Learning Objectives:

Tinnitus is a common and potentially debilitating global health problem. Rarely, it may be the presenting symptom of a serious underlying condition such as vestibular schwannoma, thereby necessitating a thorough assessment. Causes of tinnitus are described and divided into two main categories: subjective (heard by the patient only) and objective (heard by the examiner also). History and examination is key to differentiating between aetiologies however in many cases there is no identifiable underlying cause. The authors provide an approach to tinnitus by means of a diagnostic algorithm. Management in primary care is discussed as well as Department of Health guidance on when patients are to be referred to secondary care.