectiveness of psychological therapies for children and young people.

People with high-risk symptoms, such as tinnitus with facial weakness should be referred to a specialist within 24 hours, says the guidance.  

Tinnitus is sometimes associated with problems concentrating, listening or sleeping, and can have a significant impact on mental wellbeing.

Tracey Moore, chair of the guideline committee said that it was “incredibly important” that people affected by tinnitus were appropriately assessed and offered management strategies that are most likely to help.

Francesca Oliver, audiology expert at charity Action on Hearing Loss, said: “Tinnitus can have a negative impact on many aspects of someone’s life including their wellbeing, mental health and relationships. So we very much welcome the launch of the consultation on a guideline for this condition.”

She added: “We’re glad to see hearing aids mentioned as a viable course of action for those with tinnitus and hearing loss – they are a hugely cost-effective treatment that can help many people with tinnitus. We also welcome the suggestion that more research needs to be done into other treatments, as this currently receives very little funding.”

The guidance is out for consultation until 5 pm Friday 1 November, with final guidance expected in March 2020.

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