1. The sensation of sounds in the ears or head in the absence of an external sound source Tinnitus

2. Pathophysiology Still poorly understood Almost every ear disease and cause of deafness can be associated with tinnitus Useful web resource if RNID website

3. Any areas that want to discuss? Current pathways: Manage in primary care – the majority Referral to ENT – who to refer and when?

4. History Description of the sound Pulse, ringing, whoosh Unilateral, Bilateral Intrusive (sleep interrupted?) Persistent or intermittent Associated symptoms Hearing loss Vertigo

5. Examination and Investigation TMs EAMs Cranial, Carotid, Cardiac bruit – especially if pulsatile Consider FBC, TFT

6. Management Treat any underlying cause if found Bilateral +/- symmetrical hearing loss, No other symptoms, not intrusive –advice Unilateral < 3/12. No worrying feature. Manage primary care Objective tinnitus - refer Unilateral tinnitus > 3/12 refer - ?CPA lesion Intrusive tinnitus – refer Bilateral + asymmetrical hearing loss > 3/12 – refer Tinnitus therapy Masking with white noise therapy Pillow radio Bilateral, none intrusive tinnitus – Ok to manage in primary care Advice and reassurance RNID website useful

7. Management Advice Sound therapy Tinnitus councelling