British Tinnitus Association

Don McFerran FRCS, Consultant Otolaryngologist, Colchester Hospital University Foundation Trust

Various health care professionals may be involved in the management of tinnitus. There is much overlap of responsibility and no clear demarcation of duties. Therefore roles that are undertaken by a doctor in one region may be performed by an audiologist, audiological scientist or hearing therapist in another region.

Doctors
Various doctors may be involved in the management of tinnitus, including:
• GPs
• ENT (Ear, Nose and Throat) specialists, sometimes called Otologists
• Audiological physicians

All doctors undergo similar basic general medical training, lasting roughly 5½ years. In most medical schools this comprises approximately 3 years of undergraduate training and 2½ years of clinical medical student training. It is only during this latter 2½ years that students meet patients. A few medical schools have integrated training in which students interact with patients throughout the entire course. Until recently, all newly qualified doctors then did 1 year of closely supervised pre-registration house jobs before embarking on post-graduate training for their chosen niche in the profession. This process has lately undergone reform and new medical trainees now undertake a 2 year Foundation Programme which exposes them to a wide variety of different medical practices. Unfortunately, teaching on tinnitus is not a compulsory part of the syllabus.

GPs
Some GPs have good knowledge of tinnitus: others have little. However they all have a fundamental role in the treatment of tinnitus. To access tinnitus services in the UK a person must first get their GP to write a referral letter to the local tinnitus unit. There is no mechanism by which people can be seen in tinnitus clinics without such a referral.

ENT specialists
Doctors who have trained as ENT specialists have undertaken postgraduate training in surgery and in the UK are known as Mr, Miss or Mrs rather than Dr. All ENT specialists receive some information about tinnitus during their training. However, ENT has become sub-specialized, with some doctors developing particular interest in ears whereas others concentrate on other aspects such as the nose or children’s ENT complaints. This means that although all ENT specialists have some knowledge of tinnitus they are not all experts. An ENT specialist will take a medical history from the person, perform a clinical examination and arrange for any tests. They may then get involved in further treatment such as tinnitus retraining therapy (TRT). However, many ENT specialists will delegate such treatment to other members of the team. In the rare event of surgery being required in the management of tinnitus this will be undertaken by an ENT specialist.

Audiological physicians
Audiological physicians receive the same basic training as any other doctor and then, after a period of postgraduate training, specialize in the non-surgical management of hearing, tinnitus and balance disorders. Part of the training for this specialty includes an MSc in audiological medicine. Audiological physicians are well trained in the management of tinnitus and many run dedicated tinnitus clinics. They listen to the person’s symptoms, examine their ears and perform any necessary investigations. They then arrange for the most appropriate treatment such as hearing aids, sound generators, TRT and counseling. However, audiological physicians are still a rarity and are only employed in a relatively small number of hospitals.

Other health care professional’s (HCP's)

Audiologists
Audiologists form the backbone of hospital based audiology departments. There are a variety of routes to qualification, but it is increasingly the case that an audiologist will have a relevant degree in addition to professional qualifications. Much of their time is spent performing hearing and balance tests and fitting and maintaining hearing aids. They may also fit sound generators (previously known as maskers). Some audiologists have been on tinnitus training courses and undertake TRT or similar forms of tinnitus therapy.

Audiological scientists
Audiological scientists start by getting a university degree, usually in a science based subject. They then go back to university to obtain a master's degree in audiology and finally get hands-on experience under a fully qualified audiological scientist. Their duties overlap to a very considerable extent with those of audiologists, though audiological scientists tend to be involved with the more sophisticated diagnostic testing of both hearing and balance disorders. Some audiological scientists specialise in children’s hearing problems (paediatric audiology). Some audiological scientists have a research commitment. In some hospitals an audiological scientist is the main provider of tinnitus therapy.

Hearing therapists
Hearing therapists generally have a primary university degree or audiology qualification and have worked with the hearing impaired in some guise. They then undertook a 2 year diploma in hearing therapy. They have a wide remit, supporting people with hearing or balance problems as well as tinnitus. They offer help with acclimatising to hearing aids and teach lip-reading. They advise on assistive listening devices such as amplified telephones. They supply general information and advice regarding the auditory system and explain conditions such as Menieres Disease or Otosclerosis. In many units hearing therapists are the main providers of TRT and other forms of tinnitus management. A few hearing therapy departments accept tinnitus patients directly from the GP which can speed the patients’ progress through the system. The vast majority of units, however, still stipulate that new tinnitus patients should be assessed by an ENT specialist or audiological physician prior to referral to a therapist.

Audiological careers are being restructured and the above structure will change over the coming years. For example, no more Hearing Therapists are being trained and their role will increasingly be taken by audiologists who have received appropriate specialised training.

Nurse specialists
In a small number of units people with a nursing background are trained to provide a similar service to that given by hearing therapists.

Physiotherapists
A few tinnitus clinics use the services of physiotherapists, especially for teaching relaxation techniques to people with tinnitus.

Clinical psychologists
Clinical psychologists do an initial 3 year university course followed by 2 years of supervised work in a psychology department. They then undertake a further 3 years in university to obtain a doctorate in psychology. Psychologists approach tinnitus slightly differently to other professionals and are more likely to use mainstream psychological methods such as cognitive behavioural therapy (CBT) rather than Tinnitus Retraining Therapy (TRT) techniques.
There are very few clinical psychologists in the UK who specialise in tinnitus. Because of this scarcity, psychological techniques including CBT are being taught to a number of audiologists. 

Reviewed March 2009 © British Tinnitus Association

This information is not a substitute for medical advice. You should always see your GP / medical professional