Investigations in tinnitus

Investigations

Audiological assessment

• an audiological assessment should be offered to people with tinnitus
  
  
• consider tympanometry when middle-ear or Eustachian tube dysfunction, or other causes of conductive hearing loss contributing to tinnitus, are suspected
  
• do not offer acoustic reflex testing or uncomfortable loudness levels/loudness discomfort levels testing as part of an investigation of tinnitus
  
• do not offer otoacoustic emissions tests as part of an investigation of tinnitus unless the tinnitus is accompanied by other symptoms and signs

Imaging

Non-pulsatile tinnitus

• MRI of the internal auditory meati (IAM) should be offered to people with non-pulsatile tinnitus who have associated neurological, otological or head and neck signs and symptoms
  
  • if they are unable to have MRI (IAM), offer contrast-enhanced CT (IAM)
• MRI (IAM) should be considered for people with unilateral or asymmetrical non-pulsatile tinnitus who have no associated neurological, audiological, otological or head and neck signs and symptoms. If they are unable to have MRI (IAM), consider contrast-enhanced CT (IAM)
  
• do not offer imaging to people with symmetrical non-pulsatile tinnitus with no associated neurological, audiological, otological or head and neck signs and symptoms

Pulsatile tinnitus

• imaging should be offered to people with pulsatile tinnitus
  
• for people with synchronous pulsatile tinnitus, consider an MRI of the head, neck, temporal bone and internal auditory meatus (if clinical examination and audiological assessment are normal) or contrast-enhanced CT if this is contra-indicated. Consider offering contrast-enhanced CT of temporal bone if an osseous or middle-ear abnormality is suspected, then an MRI if further investigation of soft tissue is required.
  
• for people with non-synchronous pulsatile tinnitus (for example, caused by palatal myoclonus) consider MRI of the head, or if they cannot have MRI, contrast-enhanced CT of the head

Reference:

• NICE (March 2020). Tinnitus:assessment and management