Tinnitus is the perception of sound in the absence of an external source (1). It is not considered a disease in itself but rather a symptom of various underlying conditions. The underlying causes of tinnitus are often difficult to pinpoint. It is thought to result from cochlear injuries that lead to peripheral deafferentation, prompting adaptive changes in the central nervous system. It is frequently associated with auditory disorders such as Ménière’s disease, noise-induced hearing loss, and presbycusis (1). Recent studies also suggest that both auditory and non-auditory factors may influence tinnitus, indicating its multifactorial in nature and. For example, cardiovascular risk indicators, including dyslipidemia and hyperglycemia, have been associated with tinnitus occurrences (2). Additionally, hematological parameters such as hemoglobin and platelet counts have been correlated with tinnitus severity, suggesting the involvement of vascular and inflammatory pathways in its pathophysiology (3).

Globally, tinnitus affects around 749 million adults, with 120 million experiencing severe symptoms (4). It can markedly impair QoL, with certain personality traits such as neuroticism, anxiety-proneness, and heightened stress sensitivity exacerbating its perception as a distressing symptom, particularly in those with comorbid illness (5, 6). Chronic tinnitus is associated with reduced QoL through sleep disturbance, cognitive and emotional difficulties, and impaired concentration, often leading to frustration, irritability, and chronic stress. These challenges can interfere with daily functioning, work productivity, and social relationships, and in severe cases may be associated with suicidal ideation (5, 7). Given these wide-ranging consequences, effective assessment and management are essential.

Tinnitus evaluation typically involves a medical history and clinical examination to identify treatable causes (8, 9). Recommended assessments include ear, nose, and throat (ENT) examination, audiological evaluation, and the use of validated questionnaires to assess tinnitus impact (9).

Management approaches are varied. Conservative strategies, such as improving sleep, managing stress, and reducing caffeine, are often advised to reduce symptoms and enhance QoL (8, 10). Evidence-based interventions include behavioral therapy, sound therapy, and medication, while surgery is rarely used and reserved for specific underlying conditions such as Ménière’s disease or tumors (11). Cognitive behavior therapy (CBT) is one of the interventions that has consistently shown effectiveness in improving QoL for tinnitus patients (8, 12). Other options include tinnitus retraining therapy (TRT), melatonin, antidepressants, and cognitive training to address sleep, mood, and cognitive symptoms (8, 13).

The prevalence of tinnitus among adults in Saudi Arabia is 37.6%, with 23% experiencing a mild handicap as measured by the Tinnitus Handicap Inventory (THI). Unfortunately, nearly 60% of individuals with tinnitus did not seek medical support, with reported barriers including the belief that no treatment was available (66.7%), perceiving the condition as tolerable (22.5%), or not knowing which specialty to consult (10.8%) (14). An earlier study conducted in Saudi Arabia in 2011 found that 43% of participants experienced bilateral tinnitus, and 76% had some degree of hearing loss (15).

The high prevalence of tinnitus in Saudi Arabia, combined with misconceptions about its management and the limited research on clinical practices, underscores the need for further investigation. These reported barriers highlight the importance of improving patient awareness, correcting misconceptions about available treatments, and strengthening referral pathways. This study, therefore, aimed to examine current practices among audiologists in assessing and managing tinnitus patients, to identify areas for improvement, and to guide future tinnitus care in the country.

A total of 96 audiologists were included in the study. Their demographic information is presented in Table 1. The questionnaire focused on audiologists’ reported practices and did not collect patient-level clinical details such as comorbid hearing loss, vertigo, or age of tinnitus onset. Thus, the findings reflect professional practices rather than specific patient characteristics. The majority of the audiologists (64.6%) reported seeing 1–5 individuals with tinnitus per week, while 21.9% see 6–10 patients and 13.5% see more than 10 patients weekly. Regarding patients’ emotional status at first consultation, audiologists reported that nearly half (47.9%) perceived their patients as distressed, while 36.5% perceived them as neutral and 15.6% as positive.

This study provides new insight into audiologists’ current practices in tinnitus care in Saudi Arabia and highlights several important gaps. The main findings revealed that most audiologists underutilized psychoacoustic tests and validated questionnaires, instead relying on standard audiological measures. Management strategies centered mainly on hearing aids and counseling, with limited uptake of evidence-based psychological approaches such as CBT and TRT. Outcome evaluation was inconsistent across clinics, often relying on unstructured interviews rather than standardized tools. Satisfaction with effectiveness was moderate, with group comparisons showing significantly higher satisfaction among audiologists working in specialized clinics, within multidisciplinary teams, offering same-appointment care, and having more trained colleagues. However, regression analysis demonstrated that these factors were interdependent, suggesting that comprehensive, well-resourced clinical environments, rather than single elements in isolation, are most likely to enhance tinnitus care.

One strength of this study is that it is the first to provide national-level data on tinnitus practice in Saudi Arabia, moving beyond prevalence studies to examine how audiologists assess, manage, and evaluate outcomes. When compared with existing literature from other countries, several contrasts become evident. In terms of appointment structure, only 14.6% of audiologists reported having specialized tinnitus clinics within their workplaces, compared with Northern and Southern Europe, where these are more common (17). Appointment times were typically shorter in Saudi Arabia, with half of audiologists offering 30 min, one-quarter 15 min, and only one-quarter 60 min. By contrast, in the UK, average appointments last 60–75 min, while in Northern Europe, they typically range from 30 to 60 min (16, 17). Shorter consultation durations may compromise the comprehensiveness of assessment and limit opportunities for counseling, despite evidence that nearly half of individuals with tinnitus experience significant distress and require psychological support. Referral pathways in this study were broadly appropriate, with patients directed by GPs, ENTs, neurologists, psychologists, or self-referral, consistent with international practices. Increasing community awareness of self-referral options could help reduce delays in accessing services, particularly given that many individuals with tinnitus in Saudi Arabia do not seek medical help (14).

The limited uptake of multidisciplinary care, group therapy, and family involvement also contrasts with evidence showing that these approaches improve adherence, provide psychosocial support, and enhance QoL (9, 18–23). In this study, only 32.3% of audiologists in this study reported participating in multidisciplinary teams, and none reported any involvement in group therapy. Greater expansion of collaborative, patient-centered models of care could therefore strengthen service provision.

Assessment practices showed strong reliance on audiological measures such as pure tone and high-frequency audiometry, speech audiometry, tympanometry, and otoacoustic emissions, consistent with best practice (9). However, psychoacoustic measures (pitch and loudness) and validated questionnaires were underutilized, despite recommendations from international guidelines (9, 24). Only 41.7% of audiologists reported using psychoacoustic measures during assessment, and 25% during follow-up. Although these rates are relatively low, they are still higher than those reported in the UK (17 and 4%, respectively) (16). Recent findings demonstrate that THI scores correlate strongly with tinnitus loudness but not pitch (25), which emphasizes the value of integrating psychoacoustic measurements alongside self-reports. Validated questionnaires such as the THI were also seldom employed (25% at assessment and 23% at follow-up), and no standardized tools were used to assess anxiety or depression. Instead, most audiologists relied on unstructured interviews, which hindered comparability across clinics. These findings highlight an urgent need to increase the uptake of validated measures for both tinnitus severity and psychological comorbidities.

International guidelines for tinnitus practice, such as the Clinical Practice Guideline for Tinnitus developed by Tunkel et al. (24) and the Multidisciplinary European Guideline for Tinnitus developed by Cima et al. (9), recommend incorporating standardized questionnaires and psychoacoustic measures into clinical pathways. However, the lack of validated Arabic-language tinnitus tools presents a barrier in Saudi Arabia. Developing culturally and linguistically appropriate measures, as well as raising awareness of existing Arabic-language instruments (26–28), would allow for more accurate assessment and tailored interventions. Outcome evaluation in this study was highly variable, with 45.8% relying on unstructured interviews, 28.1% on structured interviews, 22.9% on questionnaires, 30.2% on objective measures, and 16.7% reporting no formal evaluation. This heterogeneity illustrates the importance of standardized outcome assessment protocols in clinical practice.

In terms of management, hearing aids and directive counseling were the most commonly used strategies, while sound generators, CBT, and TRT were underutilized. This differs from European practice, where CBT and TRT are more widely implemented (16, 17). CBT is strongly recommended for managing tinnitus-related distress (12, 21, 29, 30), and TRT combines counseling with sound therapy to facilitate habituation (13, 31). The limited application of these therapies in Saudi Arabia likely reflects gaps in professional training. Without adequate preparation in psychological approaches, audiologists are unable to provide comprehensive, interdisciplinary care. Variation in assessment, management, and outcome practices further highlight the absence of national protocols. Implementing standardized guidelines would reduce variability and improve consistency across services (24, 32).

The statistical findings also carry important implications. Audiologists’ mean satisfaction score (3.25 on a five-point scale) indicates only moderate confidence in their effectiveness. Group comparisons showed that higher satisfaction was significantly associated with organizational resources such as specialized clinics, multidisciplinary care, integrated appointments, and trained colleagues. This suggests that structural and organizational support has a major influence on clinicians’ perceived effectiveness. However, the regression model showed that none of these factors remained significant when analyzed simultaneously, suggesting that their effects overlap. In practice, we need comprehensive service environments that combine specialized clinics, collaborative care, integrated appointments, and adequate counseling support to achieve meaningful improvements. This finding aligns with international evidence highlighting the benefits of multidisciplinary and well-resourced care models (9, 19, 20, 32). By contrast, audiologists in the UK and USA report higher satisfaction (16, 33), likely due to greater availability of training and resources.

The study has limitations. The sample size was relatively small, which may reduce the generalizability of the findings. The demographic distribution was unbalanced, with overrepresentation of younger audiologists and those practicing in the central region. The reliance on self-reported data introduces recall and social desirability bias, and structured survey responses may not capture the full range of clinical practices. Finally, the survey was designed to capture audiologists’ practices rather than patient-level clinical data, so details on comorbid conditions or age of tinnitus onset were not collected. These limitations suggest that findings should be interpreted with caution.

Overall, the findings reveal systemic challenges: limited specialized services, inadequate use of standardized assessment tools, and restricted access to evidence-based psychological approaches. Importantly, no national clinical protocols currently exist, emphasizing the pressing need for evidence-based guidelines to standardize care and reduce variability across clinics. At the same time, opportunities for improvement were identified: investing in training, expanding workforce capacity, and strengthening interprofessional collaboration could support the development of a more consistent and effective model of tinnitus care.

Tinnitus practice in Saudi Arabia shows notable gaps, particularly in training, standardized protocols, and resource availability. Targeted actions, such as implementing evidence-based guidelines, expanding specialized training, and improving resources, are essential to strengthen care. Addressing these gaps will enhance service delivery, patient satisfaction, and overall quality of life for individuals with tinnitus.