BSHAA submitted a detailed response on behalf of members to NICE’s consultation on its draft guideline on the management and assessment of tinnitus. Our response aims to help NICE ensure that its final guideline – which is due to be published in 2020 – is fit for purpose.
We have one substantial concern that means, in its current form, the guidance is highly likely to lead to a significant deterioration in access to care for hearing loss amongst the high percentage who have tinnitus as a co-morbidity, whilst at the same time increasing the cost of providing hearing care to each individual.
As per NICE’s previous guideline on hearing loss that was published in 2018 (NG98), the vast majority of hearing care should be provided within routine audiology services, with only a minority requiring referral into specialist audiology. The draft guideline on tinnitus, however, overturns that recommendation and risks unnecessary referral into more complex care for the majority of routine cases.
Diverting routine hearing loss cases into specialist services will lead to service users having much longer waiting times to clinics which are geographically less convenient and accessible. NG98 recommends that the majority of provision of hearing care is community based, which is rarely the case for the specialist treatment that the tinnitus guideline incorrectly directs patients towards.
It is essential that guidelines for access to and treatment of tinnitus are consistent with and complementary to those for routine hearing loss, and that access to hearing loss treatment is not further undermined in the way this guidance proposes.
The risk of substantial degradation of services for hearing loss is unacceptable, given that it is the most prevalent source of disability in the UK and is ranked as one of the highest burdens of disability (as recognised by the World Health Organisation).