Ringing in the Ears? Learn When and How To Test For Tinnitus
If you’re hearing ringing, buzzing, humming or other sounds in your ears, that’s called tinnitus. The overwhelming majority of tinnitus cases can’t be observed from the outside, so how do you test for it?
This guide will walk you through the various ways tinnitus can be tested and diagnosed.
Testing for Tinnitus
Testing for tinnitus is somewhat tricky because almost all tinnitus is subjective. Subjective tinnitus cannot be measured with instruments or heard from the outside, so tests mostly rely on self-reporting by patients. Objective tinnitus can be measured using special equipment, but it’s extremely rare.
And while diagnosing tinnitus itself is relatively simple, you might need to undergo a long series of tests to discover the root cause. The first step is talking to your primary care provider.
Physical and Ear Exam
Almost everyone has had tinnitus at some point—usually after being exposed to loud noise. It typically disappears quickly, but if your tinnitus hangs around for days or weeks, you need to see a doctor.
Your ENT or primary care physician will go through a few standard steps, including:
- Reviewing your complete medical history
- Conducting a thorough physical examination
- Checking the medications, you are taking to see if the tinnitus could be a side effect
In addition to these basic steps, your doctor will perform some tests specific to tinnitus. The American Academy of Family Physicians has a diagnostic approach for testing tinnitus.
These tests may include:
- An audiological exam with an otoscope to check for any physical causes
- A hearing assessment to check for underlying hearing loss
- An evaluation of your balance, coordination, and nervous system
- Establishing whether the symptoms occur in one or both ears—bilateral or unilateral tinnitus
- Using a stethoscope or recording device to detect signs of objective tinnitus
If the tinnitus is caused by something simple like an ear wax impaction or an ear infection, your doctor will prescribe a treatment for the underlying medical condition and send you on your way.
But if the doctor suspects your tinnitus is caused by a chronic condition, such as hearing loss or a neurological disorder, they will refer you to a specialist.
Testing Subjective Tinnitus
If initial tests indicate your tinnitus is here to stay, your care team needs more testing to develop a plan to tackle your symptoms.
As we’ve already mentioned, most tinnitus is subjective and can’t be measured with instruments. However, modern medicine has developed techniques to effectively diagnose subjective tinnitus based on the tinnitus suffer’s subjective experience.
Tinnitus Pitch Matching
Tinnitus sound matching or pitch matching tests will help your hearing health professional better understand your tinnitus symptoms. The audiologist matches the tone and the pitch to recreate the tinnitus sound the patient hears.
This is a crucial part of common treatment options that use sounds, such as masking and tinnitus retraining therapy. The audiologist needs to approximate the tinnitus sound as precisely as possible to mask your symptoms with sound generators or hearing aids.
Minimum Masking Level
When preparing to treat your tinnitus symptoms, an audiologist needs to determine your minimum masking level—the lowest sound level that masks your tinnitus. This is a vital part of tinnitus masking therapy and calibrating hearing aids. It is usually found through threshold audiometry tests.
Loudness Discomfort Levels
In some people, loud sounds are excruciating.
Hyperacusis is an extreme sensitivity to sound.
It’s essential to understand the level at which sound becomes painful to treat people with this condition. Alternative therapies like hearing aids are suggested.
The most common causes of tinnitus are noise-induced hearing loss and age-related hearing loss. These are both forms of sensorineural hearing loss, which refers to damage or degradation of the inner ear caused by age or prolonged loud noise exposure.
Given the robust connection between hearing loss and tinnitus, testing for chronic tinnitus usually involves a battery of hearing tests to get a grasp on your hearing health.
Speech audiometry evaluates hearing accuracy. It’s a subjective test that assesses whether tinnitus is affecting your hearing or hearing loss is contributing to your tinnitus.
The test has two parts:
- A person is asked to repeat what they hear through headphones at various frequencies in a quiet environment.
- Competing sounds are played alongside lists of words to determine your hearing threshold. What is the lowest level of sound at which you can recognize at least half of the speech?
Pure Tone Testing
A pure tone audiogram is a test that is done with a handheld audiometer. The audiologist will gradually increase and decrease the sound and frequency during the test.
This is done primarily on adults and older children who can report what they hear.
Before doing this test, people should avoid loud noise and loud music so that it doesn’t skew the results.
An audiologist will insert a probe inside your ear canal and then send in a puff of air to test how the eardrum moves. Problems in the eardrum can cause hearing loss and tinnitus, so it’s essential to see if it’s functioning.
The movement of the eardrum is plotted onto a graph called a tympanogram. This test reports a problem with your middle ear if there is one.
Acoustic Reflex Testing
The acoustic reflex test is another objective hearing test. When you hear a sound, muscles in your ear contract reflexively.
The way your ear muscles respond to various sound intensities is an excellent indicator of your hearing health. The response of your nerves to sound is also recorded.
When you hear a sound, muscles in your ear contract reflexively.
Otoacoustic Emission Testing (OAE testing)
The OAE hearing test checks the hair cells inside your cochlea or inner ear. The hair cells of your inner ear vibrate when they hear sound. The OAE test measures this function to see if there’s any problem with your inner ear.
There are many subtypes of this test, including:
In this test, the audiologist inserts a probe and microphone into the ear. Sound is played via the probe, and the echo is recorded. If the hair cells are normal, they will echo back a sound.
Because of the strong connection between tinnitus and hearing loss, the average hearing professional will look at the ears first.
If they find that you have normal hearing, they may run diagnostic tests to see if the tinnitus sound a patient hears is caused by another underlying disorder.
Magnetic resonance imaging or a CT scan may be used to rule out severe conditions that could be to blame for tinnitus sounds, like:
- Acoustic neuroma
- Malignant tumors
- Fluid build-up
- Brain lesions
Magnetic resonance angiography, a subset of magnetic resonance imaging, can check the blood vessels supplying the ear and the brain’s auditory cortex to identify the source of pulsatile tinnitus.
Pulsatile tinnitus is a rarer form of objective tinnitus caused by a problem in the cardiovascular system.
People with pulsatile tinnitus report sounds that pulse or throb in time with their heartbeats.
Your primary care provider or ear, nose and throat doctor might order blood tests to detect other causes of tinnitus like:
- Cardiovascular disease
- High blood pressure
- Thyroid disorders
Measuring Tinnitus Burden
Tinnitus symptoms vary significantly from person to person. In some cases, it’s just a minor annoyance that can easily be ignored, but chronic tinnitus can be severely debilitating for many.
Do you know the difference between chronic and acute tinnitus? It’s about how long does the tinnitus last. Read more about it in our post.
To better understand how their patients experience tinnitus, doctors are increasingly using tinnitus questionnaires to measure the impact of tinnitus on everyday life alongside traditional diagnostic tools like physical examination and hearing tests.
Tinnitus Handicap Inventory
The THI or Tinnitus Handicap Inventory is a self-reported standardized measurement. It attempts to measure how tinnitus adversely affects a person’s life. There’s also a simplified version of this known as the Tinnitus Handicap Questionnaire.
Tinnitus Reaction Questionnaire
The Tinnitus Reaction Questionnaire measures the psychological distress from tinnitus. It’s a reliable test similar to clinical testing for psychological impact, but it is self-reported.
Tinnitus Primary Functions Questionnaire
The Tinnitus Primary Functions Questionnaire checks four specific ways that tinnitus affects your life:
Tinnitus Functional Index
The Tinnitus Functional Index or TFI measures the severity of the tinnitus. A patient is asked to rate on a scale the extent to which tinnitus causes:
- Sleep disturbances
- Hearing loss
- Emotional distress
- Problems of cognition
- Inability to relax
- Poor quality of life
- Loss of control
In short, this tinnitus questionnaire measures how tinnitus disturbs and disrupts daily life.
Visual Analog Scales
Visual analog scales use cartoon faces that go from smiling to frowning. They’re commonly used to rate pain symptoms, but they can also be used for tinnitus. Doctors may use this scale to evaluate if tinnitus treatment has improved your tinnitus symptoms and by how much.
It isn’t always easy to diagnose tinnitus. The condition has many causes, but the most common is hearing loss. Be prepared to undergo several rounds of testing to find the source of the sound you’re hearing in your ears.
Fortunately, tinnitus research is advancing rapidly, and the field is constantly discovering new methods to test and treat tinnitus symptoms. The first step to feeling better is contacting your doctor. If you have chronic tinnitus, get in touch with a hearing health professional today.
1. Crummer RW, Hassan GA. Diagnostic approach to tinnitus. Am Fam Physician. 2004;69(1):120-126.