Diagnostic Imaging Pathways - Tinnitus

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Population Covered By The Guidance

This pathway provides guidance on the imaging of adult patients with tinnitus.

Date reviewed: January 2012

Date of next review: 2017/2018

Published: January 2012

Quick User Guide

Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.

No radiation None 0
Minimal radiation Minimal < 1 millisieverts
Low radiation Low 1-5 mSv
Medium radiation Medium 5-10 mSv
High radiation High >10 mSv


Pathway Diagram


Image Gallery

Note: These images open in a new page
1a Click to view full size image

Acoustic Neuroma

Image 1a and 1b (Magnetic Resonance Imaging): Pre- and post-contrast images demonstrating an enhancing lesion within the right cerebello-pontine angle and internal auditory canal (arrows). Appearances are typical of an acoustic neuroma. The lesion measures up to 17mm. Its medial aspect almost contacts the pons. A small vessel in interposed between the mass and the pons. The inferior aspect of the lesion approaches the fundus of the right internal auditory canal.

1b Click to view full size image

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Teaching Points




Computed Tomography (CT)


Magnetic Resonance Imaging (MRI) in the Evaluation of Non-pulsatile Tinnitus


Magnetic Resonance Imaging (MRI / MRA / MRV) in the Evaluation of Pulsatile Tinnitus





References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

  1. Weissman JL, Hirsch BE. Imaging of tinnitus: a review. Radiology. 2000;216:342-9. (Review article)
  2. Marsot-Dupuch K. Pulsatile and nonpulsatile tinnitus: a systemic approach. Semin Ultrasound CT MR. 2001;22(3):250-70. (Review article)
  3. Sismanis A. Pulsatile tinnitus: a 15-year experience. Am J Otol. 1998;19:472-7. (Level II/III evidence)
  4. Remley KB, Coit WE, Harnsberger HR, et al. Pulsatile tinnitus and the vascular tympanic membrane: CT, MR and angiographic findings. Radiology. 1990;174:383-9. (Level III evidence)
  5. Dietz RR, Davis WL, Harnsberger HR, et al. MR imaging and MR angiography in the evaluation of pulsatile tinnitus. AJNR Am J Neuroradiol. 1994;15:879-89. (Level III evidence). View the reference
  6. Olsen WL, Dillon WP, Kelly WM, et al. MR imaging of paragangliomas. AJNR Am J Neuroradiol. 1986;7:1039-42. (Level IV evidence)
  7. Vogl T, Bruning R, Schedel H, et al. Paragangliomas of the jugular bulb and carotid body: MR imaging with short sequences and Gd-DTPA enhancement. AJNR Am J Neuroradiol. 1989;10:823-7. (Level III evidence)
  8. DeMarco JK, Dillon WP, Halbach VV, et al. Dural arteriovenous fistulas: evaluation with MR imaging. Radiology. 1990;175:193-9. (Level IV evidence)
  9. Shin EJ, Lalwani AK, Dowd CF. Role of angiography in the evaluation of patients with pulsatile tinnitus. Laryngoscope. 2000;110:1916-20. (Level III evidence)

Further Reading

  1. Lockwood AH, Salvi RJ, Burkard RF. Current concepts: tinnitus. N Engl J Med. 2002;347(12):904-10. (Review article)
  2. Willinsky RA. Tinnitus: imaging algorithms. Can Assoc Radiol J. 1992;43:93-9. (Review article)
  3. Branstetter B, Weissman J. The radiological evaluation of tinnitus. Eur Radiol. 2006;16(12):2792-802. (Review article)

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Information for Consumers

Information from this website

Information from the Royal Australian and New Zealand College of Radiologists’ website

Consent to Procedure or Treatment

Radiation Risks of X-rays and Scans

Computed Tomography (CT)

Magnetic Resonance Angiography (MRA)

Magnetic Resonance Imaging (MRI)

Computed Tomography (CT)

Contrast Medium (Gadolinium versus Iodine)

Gadolinium Contrast Medium

Iodine-Containing Contrast Medium

Magnetic Resonance Imaging (MRI)

Radiation Risk of Medical Imaging During Pregnancy

Radiation Risk of Medical Imaging for Adults and Children



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