How is it Diagnosed?
Tinnitus is the perception of sound, such as ringing or buzzing, in the absence of
external noise. Diagnosis is primarily clinical, based on patient history and symptom
characterization. The first step is a comprehensive history, noting the onset, duration,
pitch, and pattern (intermittent or constant), along with associated hearing loss, vertigo,
or ear pain. Unilateral tinnitus is considered more suspicious and warrants detailed
evaluation.
A physical examination of the head, neck, and ears is performed. Otoscopic examination
helps detect external or middle ear pathologies like wax impaction or otitis media.
Audiological evaluation is crucial. Pure tone audiometry assesses hearing loss, while
tympanometry evaluates middle ear function. Speech discrimination testing may also be
done.
If pulsatile tinnitus (rhythmic and synchronous with the heartbeat) is reported, vascular
causes like arteriovenous malformations, glomus tumors, or carotid stenosis must be
considered. In such cases, imaging studies such as contrast-enhanced MRI or CT
angiography of the brain and temporal bones are warranted.
In non-pulsatile tinnitus, imaging may be advised if there is asymmetry in hearing or
unilateral symptoms. MRI of the internal auditory canal can help rule out vestibular
schwannoma or other retrocochlear pathologies.
Blood tests may be ordered to rule out underlying conditions such as thyroid
dysfunction or anemia. In summary, tinnitus diagnosis involves a multidisciplinary
approach combining clinical evaluation, audiometry, and imaging, guided by symptom
characteristics.