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Tinnitus management in Ireland: a pilot study of general practitioners



Tinnitus is a phenomenon that affects approximately 15% of the adult population. A minority of patients will experience chronic bothersome tinnitus that has a detrimental effect on their quality of life. Management of such tinnitus is challenging for healthcare practitioners. Primary care services are the first point at which patients seek expert medical advice about their condition and General Practitioners (GPs) must be equipped with the knowledge to appropriately triage and guide patients.


To date, there has been little research surrounding tinnitus management in Ireland. The aim of this study is to determine how GPs assess and manage tinnitus patients in Ireland.


This is a quantitative study in the form of an online survey. The 15-item questionnaire was made available through SurveyMonkey and was distributed by email to GPs in Cork, Kerry and South Dublin.


The survey obtained 43 responses. Sixty-three percent of GPs do not follow any routine criteria for onward referral. Forty percent feel that tinnitus has sufficient impact on their practice to warrant further training. GPs expressed a need for clearer guidance on tinnitus management and better access to resources such as ENT (ear nose throat), MRI (magnetic resonance imaging) and audiology.


This study demonstrates there is wide variation in how tinnitus is evaluated and managed by GPs, which represents a gap in clinical care. We recommend further research, implementation of a service model for tinnitus, national clinical guidelines, training pathways for primary care staff and establishment of regional direct-access tinnitus clinics throughout Ireland.

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  1. McFadden D (1982) Tinnitus: facts, theories, and treatments. National Academies Press (US) Copyright (c) National Academy of Sciences, Washington (DC)

    Google Scholar 

  2. Adrian D, El Refaie A (2000) The epidemiology of tinnitus. In: Tyler R (ed) Tinnitus handbook. Singular, pp 1–23

    Google Scholar 

  3. McCormack A, Edmondson-Jones M, Somerset S, Hall D (2016) A systematic review of the reporting of tinnitus prevalence and severity. Hear Res 337:70–79

    Article  Google Scholar 

  4. Watts EJ, Fackrell K, Smith S, Sheldrake J, Haider H, Hoare DJ (2018) Why is tinnitus a problem? A qualitative analysis of problems reported by tinnitus patients. Trends Hear 22:2331216518812250

    PubMed  PubMed Central  Google Scholar 

  5. Tunkel DE, Bauer CA, Sun GH, Rosenfeld RM, Chandrasekhar SS, Cunningham ER, Archer SM, Blakley BW, Carter JM, Granieri EC et al (2014) Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg 151(2 Suppl):S1–S40

    Article  Google Scholar 

  6. Stockdale D, McFerran D, Brazier P, Pritchard C, Kay T, Dowrick C, Hoare DJ (2017) An economic evaluation of the healthcare cost of tinnitus management in the UK. BMC Health Serv Res 17(1):577

    Article  Google Scholar 

  7. Bartels H, Middel BL, van der Laan BF, Staal MJ, Albers FW (2008) The additive effect of co-occurring anxiety and depression on health status, quality of life and coping strategies in help-seeking tinnitus sufferers. Ear Hear 29(6):947–956

    CAS  Article  Google Scholar 

  8. Heller AJ (2003) Classification and epidemiology of tinnitus. Otolaryngol Clin N Am 36(2):239–248

    Article  Google Scholar 

  9. Department of Health (2009) Provision of services for adults with tinnitus. In: Health DO (ed) A good practice guide. Central Office of Information, London

    Google Scholar 

  10. El-Shunnar SK, Hoare DJ, Smith S, Gander PE, Kang S, Fackrell K, Hall DA (2011) Primary care for tinnitus: practice and opinion among GPS in England. J Eval Clin Pract 17(4):684–692

    Article  Google Scholar 

  11. McKenna L, Hallam RS, Hinchcliffe R (1991) The prevalence of psychological disturbance in neurotology outpatients. Clin Otolaryngol Allied Sci 16(5):452–456

    CAS  Article  Google Scholar 

  12. Pinto PC, Marcelos CM, Mezzasalma MA, Osterne FJ, de Melo Tavares de Lima MA, Nardi AE. 2014. Tinnitus and its association with psychiatric disorders: systematic review. J Laryngol Otol 128(8):660–664

    CAS  Article  Google Scholar 

  13. Geocze L, Mucci S, Abranches DC, Marco MA, Penido NO (2013) Systematic review on the evidences of an association between tinnitus and depression. Braz J Otorhinolaryngol 79(1):106–111

    Article  Google Scholar 

  14. Hoare DJ, Hall DA (2011) Clinical guidelines and practice: a commentary on the complexity of tinnitus management. Eval Health Prof 34(4):413–420

    Article  Google Scholar 

  15. Melnyk B (2015) Important information about clinical practice guidelines: key tools for improving quality of care and patient outcomes. Worldviews Evid-Based Nurs 12(1):1–2

    Article  Google Scholar 

  16. Fuller TE, Haider HF, Kikidis D, Lapira A, Mazurek B, Norena A, Rabau S, Lardinois R, Cederroth CR, Edvall NK et al (2017) Different teams, same conclusions? A systematic review of existing clinical guidelines for the assessment and treatment of tinnitus in adults. Front Psychol 8:206

    Article  Google Scholar 

  17. Cima RFF, Mazurek B, Haider H, Kikidis D, Lapira A, Noreña A, Hoare DJ (2019) A multidisciplinary European guideline for tinnitus: diagnostics, assessment, and treatment. HNO. 67(1):10–42

    CAS  Article  Google Scholar 

  18. Naughton P (2004) The quest for quiet: people’s experiences of tinnitus in Ireland. Irish Tinnitus Association, Ireland. Cork Deaf Association, Cork City

  19. Irish College of General Practitioners (2018) Icgp curriculum for GP training in Ireland. ICGP, Ireland, Dublin City

  20. Clark B, Sitzia J, Kelley K, Brown V (2003) Good practice in the conduct and reporting of survey research. Int J Qual Health Care 15(3):261–266

    Article  Google Scholar 

  21. Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101

    Article  Google Scholar 

  22. Qualitative data analysis (2009) SlideShare; [accessed 2019 24 April 2019].

  23. Philpin SM, Jordan SE, Warring J (2005) Giving people a voice: reflections on conducting interviews with participants experiencing communication impairment. J Adv Nurs 50(3):299–306

    Article  Google Scholar 

  24. General practitioners or family doctors (2019) HSE; [accessed 2019 24/04/2019].

  25. Zöger S, Svedlund J, Holgers KM (2006) Relationship between tinnitus severity and psychiatric disorders. Psychosomatics. 47(4):282–288

    Article  Google Scholar 

  26. Hoare DJ, Gander PE, Collins L, Smith S, Hall DA (2012) Management of tinnitus in English NHS audiology departments: an evaluation of current practice. J Eval Clin Pract 18(2):326–334

    Article  Google Scholar 

  27. Walsh PM (2019) Otorhinolaryngology head & neck surgery: a model of care for Ireland. In: Royal College of Surgeons Ireland Surgical Affairs, Health Service Executive, editors.: RCSI. p. 13.

  28. El Refaie A, Davis A, Kayan A, Baskill J, Lovell E, Owen V (2004) A questionnaire study of the quality of life and quality of family life of individuals complaining of tinnitus pre- and post-attendance at a tinnitus clinic. Int J Audiol 43(7):410–416

    Article  Google Scholar 

  29. Aazh H, Moore BCJ (2018) Effectiveness of audiologist-delivered cognitive behavioral therapy for tinnitus and hyperacusis rehabilitation: outcomes for patients treated in routine practice. Am J Audiol 27(4):547–558

    Article  Google Scholar 

  30. Weise C, Kleinstäuber M, Andersson G (2016) Internet-delivered cognitive-behavior therapy for tinnitus: a randomized controlled trial. Psychosom Med 78(4):501–510

    Article  Google Scholar 

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The authors wish to thank Dr. Derek Hoare for granting permissions to use and modify the questionnaire, the Systems Developer in the HSE who helped to distribute the surveys via email, the statistician Margaret Cole in UCC and the staff in the Department of Speech and Hearing Sciences, UCC for their valuable feedback.

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Correspondence to Amr El Refaie.

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Ethical approval was granted by the Social Research and Ethics Committee (SREC), University College Cork (UCC), Ireland. Informed consent was obtained from GPs when they accessed the online survey.

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Kilroy, N., El Refaie, A. Tinnitus management in Ireland: a pilot study of general practitioners. Ir J Med Sci 189, 1391–1401 (2020).

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  • Audiology
  • General practitioners
  • Primary health care
  • Quality of life
  • Tinnitus
  • Triage