As a GP, it’s important to understand the treatment options and referral routes for patients who have tinnitus.
Identifying tinnitus
There’s no test for tinnitus, but if someone describes hearing sounds in their head or ears – such as buzzing, ringing or whistling – and they’re not coming from an external source, it’s defined as tinnitus.
You can listen to what tinnitus sounds like for some people here.
Pulsatile tinnitus is different, and can be caused by changes in blood flow in the blood vessels near the ear. This type of tinnitus may be identified by using a stethoscope to check for pulsatile sounds in the neck and skull.
Your role as a GP
Tinnitus is linked with stress and can have mental health impacts, so it’s important to show that you’re taking your patient’s concerns seriously.
People are often told there’s nothing that can be done about tinnitus or that there’s no cure, which can leave them feeling very hopeless. But you can provide practical information, support and reassurance.
Explain to your patient that there are many different therapies, products and techniques that can reduce the impact that it has on their life. These include:
- counselling, such as relaxation therapy and cognitive behavioural therapy (CBT)
- sound therapy, including noise-generating apps and devices such as personal music players and sound pillows
- tinnitus groups, which exist in some areas of the UK and online – these provide opportunities to share coping strategies and reduce feelings of isolation
- hearing aids, which can be effective for patients who have hearing loss as well as tinnitus because they can amplify environmental sounds and make tinnitus less prominent
Learn more about ways to manage tinnitus.
The range of tinnitus support varies within each audiology service, so it’s important to be aware of what’s available in your local area.
Preliminary assessments that you can carry out
Tinnitus can sometimes be a symptom of an underlying ear condition or hearing loss.
Otoscopy
Always perform otoscopy to check for wax and any outer or middle ear pathology.
Blocked ears can result in internal sounds becoming more obvious. Temporary hearing loss from any cause can result in temporary tinnitus, which can persist if the cause is not alleviated quickly.
Hearing check
Perform a hearing check to screen for hearing loss. This can be a handheld pure tone check or an audiometry screen at 25db across 500hz, 1, 2 and 4 KHz.
A tuning fork can be used to assess for symmetrical hearing loss and whether it is conductive or sensorineural in nature.
Referring patients
When considering whether to refer someone to ENT or directly to audiology, it’s best to consider their hearing as well their tinnitus.
A patient can be referred directly to audiology if they appear to have age-related hearing loss and none of the following additional problems:
- dizziness (rotatory)
- single-sided tinnitus
- sudden or single-sided hearing loss
- ear infections
- any other outer or middle ear pathology
How hearing therapy can help your patients
Hearing therapists can discuss coping strategies, products that may help, and be a source of support for your patient.
Some audiologists may also be trained to use aspects of CBT, but if someone has very distressing symptoms, they may benefit from a referral to a clinical psychologist.