When should I consider referring a patient with tinnitus for specialist evaluation?

Consider referring a patient with tinnitus for specialist evaluation in the following situations:

• Immediately (to be seen within a few hours) if tinnitus is associated with a high risk of suicide, sudden onset of significant neurological symptoms (e.g., facial weakness), acute uncontrolled vestibular symptoms (e.g., vertigo), suspected stroke, sudden onset pulsatile tinnitus, or tinnitus secondary to head trauma ¹.
• Very urgently (to be seen within 24 hours) if tinnitus occurs with sudden hearing loss that developed over 3 days or less within the past 30 days ¹.
• Urgently (to be seen within 2 weeks) if tinnitus is associated with distress affecting mental wellbeing that persists after initial tinnitus support, hearing loss that developed suddenly more than 30 days ago or rapidly worsening hearing loss over 4–90 days, or persistent otalgia or otorrhoea not resolving with routine treatment ¹.
• In line with local pathways if tinnitus bothers the patient despite initial support, persistent objective tinnitus, tinnitus associated with unilateral or asymmetric hearing loss, persistent pulsatile tinnitus, persistent unilateral tinnitus, or tinnitus that has significantly changed in nature or is causing distress ¹,³.
• Less urgently, using clinical judgement, for tinnitus of uncertain cause without serious symptoms, especially if not associated with hearing loss, ear pain, drainage, vestibular symptoms, or facial weakness ¹.

Offer audiological assessment to all people with tinnitus and consider referral to ENT or audiovestibular services as appropriate ¹,³.