Evaluation of tinnitus

ABR: auditory brainstem response; CT: computed tomography; MRI: magnetic resonance imaging.

* Patients with symptoms concerning for stroke should be sent to emergency department immediately. For other patients, otolaryngologist evaluation within 1 to 2 weeks is recommended, and will likely involve imaging based on suspected causes. Our protocol for pulsatile tinnitus involves audiometric testing followed by an extensive history and physical examination, which guides additional diagnostic testing. When an intracranial vascular lesion is suspected, we obtain an MRI with contrast initially, followed by CT/CT angiography and subsequent interventional angiography in appropriate circumstances.

¶ Tinnitus can be due to presbycusis (sensorineural hearing loss with aging) or other acquired high-frequency hearing loss or due to cochlear hearing loss. Auditory testing findings of asymmetry in hearing function, reflex testing, or otoacoustic emissions in patients with no identified otologic abnormality should be followed-up with ABR and imaging studies (eg, MRI) to rule out inner ear anomalies, central nervous system lesions, and neurologic disease. Further workup may involve neurologic or neurosurgical consultation, endocrine evaluation, or angiography.