Tinnitus

Back

Acute Nose Bleeds Acute Sinusitis Adult Snoring Surgery (in the absence of Obstructive Sleep Apnoea) clinical commissioning policy AQP Audiology referral guide for practice staff Benign Paroxysmal Positional Vertigo Chronic rhinosinusitis with or without polyps Dysphonia/Altered voice in Adults and Children Ear Wax Removal Feeling of something stuck in the throat Fractured Nose Management of discharging Ear Myringotomy commissioning policies Otitis Externa Otitis media with effusion in children - suspected Perforated Tympanic Membrane Recurrent Tonsillitis/Tonsillectomy Snoring Tinnitus Tonsillectomy commissioning policy

Print this page

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.

Toggle all

History & Examination

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

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.

Tinnitus with hearing loss

Please see Hearing problems in adults guideline

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

Self-help for tinnitus - BTA website

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 referral 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 Western - Audiology- Devon ICB- 15N

Referrals to ENT

e-Referral Service Selection

Specialty: Ear, Nose & Throat
Clinic Type: Tinnitus
Service: DRSS Western – Ear Nose and Throat- Devon ICB- 15N

Referral Form

DRSS Referral Form

Patient Information

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: April 2019

Referral