Patients who have bilateral tinnitus with no ENT red flags (discharging ears, pain, abnormal ear examination, pulsatile tinnitus, facial nerve palsy) do not require referral to ENT. Please direct the patient to the Tinnitus UK website.
Patients with persistent unilateral tinnitus without red flags (discharging ears, pain, abnormal ear exam, pulsatile tinnitus, facial nerve palsy) can be referred to Audiology who will assess the hearing and refer for an MRI Internal Auditory Meatus (IAM) scan to look for the small possibility of vestibular schwannoma if appropriate.
Patients with pulsatile tinnitus lasting >6 weeks with normal or corrected FBC/TFTs (anaemia and hyperthyroidism are common, easily managed causes of pulsatile tinnitus) should be referred to ENT for hearing testing, examination and consideration of imaging: please see Pulsatile Tinnitus.
Many patients find tinnitus distressing, and it is important to reassure them that this is a common symptom that will usually settle in time. The Tinnitus UK website (see above) has information on distraction techniques which many find useful. If the patient is extremely upset and needs more psychological support a referral can be made to the Audiology team for their Tinnitus Counselling Clinic where specially trained Audiologists use CBT techniques to help patients manage their symptoms.
C.M & L.M – 19-04-2025
Who to refer
- Patients with tinnitus and red flags (discharging ears, pain, abnormal ear examination, pulsatile tinnitus, facial nerve palsy)
- Pulsatile tinnitus where other relevant conditions have been excluded (eg hyperdynamic circulation) and symptoms continue beyond 6 weeks
- Possible Meniere’s disease
- Persistent unilateral tinnitus and no red flags (refer AUDIOLOGY)
Who not to refer
- Those with no red flags and uncomplicated bilateral tinnitus unless symptoms are causing ongoing distress, in which case please refer to Audiology
How to refer
By SCI Gateway to Lauriston or St John’s Hospital → ENT → Ear → Tinnitus.
- Tinnitus is very common and usually will settle with time.
- Tinnitus is best managed by the patient trying to distract themselves from the noise with other noises in their environment (advise against other noise that is too loud, but they should avoid silence) or other activities. There are many apps available that will offer a range of background noises that can be used for this purpose.
- Check for any simple causes of hearing loss which could be triggering tinnitus and manage these – for example wax impaction causing conductive hearing loss.
