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 and examination

  • Tinnitus persisting for more than 6 weeks
  • Conduct ear and neurological examination

Red Flags

'Red Flag' indicates a need for specialist assessment, not 2WW referral
  • Persistent unilateral tinnitus
  • Pulsatile tinnitus in the absence of cardiovascular causes e.g. heart murmurs or carotid bruits
  • Presence of ear pain, discharge, abnormal ear examination
  • Coincident neurological symptoms e.g. vertigo or facial palsy – refer urgently to ENT

See 2WW guidelines in formulary 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

Bilateral tinnitus with 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 Tinnitus for more than 6 weeks with significant impact on QoL despite adequate self-treatment

Urgent referral to ENT:
  • Pulsatile tinnitus in absence of cardiovascular cause
  • Tinnitus co-existent 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 to Chime Audiology as paper referrals as this service is not provided on e-Referral Service:

  • Audiology Department, RD&E Hospital Wonford. Tel: 01392 402 223/6
Urgent referrals to ENT

e-Referral Service Selection

  • Specialty: Ear, Nose & Throat
  • Clinic Type: Tinnitus
  • Service: DRSS-Eastern-Ear Nose and Throat-NEW Devon CCG- 99P

Supporting information

Patient Information

Evidence

Update on the management of tinnitus - BTA

This guideline has been developed by Royal Devon and Exeter Healthcare Foundation Trust based on local guidelines.

Pathway Group

This guideline has been signed off by the Eastern Locality on behalf of NEW Devon CCG.

Publication date: July 2017

Review date: June 2019

 

Home > Referral > Eastern locality > ENT & Audiology > Tinnitus

 

  • First line
  • Second line
  • Specialist
  • Hospital