Intended for healthcare professionals

Practice Guidelines

Assessment and management of tinnitus: summary of NICE guidance

BMJ 2020; 368 doi: (Published 31 March 2020) Cite this as: BMJ 2020;368:m976
  1. Sedina Lewis, senior research fellow1,
  2. Emtiyaz Chowdhury, health economist1,
  3. David Stockdale, lay member2,
  4. Veronica Kennedy, topic adviser and consultant audiovestibular physician3
  5. on behalf of the Guideline Committee
  1. 1National Guideline Centre, Royal College of Physicians, London, UK
  2. 2British Tinnitus Association, Sheffield, UK
  3. 3Bolton NHS Foundation Trust, Bolton, UK
  1. Correspondence to S Lewis sedina.lewis{at}

What you need to know

  • Healthcare professionals need to be alert to the impact of tinnitus on wellbeing and quality of life and provide reassurance at the first point of contact

  • Tinnitus support and information should be provided to patients with tinnitus at all stages of care, and to family members or carers if appropriate

  • Offer an audiological assessment to people with tinnitus

  • Consider psychological therapies for adults with significant tinnitus related distress

  • Offer magnetic resonance imaging (MRI) of internal auditory meatuses (IAM) to people with non-pulsatile tinnitus who have associated neurological, otological, or head and neck signs and symptoms

Tinnitus is a common condition in children, young people, and adults. It is the perception of sounds in the ears or head that do not come from an outside source.1 Ten per cent of the population will have tinnitus at some point.2 It can be associated with difficulty in concentrating and listening, and for some people it can be extremely distressing and have a substantial impact on their mental wellbeing, family, work, and social life.2

This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) guideline on tinnitus: assessment and management ( The guideline does not cover the full clinical pathway but focuses on areas raised at the stakeholder consultations.


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline development committee (GC)’s experience and opinion of what constitutes good practice. The levels of evidence supporting the recommendations are given in italics in square brackets.

Tinnitus support

Tinnitus support (sometimes known as tinnitus counselling) should provide people with tinnitus and their family members or carers with the opportunity to discuss their experience of tinnitus with a healthcare professional (including …

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