Current RMA Instruments
| Reasonable Hypothesis SOP | 084 of 2020 |
| Balance of Probabilities SOP | 085 of 2020 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 388.3
- ICD-10-AM Codes: H93.1
Brief description
Tinnitus is the perception of sound (often ringing) in the ear/s or head when no external physical source for the sound is present. Tinnitus is a symptom, not a disease in itself. However, for SOP purposes is treated as an injury or disease.
The critical feature of the tinnitus SOP definition is ‘persistence’. Though the tinnitus need not be present all the time, the tinnitus needs to, at a minimum, intermittently reoccur without an external stimulus for a period of at least three consecutive months.
Confirming the diagnosis:
The diagnosis relies on self-report of symptoms. Testing is possible to identify the frequency and loudness of the tinnitus and how effectively it can be masked. The routine investigation of tinnitus includes an audiogram.
The relevant medical specialist is an Ear, Nose and Throat surgeon.
Additional diagnoses covered by these SOPs
- Nil
Conditions not covered by these SOPs
- Conductive hearing loss*
- Meniere’s disease*
- Sensorineural hearing loss*
*another SOP applies
Clinical onset
The clinical onset will be when the symptoms first became persistent. This will be based on self-report.
Clinical worsening
The usual course for tinnitus is for it to persist but not worsen unless there is further damage to hearing, ongoing exposure to the cause of the tinnitus or the overlay of psychological factors, which can worsen the perception of the tinnitus. Conventional medical therapy is generally ineffective at reducing or abolishing the tinnitus. The aim of therapy is to alleviate distress associated with the tinnitus.
In some cases, it may be approriate to address claims for worsening as an impairment reassessment rather than an aggravation.
Further comments on diagnosis
Exposure to a loud noise can produce a temporary episode of non-persistent tinnitus. Repeated exposures can produce repeated temporary bouts. Tinnitus should only be diagnosed where there are persistent or recurring symptoms without ongoing triggers.