Most tinnitus is bilateral, non-pulsatile and accompanied by symmetrical age- or noise-related hearing loss, and imaging adds nothing. The exceptions are well recognised and worth checking for at every first visit.
Unilateral tinnitus, especially with asymmetric sensorineural hearing loss, raises the question of a vestibular schwannoma. Pulsatile tinnitus suggests a vascular cause. Focal neurological signs need prompt assessment.
- Ask whether the tinnitus is in one ear or both, and whether it pulses with the heartbeat.
- Compare hearing thresholds between ears; asymmetric loss with unilateral tinnitus warrants MRI.
- Listen over the ear and neck in pulsatile tinnitus and consider vascular imaging.
- Examine cranial nerves and look for any focal neurological deficit.
Why it matters
Targeting imaging to red flags avoids routine scans while catching the uncommon serious causes.
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