Ringing in the Ears: Approaches to Imaging and Management of Tinnitus

ABSTRACT Tinnitus is a condition in which patients perceive sound without an external stimulus. It can be classified into either pulsatile or nonpulsatile tinnitus. This condition affects around 14% of the global population, and the severity of tinnitus can range from barely noticeable to devastating. In most cases, tinnitus is benign and nonpulsatile in nature. The diagnostic role of imaging is to detect treatable and specific pathology. Therefore, a comprehensive clinical assessment, which includes a meticulous examination for associated symptoms like hearing loss, vertigo, or headaches, along with a thorough physical examination, otoscopy, and audiologic testing, is imperative before considering any imaging studies as the choice of imaging will depend on various factors. Nonpulsatile or continuous tinnitus is most commonly associated with presbycusis but can also be caused by functional injuries due to ototoxic medications or exposure to loud noise and usually requires no imaging evaluation. Unlike nonpulsatile tinnitus, imaging patients with pulsatile tinnitus typically reveals perceptible findings. The cause of pulsatile tinnitus is usually a vascular tumor, vascular malformation, or vascular anomaly. Other causes of tinnitus include idiopathic intracranial hypertension, otosclerosis, Paget’s disease, and Meniere’s disease. One of the main challenges is that the underlying cause of tinnitus is often unknown. Another challenge is that tinnitus can have a significant effect on a person’s quality of life, yet the condition is not life-threatening and there is no cure. We present a clinical review of the most prevalent causes of tinnitus along with an emphasis on the diagnostic imaging workup and management of common presentations.