Millions of people worldwide are suffering from tinnitus , representing a major financial burden to the health care system . Since it is a subjective disease, there is no objective means to identify the presence of tinnitus, so the assessment relies on patient reports [3, 22], which makes the self-reports of tinnitus conditions particularly important. Therefore, the original intention of this study is to understand the real world evidence of tinnitus patients, that is, to examine patient-centered self-reports during clinical diagnosis and treatment of tinnitus.
Tinnitus treatment remains an unsolved challenge. However, consultation, as discussed by us and other researchers, is a very important management method . Tyler et al.  and Henry et al.  even proposed that consultation education should be included in every clinical tinnitus treatment regimen . Educational counseling is a form of psychological therapy that is often very satisfactory, it is cost-effective even in the long term , and it is easy for clinicians to implement. A vast majority of patients in the present study also said that counseling relieves tinnitus; 66.7% (item 6R) of the return visit respondents who did not report deteriorated symptoms considered that the main factors behind the curative effects included the physician’s explanation and guidance, which is in conformity with a previous study. Due to the small sample size, we did not conduct a vertical comparison of the differences in the factors influencing efficacy of respective outpatient modes, but in general, counseling education, an easy to implement and minimal burden intervention method that brings strong benefits, is a clinical practice worthy to be widely implemented.
Tinnitus patients, the vast majority of whom have good physical and cognitive abilities, require and expect good health care. The traditional medical model has been unable to satisfy tinnitus patients. “People-centered” shared decision making has been developed for such complex chronic diseases . At present, there is no clear research on tinnitus sharing decisions, but in fact, consulting education is one of them. Pryce H et al. proposed that patient preferences would matter considerably in how tinnitus is managed over time, so it is important to clarify patients' preferences in decision-making , which requires doctors and patients to have enough time to listen, understand and communicate. Educational counseling is requires physicians to have adequate time and energy to explain instructions and interact with patients. In the communication between doctors and patients, long-term trust, a friendly relationship, and a scientific view must be established, and patients should be encouraged to take more responsibility for themselves, so that the patient can experience “peaceful coexistence” with the disease. Tinnitus patient relationships are notoriously challenging , especially with regard to the domestic fast-food treatment model, long communication and positive interactions can also reduce the dissatisfaction and negative association of patients in waiting , and effectively improve the doctor–patient relationship. National surveys have shown that many people want to be more involved in decisions about their care . In fact, most patients show they expect to have more time to spend with their doctors.
One of the critical resources in today’s healthcare is time . In the real world of tinnitus, the time for patients in the otological medicine outpatient is obviously more abundant than that in the routine otolaryngology department, although either of the two modes, less than one-third of them meet the expectation. Yet, we found that with respect to patient visits, otological medicine outpatients, who could also be called specialized outpatients, felt that their doctors took more “initiative”, physicians provided information more proactively, and in the process of interacting with doctors they felt more satisfied. The main reason for dissatisfaction with the communication was that the communication time was too short. Albrecht et al.  proposed that satisfaction is a determinant of compliance. Previous studies showed that patients' attitudes toward disease and satisfaction toward treatment can affect treatment adherence, even directly affect health outcomes [4, 18]. Therefore, we thought it was significantly related to the difference in return rate between the two models. Due to the small sample size, the efficacy of the two modes was difficult to compare. Moreover, it has been reported that usually otolaryngologists often feel unable to provide effective services and prefer referring their tinnitus patients to audiologists . However, in a populous country such as China, where medical resources are relatively limited, the specialized outpatient mode, such as in the otological medicine department, seems to be the optimal way to improve the experience and quality of treatment for patients. It more increase tinnitus patients to their own sense of control, better service for tinnitus patients. In terms of patient satisfaction and treatment adherence, specialized outpatient services that are more likely to be completed are more suitable for long-term and fine management of tinnitus.
In this study, doctors and patients were anonymous, i.e., they did not know each other, and the study was designed so as to avoid errors caused by the doctor–respondent inductive communication, reduce the bias of the results, and obtain objective and reliable results. However, it was possible to cross-visit patients, which made the result statistics biased. In retrospect, due to psychological cues, education, distance, social and economic relations, and other individual differences, information was biased to different degrees. Nevertheless, this is the real world evidence of tinnitus patients, and this study lays a foundation for the implementation of an optimal treatment path and long-term management of tinnitus patients, which should be continuously further optimized.