The cause of pulsatile tinnitus is not always easy to identify. Tinnitus is a symptom, not a specific disease. Regardless of whether it is called a disease or a symptom, patients still want the strange ringing or humming in their ears to stop. Therefore physicians have developed a clinical pathway to identify the cause of tinnitus so that treatment for the underlying disease can be administered.
The first step in diagnosing any medical condition is a complete patient medical history. The physician will note the date that you first noticed the tinnitus; whether it is in one or both ears. Is it more prevalent in the morning or the evening? You will be asked to describe the sound that you are hearing and what conditions make it better or worse. He will also discuss any related conditions that you are experiencing such as dizziness, vertigo, nausea, vomiting, or hearing loss. Once he compiles the data and family history including prescription and over-the-counter medication, he will be able to make a diagnosis. The treatment plan will depend on how aggressive you want to pursue a solution. Tinnitus is not bothersome for some individuals; they simply ignore the sounds. For others, the noises are unbearable and an aggressive form of therapy should be pursued by the physician.
The tinnitus workup includes a number of blood tests, especially if the history and physical exam lead the doctor to suspect that there is a hormonal or metabolic cause. He will send for tests of thyroid hormone, complete blood chemistry (CBC), and tests to measure blood cholesterol. Tests for vitamin deficiencies are less often ordered, but vitamin B12 levels may be assessed. If the cause is likely to be physical, like an abnormal blood vessel, the doctor may order a special CT or MRI study. These tests are “special” because they specifically focus on the blood vessels (CTA and MRA). The studies are done in such a way to make the blood vessels in and around the ear “light up” so that they can be carefully studied. These tests are not only diagnostic but if a physical cause is identified they will be instrumental in planning surgery to treat the tinnitus.
At some point in the tinnitus workup, a referral is usually made to an audiologist for audiometric testing. This is done to better characterize the tinnitus, judge severity, and create a common language for the patient and the clinician. For example, the audiometric testing identifies the quality of the tinnitus sound. What is ringing? What is clicking? Formal and complete audiometric testing is called an audiogram—a map of your hearing system.