Tinnitus Triage Guidelines

October 2010

My Patient Complains About Tinnitus—What Should I Do?

Tinnitus ("ringing in the ears") is experienced by 10%–15% of the adult population. Of those, about one out of every five requires some degree of clinical intervention. When clinical intervention is required, often only some basic education is needed. However, some people with tinnitus have need for individualized care, or they have urgent medical issues. The following are general guidelines for triaging the patient who complains about tinnitus.

If the patient has physical trauma, facial palsy, or unexplained sudden hearing loss:

Refer the patient to Emergency Care or Otlaryngology (if unexplained sudden hearing loss—Audiology referral prior to Otolaryngology visit same day—emergency referral).

If the patient expresses suicidal ideation or manifests obvious mental health problems:

Refer the patient to Emergency Care or Mental Health and report suicidal ideation (may be emergency—if so, escort patient to Emergency Care or Mental Health).

If the patient has any of the following:

• Symptoms suggest somatic origin of tinnitus (e.g., tinnitus that pulses with heartbeat)
• Symptoms seem to be caused by movement of head or neck
• Ear pain, drainage, or malodor
• Vestibular symptoms (e.g., dizziness/vertigo)

Refer the patient to Otolaryngology (urgency determined by clinician; refer to Audiologist for follow-up management).

If the patient has all of the following:

• Symptoms suggest neural origin of tinnitus (e.g., tinnitus does not pulse with heartbeat)
• No symptom from moving head or neck
• No ear pain, drainage, or malodor
• No vestibular symptoms (e.g., no dizziness/vertigo)
• No unexplained sudden hearing loss or facial palsy

Refer the patient to Audiology (not urgent).