What initial assessments should I perform for a patient presenting with new-onset tinnitus?

Initial assessments for a patient presenting with new-onset tinnitus should include:

• History and symptom review: Assess for sudden onset, pulsatile tinnitus, associated neurological symptoms (e.g., facial weakness), acute vestibular symptoms (e.g., vertigo), or signs of stroke, which require immediate referral ².
• Hearing assessment: Offer an audiological assessment to all patients with tinnitus to evaluate hearing thresholds and differentiate types of hearing loss ²,³.
• Exclude treatable causes: Examine for impacted earwax, otitis externa or media, and temporomandibular joint dysfunction as potential underlying causes ²,⁴.
• Assess psychological impact: Evaluate the effect of tinnitus on mental wellbeing, including distress, sleep disturbance, anxiety, or depression, using validated questionnaires if appropriate ³.
• Physical examination: Conduct an ear examination to identify any otological abnormalities and consider tympanometry if middle ear dysfunction is suspected ³.
• Medication review: Review current medications to identify any that may contribute to tinnitus ².

Referral urgency: Immediate referral is indicated if tinnitus is associated with high suicide risk, sudden neurological signs, acute vestibular symptoms, suspected stroke, sudden hearing loss within 30 days, or pulsatile tinnitus ². Urgent referral (within 2 weeks) is advised for tinnitus with distress affecting daily activities, sudden hearing loss older than 30 days, or persistent otalgia/otorrhoea ².