Research review: Decision-making aid for clinicians with tinnitus patients

BTA’s Researcher Dr Georgie Burns O’Connell reviews An effective decision-making aid for patients with tinnitus: A retrospective review of 205 patients by Declan Murphy and John Phillips, May 2020.

Why did they do this research?

Access to tinnitus services can be a postcode lottery, and quality of care can vary as there is not a defined treatment pathway for tinnitus patients. The increase in demand for healthcare, rising costs, reduced budgets and staff shortages mean there is a need for new ways of working.

In 2015, a tool to help clinicians and patients make joint treatment decisions was rolled out at the Norfolk and Norwich University Hospitals NHS Foundation Trust. It was created with the aim of providing helpful management options for tinnitus patients. The study assesses the effectiveness of this new decision-making aid.

Decision-making aid developed at the Norfolk and Norwich University Hospital which assigns individuals with tinnitus to different treatment pathways based on their THI, red flag symptoms and hearing loss according to PTA. Abbreviations: THI: Tinnitus Handicap IndexHow do clinicians use the tool?

The tool highlights three different referral pathways for tinnitus patients:

  • advice and direction to self-management resources
  • group therapy
  • individualised tinnitus therapy (ITTx)

What did the research find?

Out of 205 patients only one was re-referred in 12 months (0.05%). The new way of working provided patients with a personalised care route to suit their specific needs. Given that all patients were previously referred to ITTx, this tool appears to be cost effective and could save the NHS money.

As promising as these findings are, the patients were not asked about their satisfaction with the service. Therefore, they may have chosen not to be re-referred because they were not happy with the service. There was also no control group included in this study, which meant the new decision aid was not compared to other management strategies.

Could other clinicians use this?

Without further research into this tool, we cannot generalise the findings across a wider number of patients and clinicians. Further research is needed to explore the influence of the decision-making aid on the patient’s healthcare experience.

The new tool could be used by clinicians alongside other treatment decision aids (e.g. Pryce et al 2018), in order to improve tinnitus patients’ experience of care.

What do we think?

  • It’s great to see important research, with clinical relevance, taking place
  • The decision-making aid has been published alongside the paper, meaning clinicians can use it right away
  • We’d love to see:
    • more research into patients’ experiences, and with wider numbers
    • comparisons with other decision-making aids


Murphy DC, Phillips JS. An effective decision-making aid for patients with tinnitus: A retrospective review of 205 patients. Clinical Otolaryngology 2020. https://doi.org/10.1111/coa.13573

Pryce H, Durand MA, Hall A, et al. The development of a decision aid for tinnitus. International Journal of Audiology. 2018;57(9):714-719. doi: 10.1080/14992027.2018.1468093

Updated 29 July 2020

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