Already have an account? Login
The guidance’s document was created to support GPs who are the first contact for tinnitus patients. This document provides simple and clear support which can be passed on to those who need help.
Tinnitus red flags
Firm indications that a patient with tinnitus should be referred onwards include:
Although many tinnitus patients do not fit into any of these imperative categories, clinicians involved in tinnitus care are firmly of the opinion that all patients with symptom should at the very least receive an audiological assessment. Local factors will determine whether this is undertaken in primary or secondary care.
At any point in time around 10% of the population experience tinnitus
Both sexes are equally affected and although tinnitus is more common in the elderly it can occur at any age, including childhood. The perceived sound can have virtually any quality – ringing, whistling, and buzzing are common – but more complex sounds can also b described.
Most tinnitus is mild
In fact, it is relatively rare for it to develop into a chronic problem of life-altering severity. In a minority of patients, the distress is ongoing and very significant, and they will require specialist support.
Underlying pathology is rare, but be vigilant
In many cases tinnitus is due to heightened awareness of spontaneous electrical activity in the auditory system that is normally not perceived. It can however be a symptom of treatable and significant otological pathology, such as a vestibular schwannoma or otosclerosis.
Tinnitus can be associated with a blocked sensation
For reasons that are not clear tinnitus and sensorineural hearing loss can give rise to a blocked feeling in the ears despite normal middle ear pressure and eardrum mobility.
Giving a negative prognosis is actively harmful
It is all too common to hear that patients have been told nothing can be done about tinnitus. Such negative statements are not only unhelpful but also tend to focus the patient’s attention on their tinnitus and exacerbate the distress.
There is no direct role for drugs
There is no conventional or complementary medication that has been shown to have specific tinnitus ameliorating qualities and there is anecdotal suggestion that repeatedly trying unsuccessful therapies worsens tinnitus.
Referral routes for tinnitus patients
Referral routes vary and depend on local protocols and commissioning, but in the majority of cases referrals are directed to ENT or audiology services. Common sense dictates that when there are possibilities of self-harm or of psychological crisis, then urgent mental health support is indicated.
Tinnitus is more common in people with hearing loss
Tinnitus prevalence is greater amongst people with hearing impairment but the severity of the tinnitus correlates poorly with the degree of hearing loss. It is also quite possible to have tinnitus with a completely normal pure tone audiogram.
Hearing aids are helpful if there is associated hearing loss
Straining to listen can allow tinnitus to emerge or, if already present, to worsen. Correcting any hearing loss reduces listening effort and generally reduces the level of the tinnitus. Hearing aids are useful even if the hearing loss is relatively mild and at a level where aids would not normally be considered. Department of Health guidelines have emphasised the value of audiometry in a tinnitus consultation, and this is the definitive basis for decisions about hearing aid candidacy.
Avoiding silence is helpful
Having continuous, low level, unobtrusive sound in the background can reduce the starkness of tinnitus. Sounds can be quiet, uneventful music, alternatively, there are inexpensive devices that produce environmental sounds which can be particularly useful at bedtime. They can be purchased online from the BTA at www.tinnitus.org.uk or by calling 0114 250 993.
Self-help is often effective
BTA provides comprehensive information and a network of tinnitus support groups around the country. BTA has a freephone telephone helpline 0800 018 0527 as well as offering advice through the website. BTA is aware from the calls they receive, that when early help is given by GPs and secondary services, patients manage their tinnitus more effectively.
At Afti Ear Room, we provide several guides about managing tinnitus which our clients have found particularly helpful, as well as providing ongoing audiological care for all clients.
Further Information
Contact Afti Ear Room Visit the BTA website
Adapted from the BTA website
