Tinnitus

Scope

This guideline covers the diagnosis and management of tinnitus in adult patients.

Virtually all adults will experience tinnitus at some point in their life, this is usually self-limiting. Bilateral tinnitus is almost never associated with significant pathology.

Assessment

History & Examination

  • Tinnitus persisting for more than 6 weeks
  • Conduct ear and neurological examination
  • If pulsatile listen to neck for carotid bruit

Red flags

See 2WW guideline for guidance about suspected neurological cancers.

ENT/Audiological presentations which may include tinnitus and in which this might be relevant include, but are not limited to:

  • Unilateral sensorineural deafness with other signs or symptoms to raise suspicion of brain tumour
  • New cranial nerve palsy
  • Headache with alarm symptoms

See 2WW guidelines for guidance about suspected head and neck cancers.

Persistent unilateral tinnitus with or without vertigo, hearing loss or other symptoms may sometimes represent acoustic neuroma, and certainly warrants investigation. However, acoustic neuroma is a benign and slow-growing tumour which does not require investigation via a 2WW pathway. It is also rare: only 2% of patients with unilateral tinnitus and sensorineural hearing loss are found to have an acoustic neuroma on MRI.

Management

Tinnitus with awareness of hearing loss
Bilateral tinnitus without hearing loss

Self-management

  • Review 6 weeks by GP if no better consider referral to audiology
  • Address co-morbidities e.g. depression, stress and anxiety
Further information

Referral

Referral Criteria

Routine referral to audiology:
  • Troublesome or intrusive bilateral tinnitus for more than 6 weeks with significant impact on quality of life despite adequate self-treatment
  • Pulsatile tinnitus in absence of cardiovascular cause or anaemia
  • Persistent unilateral tinnitus
Urgent referrals to ENT (no need to wait 6 weeks before referral):
  • Tinnitus co-existent with ear pain, discharge or abnormal exam findings
  • Tinnitus with co-existent neurological symptoms such as vertigo or facial palsy

Referral Instructions

Routine referrals to audiology

Audiology referrals should be sent via e-Referrals

  • Speciality: Diagnostic Physiological Measurement
  • Clinic type: Audiology – Hearing Asses/ Reassess
  • Service: DRSS South Devon and Torbay- Audiology- Devon CCG- 15N
Referrals to ENT

e-Referral Service Selection

  • Specialty: Ear, Nose & Throat
  • Clinic Type: Tinnitus
  • Service: DRSS South Devon and Torbay– Ear Nose and Throat- Devon CCG- 15N

Referral Forms

Tinnitus clinic referral form

DRSS Referral forms

Supporting information

Patient Information

Pathway Group

This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group.

Publication date: April 2019

 

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