referral criteria from primary care - tinnitus

Last edited 03/2020

Referring people with tinnitus:

• Refer immediately to a crisis mental health management team for assessment people who have tinnitus associated with a high risk of suicide. If needed, provide a safe place while waiting for the assessment
  
  
• Refer immediately, in line with the NICE guideline on suspected neurological conditions, people with tinnitus associated with:
• sudden onset of significant neurological symptoms or signs (for example, facial weakness), or
• acute uncontrolled vestibular symptoms (for example, vertigo), or
• suspected stroke (follow a local stroke referral pathway)
  
  
• Refer people to be seen within 24 hours, in line with the NICE guideline on hearing loss in adults, if they have tinnitus and have hearing loss that has developed suddenly (over a period of 3 days or less) in the past 30 days
  
  
• Recognise that assessment and management of the person's tinnitus may still need to continue following an immediate referral
  
  
• Refer people to be seen within 2 weeks for assessment and management if they have tinnitus associated with either of the following:


• distress affecting mental wellbeing (for example, distress that prevents them carrying out their usual daily activities) even after receiving tinnitus support at first point of contact with a healthcare professional. Refer in line with local pathways
  
  
• hearing loss that developed suddenly more than 30 days ago or rapidly worsening hearing loss (over a period of 4 to 90 days). Refer in line with the NICE guideline on hearing loss in adults
  
  
• Refer people for tinnitus assessment and management in line with local pathways if they have any of the following:
  
  
  • tinnitus that bothers them despite having received tinnitus support at first point of contact with a healthcare professional
    
    
  • persistent objective tinnitus
    
    
  • tinnitus associated with unilateral or asymmetric hearing loss
  
  
  
• Consider referring people for tinnitus assessment and management in line with local pathways if they have any of the following, in line with the NICE guideline on hearing loss in adults:
  
  
  • persistent pulsatile tinnitus
    
    
  • persistent unilateral tinnitus

Other indications include (2):

• the patient insists on seeing a specialist
• the practitioner feels uncomfortable with managing tinnitus
• adequate resources are not available in the practice, e.g. masking devices, hearing aids or audiometry
• tinnitus is severe enough to interfere with daily activities (2)
• tinnitus with membrane abnormalities with diagnostic uncertainty (2)
• tinnitus with hearing loss that would benefit from a hearing aid (2)
• objective tinnitus - this defines a tinnitus-like noise that can be heard by the examiner or anyone who cares to listen - this is very rare but may be caused by vascular tumours or neuromuscular disorders such as stapedius myoclonus (2)

Reference:

• NICE (March 2020). Tinnitus:assessment and management
• GP magazine (February 2nd 2004), 41-2.