GPAtlas
TINNITUS
gpatlas.co.uk
🔍 When to Suspect
The perception of sound (e.g., ringing, buzzing, hissing) in the ears or head in the absence of an external source
🩺 Assessment
- ◉ Symptoms + triggers → Sound description, unilateral vs bilateral, constant vs intermittent, pulsatile nature
- ◉ Risk factors/history → Noise exposure, head injury, ototoxic medications (aspirin, NSAIDs, loop diuretics), hypertension
- ◉ Impact + mimics → Crucially ask about impact on sleep, mood, concentration; check for anxiety/depression
- ◉ Exam findings → Otoscopy to exclude wax/infection, BP check, auscultation of neck if pulsatile, hearing assessment
💊 Management
🔸Key tests:
➤ Audiology referral to assess for underlying hearing loss
🔸Lifestyle:
➤ Sound therapy (background noise like a fan or white noise app), relaxation techniques (meditation, yoga)
🔸Pharmacological:
➤ No medications are routinely recommended for tinnitus itself; treat associated conditions like insomnia, anxiety, or depression if present
🔸Exacerbation/emergency:
➤ Immediate referral to CRISIS team if suicidal ideation is present
🔸Follow-up/safety-net:
➤ Reassure and provide information; refer for CBT or Tinnitus Retraining Therapy (TRT) if significant impact
⚠️ Red Flags
• Pulsatile tinnitus (synchronous with heartbeat)
• Unilateral tinnitus
• Tinnitus associated with sudden hearing loss
• Tinnitus associated with neurological symptoms (vertigo, facial weakness)
• Suicidal ideation or severe psychological distress
➡️ Referral Criteria
Routine: Refer for assessment and imaging for persistent pulsatile or unilateral tinnitus; urgent (24h) ENT referral for tinnitus with sudden hearing loss
Routine: Routine Audiology referral for hearing test and initial management advice
📌 GP Tips
🔹The key to the consultation is exploring the psychological impact of the tinnitus, not just its acoustic character
🔹If hearing loss is present, fitting a hearing aid is often the single most effective treatment for the associated tinnitus