Editing Tinnitus (section)

==Diagnosis==
The diagnostic approach is based on a history of the condition and an examination of the head, neck, and neurological system.<ref name=Yew2014/> Typically an audiogram is done, and occasionally [[medical imaging]] or [[electronystagmography]].<ref name=Yew2014/> Treatable conditions may include middle ear infection, acoustic neuroma,
concussion, and [[otosclerosis]].<ref>{{cite journal |last1=Crummer |display-authors=etal |first1=RW |title=Diagnostic Approach to Tinnitus |journal=American Family Physician |date=2004 |volume=69 |issue=1 |pages=120–126|pmid=14727828 }}</ref>

Evaluation of tinnitus can include a hearing test (audiogram), measurement of acoustic parameters of the tinnitus like pitch and loudness, and psychological assessment of comorbid conditions like depression, anxiety, and stress that are associated with severity of the tinnitus.{{citation needed|date=December 2020}}

One definition of tinnitus, in contrast to normal ear noise experience, is that tinnitus lasts five minutes at least twice a week.<ref>{{cite journal |last=Davis |first=A |year=1989 |title=The prevalence of hearing impairment and reported hearing disability among adults in Great Britain |journal=International Journal of Epidemiology |volume=18 |issue= 4 |pages=911–917 |doi=10.1093/ije/18.4.911|pmid=2621028 }}</ref> However, people with tinnitus often experience the noise more frequently than this. Tinnitus can be present constantly or intermittently. Some people with constant tinnitus might not be aware of it all the time, but only, for example, during the night when there is less environmental noise to mask it. Chronic tinnitus can be defined as tinnitus with a duration of six months or more.<ref>{{cite journal | last=Henry | first=James A. | title="Measurement" of Tinnitus | journal=Otology & Neurotology | volume=37 | issue=8 | date=2016 | issn=1531-7129 | doi=10.1097/MAO.0000000000001070 | pages=e276–e285| pmid=27518136 }}</ref>

===Audiology===
Since most people with tinnitus also have hearing loss, a [[pure tone audiometry|pure tone hearing test]] resulting in an audiogram may help diagnose a cause. An audiogram may also facilitate fitting of a hearing aid in those cases where hearing loss is significant. The pitch of tinnitus is often in the range of the hearing loss.

===Psychoacoustics===
Acoustic qualification of tinnitus includes measurement of several acoustic parameters like frequency in cases of monotone tinnitus or {{Clarify | text = frequency range and bandwidth in cases of narrow band noise tinnitus| date = December 2024 | reason = What is bandwidth, in addition to frequency range?}}, loudness in dB above hearing threshold at the indicated frequency, {{Clarify | text = mixing-point| date = December 2024}}, and minimum masking level.<ref>{{cite journal |last1=Henry |first1=JA |last2=Meikle |first2=MB |title=Psychoacoustic measures of tinnitus. |journal=Journal of the American Academy of Audiology |date=March 2000 |volume=11 |issue=3 |pages=138–155 |doi=10.1055/s-0042-1748040 |pmid=10755810 |s2cid=34933069 }}</ref> In most cases, tinnitus pitch or frequency range is between 5&nbsp;kHz and 10&nbsp;kHz,<ref name="pmid26583098">{{cite journal | vauthors = Vielsmeier V, Lehner A, Strutz J, Steffens T, Kreuzer PM, Schecklmann M, Landgrebe M, Langguth B, Kleinjung T | title = The Relevance of the High Frequency Audiometry in Tinnitus Patients with Normal Hearing in Conventional Pure-Tone Audiometry | journal = BioMed Research International | volume = 2015 | pages = 1–5 | year = 2015 | pmid = 26583098 | pmc = 4637018 | doi = 10.1155/2015/302515 | doi-access = free }}</ref> and loudness between 5 and 15&nbsp;[[decibel|dB]] above the hearing threshold.<ref name="pmid24349414">{{cite journal | vauthors = Basile CÉ, Fournier P, Hutchins S, Hébert S | title = Psychoacoustic assessment to improve tinnitus diagnosis | journal = PLOS ONE | volume = 8 | issue = 12 | pages = e82995 | year = 2013 | pmid = 24349414 | pmc = 3861445 | doi = 10.1371/journal.pone.0082995 | bibcode = 2013PLoSO...882995B | doi-access = free }}</ref>

Another relevant parameter of tinnitus is residual inhibition: the temporary suppression or disappearance of tinnitus following a period of masking. The degree of residual inhibition may indicate how effective tinnitus maskers would be as treatment.<ref name="pmid17956813">{{cite book |doi=10.1016/S0079-6123(07)66047-6 |chapter=Residual inhibition |title=Tinnitus: Pathophysiology and Treatment |series=Progress in Brain Research |year=2007 |last1=Roberts |first1=Larry E. |volume=166 |pages=487–495 |pmid=17956813 |isbn=978-0-444-53167-4 }}</ref><ref name="pmid18712566">{{cite journal | vauthors = Roberts LE, Moffat G, Baumann M, Ward LM, Bosnyak DJ | title = Residual inhibition functions overlap tinnitus spectra and the region of auditory threshold shift | journal = Journal of the Association for Research in Otolaryngology | volume = 9 | issue = 4 | pages = 417–435 | year = 2008 | pmid = 18712566 | pmc = 2580805 | doi = 10.1007/s10162-008-0136-9 }}</ref>

An assessment of [[hyperacusis]], a frequent accompaniment of tinnitus,<ref name="pmid24012803">{{cite journal | vauthors = Knipper M, Van Dijk P, Nunes I, Rüttiger L, Zimmermann U | title = Advances in the neurobiology of hearing disorders: recent developments regarding the basis of tinnitus and hyperacusis | journal = Progress in Neurobiology | volume = 111 | pages = 17–33 | year = 2013 | pmid = 24012803 | doi = 10.1016/j.pneurobio.2013.08.002 | doi-access = free }}</ref> may also be made.<ref name="pmid25104073">{{cite journal |last1=Tyler |first1=Richard S. |last2=Pienkowski |first2=Martin |last3=Roncancio |first3=Eveling Rojas |last4=Jun |first4=Hyung Jin |last5=Brozoski |first5=Tom |last6=Dauman |first6=Nicolas |last7=Coelho |first7=Claudia Barros |last8=Andersson |first8=Gerhard |last9=Keiner |first9=Andrew J. |last10=Cacace |first10=Anthony T. |last11=Martin |first11=Nora |last12=Moore |first12=Brian C. J. |title=A Review of Hyperacusis and Future Directions: Part I. Definitions and Manifestations |journal=American Journal of Audiology |date=December 2014 |volume=23 |issue=4 |pages=402–419 |doi=10.1044/2014_AJA-14-0010 |pmid=25104073 }}</ref> Hyperacusis is related to negative reactions to sound and can take many forms. One parameter that can be measured is Loudness Discomfort Level (LDL) in dB, the subjective level of acute discomfort at specified frequencies over the frequency range of hearing. This defines a dynamic range between the hearing threshold at that frequency and the loudness discomfort level. A compressed dynamic range over a particular frequency range can be associated with hyperacusis. Normal hearing threshold is generally defined as 0–20 decibels (dB). Normal loudness discomfort levels are 85–90+ dB, with some authorities citing 100&nbsp;dB. A dynamic range of 55&nbsp;dB or less is indicative of hyperacusis.<ref name="pmid15807048">{{cite journal |last1=Sherlock |first1=LaGuinn P. |last2=Formby |first2=Craig |title=Estimates of Loudness, Loudness Discomfort, and the Auditory Dynamic Range: Normative Estimates, Comparison of Procedures, and Test-Retest Reliability |journal=Journal of the American Academy of Audiology |date=February 2005 |volume=16 |issue=2 |pages=85–100 |doi=10.3766/jaaa.16.2.4 |pmid=15807048 }}</ref><ref name="pmid25478787">{{cite journal |last1=Pienkowski |first1=Martin |last2=Tyler |first2=Richard S. |last3=Roncancio |first3=Eveling Rojas |last4=Jun |first4=Hyung Jin |last5=Brozoski |first5=Tom |last6=Dauman |first6=Nicolas |last7=Coelho |first7=Claudia Barros |last8=Andersson |first8=Gerhard |last9=Keiner |first9=Andrew J. |last10=Cacace |first10=Anthony T. |last11=Martin |first11=Nora |last12=Moore |first12=Brian C. J. |title=A Review of Hyperacusis and Future Directions: Part II. Measurement, Mechanisms, and Treatment |journal=American Journal of Audiology |date=December 2014 |volume=23 |issue=4 |pages=420–436 |doi=10.1044/2014_AJA-13-0037 |pmid=25478787 }}</ref>

===Severity===
Tinnitus is often rated on a scale from "slight" to "severe" according to the effects it has, such as interference with sleep, quiet activities, and normal daily activities.<ref name="pmid11678946">{{cite journal |last1=McCombe |first1=A. |last2=Baguley |first2=D. |last3=Coles |first3=R. |last4=McKenna |first4=L. |last5=McKinney |first5=C. |last6=Windle-Taylor |first6=P. |title=Guidelines for the grading of tinnitus severity: the results of a working group commissioned by the British Association of Otolaryngologists, Head and Neck Surgeons, 1999 |journal=Clinical Otolaryngology and Allied Sciences |date=October 2001 |volume=26 |issue=5 |pages=388–393 |doi=10.1046/j.1365-2273.2001.00490.x |pmid=11678946 }}</ref>

Assessment of psychological processes related to tinnitus involves measurement of tinnitus severity and distress, as measured subjectively by validated self-report tinnitus questionnaires.<ref name="Henry JA, Dennis KC, Schechter MA 2005 1204–1235"/> Such questionnaires measure the degree of psychological distress and handicap associated with tinnitus, including effects on hearing, lifestyle, health, and emotional functioning.<ref name="pmid17956816">{{cite book |doi=10.1016/S0079-6123(07)66050-6 |chapter=Consensus for tinnitus patient assessment and treatment outcome measurement: Tinnitus Research Initiative meeting, Regensburg, July 2006 |title=Tinnitus: Pathophysiology and Treatment |series=Progress in Brain Research |year=2007 |last1=Langguth |first1=B. |last2=Goodey |first2=R. |last3=Azevedo |first3=A. |last4=Bjorne |first4=A. |last5=Cacace |first5=A. |last6=Crocetti |first6=A. |last7=Del Bo |first7=L. |last8=De Ridder |first8=D. |last9=Diges |first9=I. |last10=Elbert |first10=T. |last11=Flor |first11=H. |last12=Herraiz |first12=C. |last13=Ganz Sanchez |first13=T. |last14=Eichhammer |first14=P. |last15=Figueiredo |first15=R. |last16=Hajak |first16=G. |last17=Kleinjung |first17=T. |last18=Landgrebe |first18=M. |last19=Londero |first19=A. |last20=Lainez |first20=M.J.A. |last21=Mazzoli |first21=M. |last22=Meikle |first22=M.B. |last23=Melcher |first23=J. |last24=Rauschecker |first24=J.P. |last25=Sand |first25=P.G. |last26=Struve |first26=M. |last27=Van De Heyning |first27=P. |last28=Van Dijk |first28=P. |last29=Vergara |first29=R. |volume=166 |pages=525–536 |pmid=17956816 |pmc=4283806 |isbn=978-0-444-53167-4 }}</ref><ref name="pmid17956815">{{cite book |doi=10.1016/S0079-6123(07)66049-X |chapter=Assessment of tinnitus: Measurement of treatment outcomes |title=Tinnitus: Pathophysiology and Treatment |series=Progress in Brain Research |year=2007 |last1=Meikle |first1=M.B. |last2=Stewart |first2=B.J. |last3=Griest |first3=S.E. |last4=Martin |first4=W.H. |last5=Henry |first5=J.A. |last6=Abrams |first6=H.B. |last7=McArdle |first7=R. |last8=Newman |first8=C.W. |last9=Sandridge |first9=S.A. |volume=166 |pages=511–521 |pmid=17956815 |isbn=978-0-444-53167-4 }}</ref><ref name="pmid22156949">{{cite journal |last1=Meikle |first1=Mary B. |last2=Henry |first2=James A. |last3=Griest |first3=Susan E. |last4=Stewart |first4=Barbara J. |last5=Abrams |first5=Harvey B. |last6=McArdle |first6=Rachel |last7=Myers |first7=Paula J. |last8=Newman |first8=Craig W. |last9=Sandridge |first9=Sharon |last10=Turk |first10=Dennis C. |last11=Folmer |first11=Robert L. |last12=Frederick |first12=Eric J. |last13=House |first13=John W. |last14=Jacobson |first14=Gary P. |last15=Kinney |first15=Sam E. |last16=Martin |first16=William H. |last17=Nagler |first17=Stephen M. |last18=Reich |first18=Gloria E. |last19=Searchfield |first19=Grant |last20=Sweetow |first20=Robert |last21=Vernon |first21=Jack A. |title=The Tinnitus Functional Index: Development of a New Clinical Measure for Chronic, Intrusive Tinnitus |journal=Ear & Hearing |date=March 2012 |volume=33 |issue=2 |pages=153–176 |doi=10.1097/AUD.0b013e31822f67c0 |pmid=22156949 |s2cid=587811 }}</ref> A broader assessment of general functioning, such as levels of anxiety, depression, stress, life stressors, and sleep difficulties, is also important in the assessment of tinnitus due to higher risk of negative well-being across these areas, which may be affected by or exacerbate the tinnitus symptoms.<ref>{{Cite book |last1=Henry |first1=J. L. |last2=Wilson |first2=PH |title= The Psychological Management of Chronic Tinnitus: A Cognitive Behavioural Approach |publisher=Allyn and Bacon |year=2000}}</ref> 

Current assessment measures aim to identify levels of distress and interference, coping responses, and perceptions of tinnitus to inform treatment and monitor progress. However, wide variability, inconsistencies, and lack of consensus regarding assessment methodology are evidenced in the literature, limiting comparison of treatment effectiveness.<ref>{{Cite journal |vauthors=Landgrebe M, Azevedo A, Baguley D, Bauer C, Cacace A, Coelho C, etal |title=Methodological aspects of clinical trials in tinnitus: A proposal for international standard |journal=Journal of Psychosomatic Research |volume=73 |pages=112–121 |year=2012 |pmid=22789414 |doi=10.1016/j.jpsychores.2012.05.002 |issue=2 |pmc=3897200}}</ref> Developed to guide diagnosis or classify severity, most tinnitus questionnaires have been shown to be treatment-sensitive outcome measures.<ref name=":0">{{cite journal |last1=Martinez-Devesa |first1=Pablo |last2=Perera |first2=Rafael |last3=Theodoulou |first3=Megan |last4=Waddell |first4=Angus |title=Cognitive behavioural therapy for tinnitus |journal=Cochrane Database of Systematic Reviews |date=8 September 2010 |issue=9 |pages=CD005233 |doi=10.1002/14651858.CD005233.pub3 |pmid=20824844 | url =  https://www.hopefortinnitus.com/storage/app/media/forms/cochrane-review-of-cbt.pdf | archive-url = https://archive.today/20241211090451/https://www.hopefortinnitus.com/storage/app/media/forms/cochrane-review-of-cbt.pdf | archive-date = 2024-12-11 | url-status = live}}</ref>{{Request quotation|date=December 2024|reason = Not obvious what statements are used to support this sentence.}}

===Pulsatile tinnitus===
If examination reveals a bruit (sound due to turbulent blood flow), imaging studies such as [[transcranial doppler]] (TCD) or [[magnetic resonance angiography]] (MRA) should be performed.<ref name="pmid28203490">{{cite journal | vauthors = Pegge S, Steens S, Kunst H, Meijer F | title = Pulsatile Tinnitus: Differential Diagnosis and Radiological Work-Up | journal = Current Radiology Reports | volume = 5 | issue = 1 | pages = 5 | year = 2017 | pmid = 28203490 | pmc = 5263210 | doi = 10.1007/s40134-017-0199-7 }}</ref><ref name="pmid23885280">{{cite journal | vauthors = Hofmann E, Behr R, Neumann-Haefelin T, Schwager K | title = Pulsatile tinnitus: imaging and differential diagnosis | journal = Deutsches Ärzteblatt International | volume = 110 | issue = 26 | pages = 451–458 | year = 2013 | pmid = 23885280 | pmc = 3719451 | doi = 10.3238/arztebl.2013.0451 }}</ref><ref name="pmid22552697">{{cite journal |last1=Sismanis |first1=Aristides |title=Pulsatile tinnitus: contemporary assessment and management |journal=Current Opinion in Otolaryngology & Head and Neck Surgery |date=October 2011 |volume=19 |issue=5 |pages=348–357 |doi=10.1097/MOO.0b013e3283493fd8 |pmid=22552697 |s2cid=22964919 }}</ref>

===Differential diagnosis===
Other potential sources of the sounds normally associated with tinnitus should be ruled out. For instance, two recognized sources of high-pitched sounds might be electromagnetic fields common in modern wiring and various sound signal transmissions. A common and often misdiagnosed condition that mimics tinnitus is radio frequency (RF) hearing, in which subjects hear objectively audible high-pitched transmission frequencies that sound similar to tinnitus.<ref>{{cite journal |last=Elder |first=JA |author2=Chou, CK |title=Auditory response to pulsed radiofrequency energy |journal=Bioelectromagnetics |year=2003 |volume=6 |pages=S162–173 |pmid=14628312 |doi=10.1002/bem.10163|s2cid=9813447 |doi-access=free }}</ref><ref name="pmid17495664">{{cite journal | vauthors = Lin JC, Wang Z | title = Hearing of microwave pulses by humans and animals: effects, mechanism, and thresholds | journal = Health Physics | volume = 92 | issue = 6 | pages = 621–628 | year = 2007 | pmid = 17495664 | doi = 10.1097/01.HP.0000250644.84530.e2 | bibcode = 2007HeaPh..92..621L | s2cid = 37236570 }}</ref>