Tinnitus is the perception of hearing a noise when there is no external source. It is extremely common, affecting around 6 million people in the UK (1 in 8 of the population). The majority (approximately 80%) of diagnoses are made in those aged over 40.Subjective tinnitus is only heard by the patient. Objective tinnitus can be heard by others when the patient is examined and is very rare.
There are management approaches which can make a significant and positive difference to patients with tinnitus. NICE has emphasised that early interventions, including explanation, help reduce disability. Patients being told there is no treatment and that the only option is to learn to live with it can lead to catastrophic thinking which fuels the condition. Stress management virtually always helps tinnitus symptoms.
White noise retrainers can help tinnitus, whether or not there is hearing loss. As tinnitus is more common in people with hearing loss, hearing aids can also be an option.
Hyperacusis is a much rarer condition, where there is heightened sensitivity to sound, causing distress. It can co-exist with tinnitus, but the approaches to management are the same.
What happens at an Audiology tinnitus or hyperacusis appointment
For patients with unilateral tinnitus, an MRI scan will be discussed. If tinnitus continues to be problematic, they will then continue on a tinnitus management pathway.
For tinnitus or hyperacusis causing psychological distress, the appointment will include audiometry and tympanometry, along with person-centred tinnitus /hyperacusis counselling.
A management session will also cover:
- sleep management
- sound therapy
- relaxation techniques
- stress management
Who to refer:
Patients aged 16 or over (and not still at school – see below) who present with distressing unilateral or bilateral tinnitus as the main concern, either with or without hearing loss. Please clearly indicate whether or not hearing loss is also present.
Patients who present with hearing loss and non-problematic tinnitus, or have long standing tinnitus, should be referred through the hearing loss pathway – please see Hearing Loss Audiology.aspx.
These referral approaches apply to those with hyperacusis too.
Who not to refer:
Patients who are still at school should be referred via Paediatric Audiology as they may require educational support.
Patients with the following red flags should be referred directly to ENT
- Recurrent infections
- Active perforations/mastoid cavities/discharge/abnormal appearance of ear drum
- Polyps, possible foreign bodies
- Persistent ear pain
- Pulsatile tinnitus
- Sudden sensorineural hearing loss (please see HearingLoss)
- Vertigo/unsteadiness not consistent with age or existing pathologies
- Conductive hearing loss
How to refer:
Please refer using SCI Gateway to:
Lothian Lauriston Audiology
Lothian -> St John’s Hospital -> Audiology
(Please note that a tinnitus service is NOT currently offered at Roodlands).
