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.
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
Bilateral tinnitus without hearing loss
- Review 6 weeks by GP if no better consider referral to Audiology
- Address co-morbidities e.g. depression, stress and anxiety
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
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 CCG- 15N
Referrals to ENT
e-Referral Service Selection
- Specialty: Ear, Nose & Throat
- Clinic Type: Tinnitus
- Service: DRSS Western – Ear Nose and Throat- Devon CCG- 15N
DRSS Referral Form
This guideline has been signed off on behalf of the NHS Devon Clinical Commissioning Group.
Publication date: April 2019
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