Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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Tinnitus can accompany an acute emergency
Sudden neurological signs, uncontrolled acute vestibular symptoms or high suicide risk changes the response from routine tinnitus assessment to immediate care.
Action: Refer immediately through neurological or stroke pathways for acute focal or uncontrolled vestibular features, and to crisis mental health services when suicide risk is high; recent sudden hearing loss requires assessment within twenty-four hours.
Synopsis
Use laterality, pulse synchrony, associated symptoms and distress to prioritise tinnitus referral and select appropriate investigation while offering useful support from first contact.
Ask whether the sound is unilateral, bilateral or perceived centrally.
Establish whether pulsation actually matches the heartbeat rather than simply sounding rhythmic.
Offer audiological assessment to people with tinnitus.
Key red flags
Tinnitus with new facial weakness, other significant neurological findings or acute uncontrolled vertigo needs immediate referral.
Investigation priorities
01
Audiological assessmentFirst step
Identify hearing impairment and provide information for treatment and referral.
Management branches
ImmediateAct on associated urgent features
Tinnitus accompanies acute neurological symptoms, uncontrolled vertigo, sudden hearing loss or severe risk.
Use immediate neurological or stroke referral for new significant neurological signs or acute uncontrolled vestibular symptoms.
Arrange assessment within twenty-four hours when hearing loss developed over three days or less during the previous thirty days.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.