Tinnitus is the perception of sound when no external sound is present. It often manifests as ringing, buzzing, hissing, or roaring. Evaluation helps understand an individual’s tinnitus, identify associated conditions, differentiate it from other auditory experiences, and reveal underlying hearing loss, which frequently accompanies the condition.
The Initial Consultation
The process begins with a consultation with a healthcare professional, often an audiologist or an otolaryngologist (ENT specialist). During this meeting, the professional gathers a detailed medical history, including current and past medications, pre-existing health issues, and exposure to loud noises. This history provides clues about contributing factors to their tinnitus.
A physical examination of the head, neck, and ears also takes place. The healthcare provider inspects the ear canal and eardrum and may palpate areas around the neck and jaw. Patients describe their tinnitus, including its quality (e.g., ringing, buzzing), pitch, loudness, and whether it is intermittent or constant. They also specify if the sound is heard in one ear, both ears, or within the head. This subjective information guides objective evaluations.
Evaluating Your Hearing
Audiological tests assess hearing function, as hearing loss often co-occurs with tinnitus. Pure-tone audiometry, a standard test, is conducted in a soundproof booth. The patient wears headphones and responds by pressing a button when hearing a tone. This test measures hearing thresholds across a range of frequencies, from low to high pitches, providing an audiogram that illustrates any hearing loss.
Speech audiometry evaluates how well a person hears and understands spoken words by presenting speech at different volumes and assessing the patient’s ability to repeat words accurately. Tympanometry assesses middle ear function by measuring eardrum movement in response to air pressure changes. These tests help determine the type, degree, and configuration of any hearing loss, which can be linked to the patient’s tinnitus. The results provide a picture of auditory system health, guiding subsequent steps.
Characterizing the Tinnitus Sound
Specific tests characterize the tinnitus sound. Pitch matching involves listening to various external tones and identifying the one that most closely matches the tinnitus pitch. This determines the predominant frequency of the perceived sound. Loudness matching involves presenting an external sound and adjusting its intensity until it matches the perceived tinnitus loudness.
The minimum masking level test determines the lowest level of external noise required to make the tinnitus inaudible. This involves presenting a broadband noise and gradually increasing its intensity until the patient reports their tinnitus is no longer heard. Results from these characterization tests provide a measurable tinnitus profile, offering insights into its acoustic properties. This data helps monitor changes, guide management strategies, and understand the individual’s tinnitus experience.
Searching for Underlying Medical Conditions
Diagnostic tests may search for an underlying medical condition causing tinnitus. If tinnitus is unilateral (in one ear) or pulsatile (a rhythmic sound often matching a heartbeat), a doctor might order imaging tests. Magnetic resonance imaging (MRI) or computed tomography (CT) scans of the head and brain can help rule out structural abnormalities, such as tumors or vascular issues, that could be compressing auditory nerves or affecting blood flow. These imaging techniques provide views of internal structures that could be contributing to the tinnitus.
Other medical tests include blood tests for systemic conditions impacting hearing or causing tinnitus, such as thyroid function, anemia, or vitamin deficiencies (particularly B12). Balance tests may be conducted if dizziness or vertigo accompanies tinnitus, suggesting vestibular involvement. These tests are not routinely performed for all patients; they are ordered based on clinical evaluation and audiological assessments to identify or rule out medical causes.