Your role as a GP
People are often told that there's no cure for tinnitus. But you can explain to your patient that there are many different therapies, products and techniques that can reduce the impact that it has on their life.
Research carried out in the UK and other countries has shown the benefits of various treatment methods for tinnitus. These include:
- behavioural techniques – relaxation therapy and cognitive behavioural therapy (CBT), together with various forms of sound therapy; this can include using sound generators (tinnitus maskers), hearing aids or combination devices (where appropriate), or other noise-generating devices such as personal music players and sound pillows
- tinnitus self-help groups, which exist in some areas of the UK – these provide opportunities to share coping strategies and reduce feelings of isolation
- hearing aids, which are often very useful if someone has hearing loss as well as tinnitus because they amplify the environmental sounds a person wants to hear, which will help to distract them from their tinnitus.
Tinnitus is linked with stress, so many things that help to relax patients also help to alleviate tinnitus. Because of the link between stress and tinnitus, it's important to show that you're taking your patient's concerns seriously.
Please note: 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
There's no test for tinnitus, but if someone describes hearing sounds in their head or ear(s) – 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 can be identified by using a stethoscope to check for pulsatile sounds in the neck and skull.
Assessing potential ear condition or hearing loss
Tinnitus can sometimes be a symptom of an underlying ear condition or hearing loss.
- Always perform a otoscopy to check for wax and other outer and middle ear pathology. Blocked ears can result in vascular 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.
- A hearing check – 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.
When you should refer your patient
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 (local protocols may vary slightly, along with the age criterion):
- dizziness (rotatory)
- single-sided tinnitus
- sudden or single-sided hearing loss
- ear infections
- any other outer or middle ear pathology.
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.
More information for your patient
We produce factsheets and leaflets that you can give to your patients to help them to manage tinnitus:
- Tinnitus – causes and therapies
- Stress and tinnitus
- Musical hallucinations
- Pulsatile tinnitus
- How to help friends and family with tinnitus
Contact our Information Line on 0808 808 0123 (telephone) or email email@example.com to order free copies, or download and print them using the links on this page.