REMEDY : BNSSG referral pathways

Tinnitus

Checked: 12-02-2018 by saffron.reavley Next Review: 12-02-2019

Introduction

There is useful information on assessment and management of tinnitus on the Clinical Knowledge Summaries website (last revised October 2017).

The local ENT GPSI also has put together the following advice:

Bilateral tinnitus rarely needs further investigation (only if there is some other reason e.g. asymmetric hearing loss, neurological signs, or abnormal ear examination).

There is some advice on management below:

Treatment of tinnitus broadly falls into 3 categories:

1) Reassurance

2) Self-help with distracting background "white noise" (e.g. using radio with low volume at night, white noise devices, smart phone apps) - the theory being by distracting the listener the tinnitus becomes less intrusive/ less of a focus and eventually they are trained to ignore it.

3) Tinnitus retraining therapy - a combination of the above plus some cognitive behavioural therapy techniques - a referral to ENT at St. Michael's requesting access to Tinnitus Retraining Therapy may help if above measures have been tried and symptoms are particularly intrusive (now available via e-referral).

4) If there is a possibility of some hearing loss then a referral to audiology for assessment of this is worthwhile as in some cases hearing aids can improve the symptoms (although a Cochrane review with not conclusive).

There is also a useful patient information leaflet

 

Self Help

The British Tinnitus Association has information on self help treatments for patients including a helpline (0800 018 0527) and a patient information leaflet.

Referral

Audiology Referral - If there is hearing loss or self help treatments are not effective or symptoms are severe then a referral for audiological testing and/or tinnitus retraining therapy may be considered. Referrals can be made to the audiology department at St Michaels Hospital via eReferral

ENT referral  - If tinnitus is unilateral or there are any red flags then consider referral to ENT via eReferral

Red Flags

A list of red flags can be found on the CKS website and include:

Pulsatile tinnitus.

Unilateral tinnitus.

Tinnitus associated with unilateral or asymmetric hearing loss.

Tinnitus associated with persistent otalgia or otorhoea that does not resolve with routine treatment (consider 2WW referral)

Tinnitus with vestibular symptoms (dizziness or vertigo).