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 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.


Bilateral 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
Further information


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

Audiology referrals should be sent via e-Referrals
  • Speciality: Diagnostic Physiological Measurement
  • Clinic type: Audiology – Hearing Asses/ Reassess
  • Service- DRSS Northern – ENT – New Devon CCG – 99p]
ENT referrals should be sent via e-Referrals
  • Speciality: ENT
  • Clinic type: Tinnitus
  • Service- DRSS Northern – ENT – New Devon CCG – 99p

Supporting Information

Patient Information


Update on the management of tinnitus - BTA

Pathway Group

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

Publication date: July 2017

Review date: June 2019


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