Oto

Problem

Tinnitus affects around one in seven people in the UK and can significantly impact sleep, concentration, and mental health. Cognitive behavioural therapy (CBT) is the most effective treatment for tinnitus distress, yet access to CBT within the NHS is limited due to long waiting lists and uneven service provision.

As a result, many patients are told that little can be done or are referred to ENT or audiology services where effective behavioural treatment may still not be readily available. This contributes to repeat GP visits, unnecessary specialist referrals, and long waiting lists.

More than one million GP consultations occur each year for tinnitus, costing the NHS hundreds of millions of pounds. Despite this demand, accessible and scalable treatment options remain limited.

Oto addresses this gap by providing immediate access to evidence-based CBT through a mobile app. By enabling patients to begin therapy at the first GP contact, Oto improves access to effective treatment while reducing pressure on specialist services.

Solution

Oto delivers CBT for tinnitus through a mobile application designed to replicate the structure and support of therapist-led treatment.

When a patient presents to their GP with tinnitus, the GP can offer Oto during the consultation. The patient receives an SMS link to download the app and begins the CBT programme immediately.

The app provides structured therapy modules, short exercises addressing sleep and anxiety, and sound tools for managing difficult moments. Patients can focus on the areas most relevant to their symptoms and progress at their own pace.

The pathway includes a six-month self-management period. If the patient does not improve after this period, they can be referred to ENT or audiology through the usual pathways. This approach creates a simple, safe step in primary care: patients receive immediate access to therapy while specialist services focus on more complex cases.

Impact

Two randomised controlled trials show Oto’s CBT-based programme significantly improves tinnitus outcomes.

• A Flinders University RCT demonstrated a statistically significant reduction in tinnitus severity compared with wait-list control.
• The UK DEFINE RCT showed smartphone-delivered CBT using Oto was non-inferior to therapist-delivered CBT, demonstrating comparable clinical outcomes at six months.
• Around 64% of participants achieved clinically meaningful improvement in tinnitus distress in the DEFINE trial.
• Oto has supported over 2,500 users in managing tinnitus through digital CBT.
• NHS England is currently conducting a real-world evaluation across multiple Integrated Care Boards to assess reductions in non-urgent ENT and audiology referrals.