What criteria should I use to refer a patient with tinnitus for specialist evaluation?

Criteria for referring a patient with tinnitus for specialist evaluation include:

• Tinnitus that persists and bothers the patient despite receiving initial tinnitus support at first contact with a healthcare professional.
• Persistent objective tinnitus (tinnitus noise detectable by an examiner).
• Tinnitus associated with unilateral or asymmetric hearing loss.
• Persistent pulsatile tinnitus.
• Persistent unilateral tinnitus.
• Tinnitus with sudden onset or rapidly worsening hearing loss (developed suddenly within 30 days or worsening over 4 to 90 days) should be referred urgently in line with hearing loss guidelines.
• Tinnitus associated with sudden onset of significant neurological symptoms or signs (e.g., facial weakness), acute uncontrolled vestibular symptoms (e.g., vertigo), or suspected stroke requires immediate referral.
• Tinnitus with hearing loss that developed suddenly (within 3 days or less) in the past 30 days should be referred to be seen within 24 hours.
• Tinnitus causing distress affecting mental wellbeing that prevents usual daily activities, even after initial tinnitus support, should be referred within 2 weeks.
• Immediate referral to crisis mental health services is required if tinnitus is associated with a high risk of suicide.

These referrals should be made in line with local pathways and relevant NICE guidelines on tinnitus and hearing loss.

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