Individual research recommendation details

Recommendation ID

NG155/3

Question

What is the optimal method for assessing tinnitus in general practice (including consultation questions, physical examinations and questionnaires)?

Any explanatory notes
(if applicable)

Why the committee made the recommendations
No evidence was identified on the clinical effectiveness of questionnaires used to assess the impact of tinnitus on a person. Questionnaires are not a substitute for a detailed clinical history. However, the committee noted the importance of using questionnaires and age-appropriate measures for assessment, which can help to inform management.

Questionnaires can provide a structured format for identifying and subjectively rating difficulties that a person with tinnitus may have. Areas that need intervention can be identified and changes that occurred as a result of the intervention can be measured. This information can be used on an individual level, and on a service level, to help ensure that appropriate resources are available.

A range of questionnaires are currently used to assess the impact of tinnitus in services across England. However, the questionnaires are typically designed to look at specific groups of people with tinnitus or specific problems associated with tinnitus. Therefore, their components may not reflect the range of needs of everyone with tinnitus. Most of the questionnaires are not designed to take account of change after intervention.

In the absence of evidence, the committee agreed that the most appropriate questionnaire that should be considered is the Tinnitus Functional Index. This provides the broadest assessment of the impact of tinnitus and incorporates a variety of components. It was also specifically designed to measure change.

The committee noted that questionnaires are not commonly used in general practice and there is also variation in how tinnitus is assessed in primary care. They thought it important that research is conducted to examine the optimal method for assessing tinnitus in general practice settings, as general practice is a gatekeeper for the further management of tinnitus (see research recommendation 3).

The committee agreed that it is crucial for healthcare professionals to discuss the results of assessments with the person. When answers to component questions are discussed with them, rather than solely focusing on overall scores, it can help people to fully engage with the management of their condition. In addition, using assessment methods such as questionnaires before and after an intervention can further inform management plans.

The committee agreed that if questionnaires cannot be used, visual analogue scales can be used to assess the impact of tinnitus. The committee noted that there are 2 types of questions in visual analogue scales that can be useful: how much does your tinnitus bother you and how much does the tinnitus interfere with what you do?

How the recommendations might affect practice
A variety of methods are used in the UK to assess the impact of tinnitus, particularly with the use of different tinnitus questionnaires. Implementing the use of a common core questionnaire to assess tinnitus will lead to the standardisation of care across the UK and encourage best practice. It will also improve individual care if the components of the questionnaire are used meaningfully as part of the discussion about tinnitus and to signpost towards appropriate support.

As the questionnaires are expected to be completed outside the consultation room, there are little or no anticipated cost implications. Some resource time would be needed to discuss the results of the questionnaires with the person. But the committee noted that even in the absence of a questionnaire, a comprehensive assessment would require a clinician to ask about the topics covered in the questionnaire.

Source guidance details

Comes from guidance

Tinnitus: assessment and management

Number

NG155

Date issued

March 2020

Other details