Diagnosing Tinnitus

At NYU Langone, otolaryngologists—ear, nose and throat (ENT) doctors—and audiologists use a variety of diagnostic tests to determine the type of tinnitus causing your symptoms and, if possible, the cause.

Doctors can’t detect most types of tinnitus. An exception is objective tinnitus, a rare type that a doctor can hear through a stethoscope or recording device. Because of this, doctors often base a clinical diagnosis of tinnitus on a person’s description of the noise and how it affects his or her life. Some people find tinnitus to be a minor annoyance that is easily ignored, but others find it so distracting that even simple tasks are difficult.

Causes of Tinnitus

The majority of people with chronic symptoms of tinnitus also have some noise-induced hearing loss. Many causes of hearing loss also cause or worsen tinnitus.

Prolonged exposure to loud noise is a major risk factor for tinnitus. People whose professions require them to be in a loud environment are especially at risk. These may include working with noisy industrial equipment or close to music amplified through powerful speakers.

Certain medications contain substances that are toxic to the ear. These may cause tinnitus or make it worse, especially when taken in large doses. They include certain antibiotics, diuretics, and chemotherapy drugs. Avoiding the use of these medications is not always possible, and taking them doesn’t necessarily mean you experience tinnitus. If you think a medication may be causing your symptoms, our doctors can help you make the best medical choices for your health.

Rarely, tinnitus is caused by disorders of the cardiovascular system, such as hypertension, that result in blood flowing through vessels near the ears with increased force. Sometimes, this forceful blood flow makes a noise that pulses at the same rate as your heartbeat. This is called pulsatile tinnitus. Improving the health of these blood vessels may alleviate tinnitus.

Tinnitus may be caused by tumors, particularly tumors of the eighth cranial nerve, which controls hearing. Acoustic neuroma, a noncancerous growth, is one example.

Other conditions that can lead to tinnitus include traumatic injury of the head or neck; Ménière’s disease, a disorder of the inner ear that affects hearing and balance; cholesteatoma, an abnormal skin growth that develops behind the eardrum; and otosclerosis, a condition in which abnormal bone growth develops in the middle ear.

Medical History and Physical Exam

A detailed medical history is an important part of diagnosing tinnitus. Your doctor asks when your symptoms began, how often tinnitus affects you, and how much it interferes with your everyday life.

Your doctor may ask you to describe what the tinnitus sounds like. Details about its tonal quality, intensity, duration, and rhythm, and whether it affects one or both ears, help doctors make a diagnosis. Your doctor also asks about past or current medical conditions or medications you’ve taken, as well as any previous damage to one or both ears, the effects tinnitus has on your family members, and other questions about your health, stress level, and exposure to loud noise.

Next, an ENT doctor performs a thorough physical examination of your ears, including the sensitive interior structures, using a handheld magnifying instrument.

Hearing Test

Many—though not all—people who have tinnitus also have hearing loss. A complete hearing test can provide doctors with information about the function of certain parts of your ear, including your external auditory canal, the middle ear system, the inner ear, and the eighth cranial nerve, which carries electrical signals from the inner ear to the brain.

An audiologist conducts a hearing test in an on-site testing suite at NYU Langone. Before your appointment, you fill out a thorough tinnitus questionnaire designed to assess the severity of your symptoms. You might want to keep a tinnitus diary, noting the frequency and intensity of noise, in the days before your appointment.

The audiologist then evaluates different aspects of your hearing, including how well the bones in your ears conduct sound, whether the middle and inner ears are working properly, and if the tiny hair cells that act as sensory receptors inside the ear are amplifying sound normally.

Doctors also test the range of your hearing by playing a variety of tones or spoken words in one or both ears. These tones and words span a specific set of high and low frequencies, and the audiologist asks you to raise your hand or repeat the words throughout this part of the hearing test. Based on your responses, doctors can assess whether tinnitus is independent of hearing loss.

Audiologists use a special high-frequency test to help determine the pitch and intensity of the tinnitus. For many people, tinnitus has a consistent sound, and matching this sound to a frequency or frequencies during a hearing test helps doctors better understand how tinnitus is affecting you.

Imaging Tests

If tinnitus is unilateral—meaning you hear the noise in only one ear—doctors may recommend an imaging test. Unilateral tinnitus may indicate a structural problem or medical condition on one side of the head that can be viewed using imaging techniques.

Doctors at NYU Langone may use one or more tests, such as an MRI scan, CT scan, or ultrasound, to assist with diagnosis. These tests create detailed pictures of structures inside the body, including the inner ear, the nerves surrounding the ear, and the brain. An MRI scan may reveal a growth or tumor near the ear or the eighth cranial nerve that could be causing tinnitus.

Imaging tests can also help doctors evaluate pulsatile tinnitus. They can show changes in the blood vessels near the ears and determine whether an underlying medical condition is causing symptoms.

Typically, if tinnitus occurs in both ears and is non-pulsatile, no diagnostic imaging tests are required to make a diagnosis and recommend treatment.