Persistent tinnitus with hearing loss is common and usually benign, but tinnitus that is pulsatile, one-sided with asymmetric hearing loss, or associated with neurological symptoms needs further assessment. Take a careful history and examine the ears before reassuring.
- Ask whether it beats with the pulse.
- Check for asymmetric hearing loss with audiometry.
- Examine the ear canal and drum for wax, effusion or a vascular mass.
- Refer promptly if there are focal neurological signs or sudden hearing loss.
Why it matters
Most tinnitus needs reassurance, but a minority signals treatable pathology.
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