Intermittent tinnitus (unilateral or bilateral, pulsatile or non-pulsatile) is so common it is essentially normal. No investigation is required if it occurs in relation to noise exposure, the patient should be advised re excessive noise levels (beware headphone use).
All persistent unilateral tinnitus with no red flags should be clearly marked as such and referred to audiology to be seen by an audiologist qualified to send the patient directly for an MRI scan if required.
Pulsatile tinnitus and tinnitus with red flags should be referred to ENT
Bilateral non pulsatile tinnitus with no ENT Red flags (e.g. without discharging ears, pain or facial nerve palsy) does not require referral. Direct the patient to the British Tinnitus Society website http://tinnitus.org.uk/
If patient is really desperate please refer to audiology marked for tinnitus counselling
Tinnitus primary care management
- Explanation of how common it is , often gets less intrusive with time
- Best managed by patient ignoring it as much as possible, with or without Tinnitus Apps or soft music.
- Do treat any cause of conductive hearing loss, the most common of which is ear wax.
Bilateral non pulsatile tinnitus with no ENT Red flags (e.g. without discharging ears, pain or facial nerve palsy) does not require referral. Direct the patient to the British Tinnitus Society website http://tinnitus.org.uk/
