Diagnosis
Î Tinnitus can occur on one or both sides of the head and can be perceived as
coming from within or outside the head.
Î The severity of tinnitus can fluctuate.
Î The character of tinnitus can also vary, with ringing, buzzing, clicking,
pulsations, and other noises described by tinnitus patients.
Î Tinnitus most often occurs in the setting of concomitant SNHL, particularly
among patients with bothersome tinnitus and no obvious ear pathology.
Î Psychiatric conditions are common in patients with bothersome tinnitus.
The association of major depression and tinnitus has been studied, with
depression reported in 48%-60% of tinnitus sufferers.
Table 3. Key Details of Medical History in the Tinnitus Patient
Key issue Significance Implication
Unilateral tinnitus Concern for focal auditory
lesion, some serious, such as VS
or vascular tumor.
Referral for comprehensive
audiologic assessment, an otologic
evaluation, and additional testing
such as imaging where indicated.
Pulsatile tinnitus Concern for vascular lesion,
systemic cardiovascular illness.
Consider cardiovascular and general
physical examination (hypertension,
heart murmurs, carotid bruits,
venous hums); examination of
the head and neck for signs of
vascular tumors or other lesions;
comprehensive audiolog y; imaging
and other testing where indicated.
Hearing loss Tinnitus is frequently associated
with hearing loss, particularly
SNHL. Differentiate between
conductive and SNHL,
unilateral and bilateral. Establish
severity of hearing loss.
Referral for comprehensive
audiology and otologic evaluation
for the wide range of pathologies that
could cause hearing loss associated
with tinnitus. Consider hearing aid
evaluation when indicated.
Sudden onset of
hearing loss with
tinnitus
Sudden hearing loss requires
prompt treatment to stabilize or
improve hearing.
See Stachler RJ, Chandrasekhar
SS, Archer SM, et al. Clinical
practice guideline: sudden hearing
loss. Otolaryngol Head Neck Surg.
2012;146(3 suppl):S1-S35.
New onset tinnitus Tinnitus perception may
diminish or disappear,
and/or tinnitus reactions may
be reduced.
Evaluation and treatment is based
on severity and presence and
absence of other symptoms.
Noise exposure Tinnitus may be associated with
prolonged or repeated noise
exposure from occupational or
recreational activities.
Counseling and education related to
potential damaging effect of noise,
acoustic trauma, and pertinent
environmental exposures.
Referral for comprehensive
audiologic assessment.
