Tinnitus care in the UK needs a holistic, patient-centered shift, says audiologist who lived with it

Dr Gladys Sanda, a UK audiologist who has spent years treating tinnitus, woke one morning in March 2020 to a persistent buzz in her head. She immediately recognized the sound as tinnitus, the perception of ringing or buzzing without an external source, a condition she had helped others manage for nearly a decade. She has said stress and an illness, including a COVID-19 infection that led to furlough, appeared to heighten the onset and the sense of loss that followed. The experience overwhelmed her at first; she felt fear and a sense of fraud despite her expertise, and she dreaded going to bed as the noise continued. To cope, she turned to listening to acoustic guitar music for hours and found comfort in the presence of her partner. Over time, she developed a way to manage the condition using established techniques, and today she still hears tinnitus daily, but it no longer controls her life. Distress can spike in moments of grief or high stress, but she has learned to anticipate and respond to those triggers rather than let the sound dictate her behavior.

Tinnitus affects roughly one in seven people in the United Kingdom, and left untreated it can impact mood, sleep and concentration. For a subset—approximately 1.5 million people with severe tinnitus—the condition is chronic and life-altering, with a higher risk of anxiety and depression. Medical professionals note that many patients feel overlooked because the most common approach emphasizes symptom management rather than addressing what amplifies distress. The link between tinnitus and stress is well documented: stress hormones can affect how the brain processes sounds, increasing the perception of tinnitus for some individuals.

To address this, Sanda has developed a three-step programme she says should guide tinnitus care toward a more holistic, patient-centered approach. The first step is a physical ear assessment to rule out obstructions or infections that could be contributing to the tinnitus. The second step involves a questionnaire to gauge anxiety and stress levels and to measure how much tinnitus intrudes on daily life. The third step is a form of talking therapy she calls “tinnitus coaching,” which combines elements of cognitive behavioral therapy (CBT) and mindfulness. The goal is not to cure tinnitus (there is currently no cure) but to rewire the brain’s threat response so the nervous system no longer treats the sound as an imminent danger. This reframing can reduce distress and improve quality of life, even when the tinnitus itself remains.

CBT and mindfulness are widely recognized as effective for tinnitus distress because they change how people think about and respond to the condition. Sanda explains that the brain’s prefrontal cortex acts as the decision-maker, determining what is important and what deserves attention. When fears dominate, the brain tends to keep the tinnitus at the center of attention. The coaching approach emphasizes that peace and quiet are not the same thing—and that a walk in a forest can be peaceful without eliminating ambient sounds. In her experience, most patients see meaningful progress, though progress length and depth vary by individual and by the factors fueling distress.

Her work with patients since starting the coaching program has involved training dozens of health professionals to adopt this broader view of tinnitus care. She notes that her method does not aim to eliminate tinnitus but to reduce its emotional impact. In her words, some patients experience rapid improvements—some after just a few sessions—while others require a longer course, sometimes up to a year, depending on what fuels their distress and how ready they are to shift from a cure mindset to one of living well with tinnitus.

The UK’s current provision for tinnitus support has drawn criticism. A report by Tinnitus UK, Ringing the Alarm, found long NHS waiting lists for ENT appointments—up to three years in some cases—and delays of up to a year for hearing-aid assistance and psychology therapy or CBT referrals. Even in private clinics, many audiologists report tinnitus care is a low priority. Against these constraints, Sanda has reached out to shape practice: she has trained about 50 healthcare professionals in both the NHS and private sectors since April of the previous year. She remains passionate about her work and says it is deeply rewarding to help patients regain life and confidence after years of struggle, often starting from tears in the first sessions and ending with renewed purpose.

The three-step model she advocates begins with a basic physical check of the ear, followed by assessment of the patient’s emotional state and daily impact, and culminates in tinnitus coaching grounded in CBT and mindfulness. She emphasizes a shift in clinical culture—from focusing primarily on hearing loss correction with devices to addressing emotional and cognitive responses to tinnitus. This broader framework aligns with growing recognition that effective tinnitus care must consider mental health and attention, not just auditory signals.

Sanda’s approach also highlights the need for ongoing research and resources within the UK health system. She notes that, while many patients benefit from hearing aids, those devices do not help everyone, and alternative strategies can be essential for reducing distress. The four types of tinnitus that should never be ignored—according to Sanda—are particularly important signals for urgent medical evaluation: tinnitus in one ear, asymmetrical tinnitus where the sound differs between ears, tinnitus accompanied by sudden hearing loss (a medical emergency), and pulsatile tinnitus—thumping or pulsing in the ear that matches the heartbeat. If tinnitus worsens during physical activity, she advises seeking medical advice promptly.

As the conversation around tinnitus care evolves, Sanda remains optimistic about what can be achieved through a holistic, patient-centered model. Her work underscores the principle that helping patients live well with tinnitus may require changes in assessment, therapy, and resource allocation across the health system. For anyone facing tinnitus, the core messages are clear: begin with a physical ear check to exclude treatable causes, assess the emotional and functional impact, and consider coaching that reframes one’s relationship with sound. Her experiences—and the stories of patients she has helped—underscore the potential for meaningful improvement even when the ringing persists.

For more information about Dr Gladys Sanda’s approach and resources for professionals and patients, visit her practice site.