Prevalence, management practice and challenges of tinnitus in a resource constrained tertiary care hospital: a convergent parallel mixed-method study

Prevalence, management practice and challenges of tinnitus in a resource constrained setting

Abstract

Introduction: Tinnitus is a common hearing disorder that carries substantial physical and psychological effects, yet physicians encounter significant difficulties in managing tinnitus due to limited diagnostic resources and a lack of collaborative care.

Objective: To determine the prevalence of tinnitus and assess current management practices, along with identifying key diagnostic and therapeutic challenges in a resource-constrained tertiary care hospital.

Methodology: This hospital-based convergent parallel mixed-methods, descriptive cross-sectional study was conducted at Rawal General and Dental Hospital, Islamabad Pakistan. A total of 2,088 adult general ENT outpatient attendees (≥ 18 years) were screened. Patients presenting with subjective tinnitus for at least one month (n=320) were enrolled in the study. Data were collected through interviews, clinical examinations, audiological testing, and evaluation of treatment strategies. Quantitative data were processed using SPSS v 25, while concurrent qualitative clinician interviews identified structural barriers.

Results: Overall ENT outpatient point prevalence of tinnitus was 13.6% (284/2,088). Bilateral tinnitus (62.3%; n=177), hearing loss (68.3%; n=194), sleep disturbances (44.7%; n=127), and anxiety/depression (28.2%; n=80) were reported in these patients. Pharmacological treatment was used in 62.0% (n=176), whereas cognitive behavioral therapy (CBT) was administered to 8.5% (n=24). Follow-up non-attendance was 62.7% (n=178). Significant association was seen between laterality and pharmacological treatment (p=0.043), laterality and imaging referral (p=0.001), hearing loss and hearing aids (p=0.026), sleep disturbance and CBT (p=0.037) and pulsatile tinnitus and imaging referral (p<0.001). Qualitative interviews (n=6) identified key systemic bottlenecks, including fragmented inter-departmental referrals, lack of dedicated audiometric diagnostic protocols, and absence of standardized counseling pathways in public tertiary care.

Conclusion: Subjective tinnitus affects an estimated 13.6% of general ENT attendees in resource-limited tertiary settings, where management relies heavily on empirical pharmacotherapy while non-pharmacological modalities remain underutilized.