From the Guidelines
The diagnostic workup for tinnitus should begin with a comprehensive history and physical examination, focusing on the characteristics of the tinnitus, associated symptoms, and potential causes, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery Foundation 1. The initial evaluation should include a targeted history and physical examination to identify conditions that, if promptly identified and managed, may relieve tinnitus 1. A detailed otologic examination should be performed, including otoscopy to assess for cerumen impaction, foreign bodies, or tympanic membrane abnormalities. Audiometric testing is essential and should include pure tone audiometry, speech audiometry, and tympanometry to evaluate hearing loss patterns that may be associated with tinnitus 1. Imaging studies such as MRI of the brain and internal auditory canals should be considered if there are asymmetric symptoms, unilateral tinnitus, or neurologic findings to rule out acoustic neuroma or other structural abnormalities, as suggested by the American College of Radiology Appropriateness Criteria 1. However, imaging is not usually appropriate in the evaluation of subjective, nonpulsatile tinnitus that does not localize to one ear, unless there are concomitant symptoms such as hearing loss, vertigo, or neurological deficits 1. Additional specialized tests may include auditory brainstem response testing, otoacoustic emissions, and vestibular testing if balance issues are present. Consultation with otolaryngology is recommended, particularly for cases with sudden onset, unilateral or pulsatile tinnitus, or associated hearing loss, to determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers 1. The workup should be tailored to the individual patient, considering their specific symptoms, risk factors, and comorbidities, as tinnitus can result from various causes including noise exposure, ototoxic medications, vascular abnormalities, or neurologic disorders 1.
From the Research
Diagnostic Workup for Tinnitus
The diagnostic workup for tinnitus involves a combination of history-taking, physical examination, and diagnostic testing to identify the underlying cause of the condition.
- A targeted history and physical examination are essential to identify treatable causes and associated symptoms that may improve with treatment 2, 3, 4.
- A comprehensive audiologic evaluation should be performed for patients who experience unilateral tinnitus, tinnitus that has been present for six months or longer, or that is accompanied by hearing problems 2, 3, 4.
- Neuroimaging is not part of the standard workup unless the tinnitus is asymmetric or unilateral, pulsatile, associated with focal neurologic abnormalities, or associated with asymmetric hearing loss 2, 4.
- The evaluation should also include a review of the patient's medical history, including any history of noise exposure, ear infections, or other ear problems 3, 5.
Diagnostic Testing
Diagnostic testing for tinnitus may include:
- Audiometry with tympanometry to assess hearing loss and middle ear function 3, 4.
- Electronystagmography to assess vestibular function 3.
- Imaging studies, such as MRI or CT scans, to rule out underlying conditions such as vascular tumors or vestibular schwannoma 2, 4.
- Laboratory tests, such as blood work, to rule out underlying medical conditions that may be contributing to the tinnitus 3, 5.
Specialty Referral
Specialty referral to an otolaryngologist or other specialist may be necessary to further evaluate and manage the patient's tinnitus, particularly if the tinnitus is persistent, bothersome, or associated with other symptoms such as hearing loss or vertigo 3, 4.