Most tinnitus needs a careful history, examination and audiogram, not imaging. The exceptions are unilateral tinnitus, especially with asymmetric hearing loss, pulsatile tinnitus, and tinnitus with focal neurological signs or other red flags. Unilateral tinnitus with asymmetric sensorineural loss warrants MRI of the internal auditory meatus for a vestibular schwannoma. Pulsatile tinnitus warrants vascular imaging chosen with the radiologist.
- Ask whether tinnitus is in one ear or both, and whether it pulses with the heartbeat.
- Arrange audiology before deciding on imaging.
- Request MRI of the internal auditory meatus for unilateral tinnitus with asymmetric hearing loss.
- Discuss vascular imaging with the radiologist for pulsatile tinnitus.
Why it matters
Targeted imaging finds the rare treatable cause while sparing most patients an unnecessary scan.
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