Guideline of the month: managing tinnitus
The key guideline for March
The British Tinnitus Association (BTA) has, for the first time, produced guidance for GPs to help with the management of tinnitus. It follows discussions with patients and GPs, with the latter saying they would like more support to help them manage the condition.
Key points for GPs
- Patients should be referred if their tinnitus is: pulsatile; unilateral; associated with vertigo; coexistent with asymmetric hearing loss; causing psychological distress; or associated with significant neurological symptoms.
- Tinnitus can result in a blocked feeling in the ears but antibiotics rarely help.
- Neither conventional nor complementary therapies have been shown to help. A positive approach and encouraging patient self-help are more effective.
- Consider a hearing aid if there is associated hearing loss. Reducing the effort a patient exerts to listen can reduce the level of tinnitus.
- Recommend that patients avoid silence, as low-level background noise, such as a fan or gentle music, can reduce the starkness of the tinnitus.
There are some 750,000 tinnitus-related GP consultations in England each year but audiology is often not available in primary care and referral pathways vary between areas. A BTA survey found 88% of patients wait up to four months to see a specialist. In addition, mental health support is sometimes indicated for psychological symptoms.
Dr Steve Brown, a GPSI in ENT in Beaconsfield, says: ‘The red-flag list is useful. If unilateral hearing loss is suspected using a tuning fork and doing Weber’s test is simple and often helpful. If audiology assessment is not possible in primary care, some private hearing aid providers will do it free. Where fullness in the ear is described with sensorineural hearing loss, tympanometry helps exclude a middle-ear effusion. Once red flags have been excluded, I try to get patients to focus on the natural history of gradual improvement. The BTA website is useful (tinnitus.org.uk).
Baguley D, McFerran D. Tinnitus guidance for GPs. Sheffield: BTA; 2017.