Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
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.
References: NICE NG155, NICE NG98