Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
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 NICE CKS.
- Hearing assessment: Offer an audiological assessment to all patients with tinnitus to evaluate hearing thresholds and differentiate types of hearing loss NICE CKS,NICE NG155.
- Exclude treatable causes: Examine for impacted earwax, otitis externa or media, and temporomandibular joint dysfunction as potential underlying causes NICE CKS,NICE NG98.
- Assess psychological impact: Evaluate the effect of tinnitus on mental wellbeing, including distress, sleep disturbance, anxiety, or depression, using validated questionnaires if appropriate NICE NG155.
- Physical examination: Conduct an ear examination to identify any otological abnormalities and consider tympanometry if middle ear dysfunction is suspected NICE NG155.
- Medication review: Review current medications to identify any that may contribute to tinnitus NICE CKS.
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 NICE CKS. 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 NICE CKS.