Tests
1st tests to order
audiometry
Test
Hearing loss is the most common cause of tinnitus.
Result
sensorineural or conductive hearing loss
Tests to consider
CBC
Test
Test is ordered in all unrecognized cases of pulsatile tinnitus, as anemia causes a hyperdynamic circulation that results in objective tinnitus.
Result
may show anemia
thyroid function tests
Test
Test is ordered if etiology of tinnitus cannot be determined, in cases of objective tinnitus (both patient and examiner can hear the noise of which the patient complains), and in patients who have tinnitus associated with pathognomonic symptoms of hyper- or hypothyroidism.
Hyperthyroidism causes a hyperdynamic state that can cause pulsatile tinnitus. Severe hypothyroidism can cause sensorineural hearing loss with associated tinnitus.
Result
hyperthyroidism or hypothyroidism
lipid profile
Test
Hyperlipidemia can cause an inner ear stroke and sudden hearing loss, which would in turn cause tinnitus.
Result
elevated cholesterol
fasting glucose
Test
Diabetes mellitus can cause sensorineural hearing loss with associated tinnitus.
Result
elevated in diabetes mellitus
fluorescent treponemal antibody absorption assay
Test
Tertiary syphilis can cause sensorineural hearing loss with associated tinnitus.
Result
positive in syphilis
MRI head
Test
Ordered in all patients with unilateral sensorineural hearing loss and normal physical exam.
Also ordered in patients with pulsatile tinnitus suspected to have arteriovenous malformations (AVMs) or glomus tumor.
MRI with gadolinium is the best test for tumors of the internal auditory canal and cerebellar pontine angle.
Do not order imaging studies in patients with nonpulsatile bilateral tinnitus, symmetric hearing loss, and an otherwise normal history and physical exam.[14][34][35]
Result
high-riding jugular vein; stenotic carotid artery; AVMs; tumor
CT temporal bones
Test
Ordered in all patients with a conductive hearing loss.[6][10]
Do not order imaging studies in patients with nonpulsatile bilateral tinnitus, symmetric hearing loss, and an otherwise normal history and physical exam.[14][34][35]
Result
aberrant carotid artery; high-riding jugular vein; glomus tumors; middle ear or inner ear abnormality; absent/underdeveloped foramen spinosum (persistent stapedial artery).
MR angiography or CT angiography
Test
Ordered in patients with pulsatile objective tinnitus.[35]
Do not order imaging studies in patients with nonpulsatile bilateral tinnitus, symmetric hearing loss, and an otherwise normal history and physical exam.[14][34][35]
Result
arteriovenous malformations; arteriovenous fistulas; aberrant carotid artery; fibromuscular dysplasia; glomus tumor
carotid angiography
Test
Performed when MRI and MR angiography fail to diagnose a lesion and pathology is highly suspected.
This test is rarely needed.
Result
carotid stenosis; fibromuscular dysplasia
auditory brainstem response (ABR)
Test
An acoustic transducer creates a click via an earphone; the elicited response is detected by surface electrodes.
Evaluates waves I, III, and V primarily, which relate to the eighth cranial nerve, the inferior olive, and the inferior colliculus, respectively.
Should be considered in cases of unilateral tinnitus or unilateral hearing loss to exclude a tumor, multiple sclerosis, or other neural causes.
Limitations of the ABR include significantly reduced reliability of the test in patients who have >60 dB of hearing loss at 2000 hz, and a 22% false negative rate for vestibular schwannomas that are smaller than 2 cm.
Result
comparison of right and left side waveforms; positive result if the difference is outside of statistical norm
minimal masking level
Test
Can also be used for follow-up of treatment to find out if the tinnitus has changed.
Result
minimum level of external tone that makes the tinnitus tone inaudible
residual inhibition
Test
The sound is heard by the patient for 1 minute, and then the patient should report any change in intensity of tinnitus. The sound that decreases tinnitus intensity by 100% is noted. The first tone offered is usually minimal masking level +10 dB.
Result
amount of noise that is able to suppress tinnitus
loudness and pitch matching
Test
This test is performed by matching the loudness and pitch of an administered tone to the perceived tinnitus tone of the patient.[36]
Result
pitch and loudness of the patient's tinnitus
loudness discomfort level testing
Test
This test is usually performed only in patients who have reduced loudness tolerance.[36]
Result
threshold level of discomfort for a sound
Emerging tests
otoacoustic emissions
Test
Assesses outer hair cell mobility and emissions are often absent or reduced in patients with conductive or sensorineural hearing loss. May see abnormalities with specific medications that could be reversible after elimination of the offending medication.
Result
reduced or absent emissions
functional MRI
PET scan
magnetoencephalographic
Test
Noninvasive measurement of magnetic activity of the brain that can show significant changes in patients with tinnitus.[38]
Result
increased activity in the auditory cortex and cochlear pathways
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