Tinnitus: systematic approach to primary care assessment and management

Sarah Ellis; Rosie Wilson; Sean Dolan

doi:10.3399/bjgp22X719057

INTRODUCTION

Tinnitus is a symptom in which patients report the perception of sound in the absence of external stimuli.¹ The nature of the sound is variable; it may include buzzing, ringing, humming, or whistling. Tinnitus affects up to 15% of the population.¹^–⁴ It affects all ages but is most common in older people with presbycusis.²^,⁴ Two per cent are significantly affected, reporting reduced quality of life outcomes.¹^,⁴ A recent international systematic review estimated the cost of tinnitus management to be as high as 7246 Euros (6115 GBP) per patient per year.¹ Despite this disease burden, the pathophysiology of tinnitus remains poorly understood.²^,⁵ It is thought to be multifactorial in nature, resulting from dysregulated neural activity at any point along the auditory pathway from the cochlea to auditory cortex.¹^,²^,⁵ The perception of tinnitus is associated with hearing loss or being in a quiet environment because of a lack of masking by background noise.¹^,²^,⁶ Tinnitus may present as an isolated symptom or may be indicative of a range of pathologies from benign conditions to clinical emergencies.² It may also pose a significant psychosocial burden on patients and is associated with anxiety and depression.²^,^{3 …}