Which specialist should I see for tinnitus, Ear, Nose, and Throat (ENT) specialist or another type of doctor?

Specialist Referral for Tinnitus Management

For patients with tinnitus, referral to an Ear, Nose, and Throat (ENT) physician or otolaryngologist is strongly recommended as the first-line specialist consultation, with subsequent referral to an audiologist for comprehensive evaluation and management. 1

Initial Specialist Evaluation

• Patients with tinnitus should first be referred to an otolaryngologist (ENT specialist) for evaluation of underlying causes and appropriate diagnostic workup 1
• The otolaryngologist will conduct a targeted examination to identify conditions that, if promptly managed, may relieve tinnitus 2
• ENT specialists have the training to distinguish between subjective tinnitus (heard only by the patient) and objective tinnitus (audible to the examiner), which requires different management approaches 3
• Patients with pulsatile tinnitus require thorough evaluation by an ENT specialist for potential vascular abnormalities 3

Audiological Assessment

• Following ENT evaluation, referral to an audiologist is recommended for comprehensive audiologic examination, especially for patients with:
  • Unilateral tinnitus 2
  • Persistent tinnitus (≥6 months) 2
  • Tinnitus associated with hearing difficulties 2
  • Any symptoms suggesting hearing loss 1
  • Atypical audiological test results showing a loss of more than 15 dB at 1000-8000 Hz 1

Specialized Management Pathways

• For complicated cases of tinnitus involving the ear with hearing changes, referral to a pediatric otolaryngologist may be considered (for younger patients) 1
• For tinnitus associated with severe anxiety or depression, additional referral to mental health specialists is warranted due to increased suicide risk 3
• For tinnitus that persists despite initial management, referral to specialized tinnitus clinics with multidisciplinary teams may be beneficial 4

Treatment Approaches by Specialists

• ENT specialists and audiologists can provide:
  • Hearing aids for patients with documented hearing loss 2
  • Sound therapy using background noise, nature sounds, or white noise machines 5
  • Remote microphone technology for patients with high-frequency hearing loss 1
  • Cognitive Behavioral Therapy (CBT), which has the strongest evidence for improving quality of life in patients with persistent tinnitus 5, 2

Common Pitfalls to Avoid

• Delaying specialist referral for persistent tinnitus (≥6 months), which can lead to increased psychological distress 2
• Relying solely on pharmacological treatments for chronic subjective tinnitus, which have limited evidence of effectiveness 2
• Using dietary supplements like Ginkgo biloba, melatonin, and zinc, which are not recommended for tinnitus management 5, 2
• Failing to distinguish between acute and chronic tinnitus, which require different management approaches 6

International Differences in Specialist Referral

• Referral pathways for tinnitus vary by country, with some health systems engaging neurology professionals (Germany, Italy, Spain) while others primarily involve audiology professionals (UK and US) 4
• Despite these differences, ENT specialists are consistently involved in tinnitus management across different healthcare systems 4

In conclusion, while tinnitus management involves multiple specialties, the evidence strongly supports initial referral to an ENT specialist/otolaryngologist followed by audiological assessment and intervention as the optimal pathway for patients with tinnitus 1, 2.