A full medical and audiological assessment should be done in order to provide best management of tinnitus. Since tinnitus is a symptom so any medical disease should be ruled out. Medical examination should be carried out with special attention given to identify factors associated with tinnitus such as disease involving auditory system, noise exposure, drug intake, mental or emotional stress, allergies, blood pressure etc.
Audiological evaluation is very important to be completed on a patient with tinnitus and should be carried out by a qualified audiologist/audiological scientist. Since tinnitus can be associated with number of conditions that may occur at any level of the auditory system, the audiological evaluation can demonstrate information regarding cause and options for treatment. It should begin by taking thorough case history which would include onset, duration, laterality, severity, pattern, associated symptoms etc. Audiological assessment includes basic audiometric testing, speech audiometry, tympanogram, acoustic reflexes and decays, oto-acoustic emissions (OAEs), auditory brainstem response (ABR). Each of these tests can possibly help Audiologist identify nature and cause of tinnitus and may indicate site of lesion. For example, the audiogram will help in determining degree and type of hearing loss, the tympanogram will determine middle ear status and the oto-acoustic emissions will assess cochlear function. The acoustic stapedial reflexes and reflex decay and ABR will distinguish between cochlear and retro-cochlear auditory dysfunction. Some patients with tinnitus will have dyssynchronous all or part of ABR waveform (Shulman, 1997).
There are other audiological measurements for tinnitus which gives an information about its pitch, loudness etc. and they also provide some information if tinnitus can be masked by an external noise. These measurements are pitch matching, loudness matching, minimal masking level and residual inhibition. Pitch matching is measuring the frequency of the tinnitus with a variety of stimuli, loudness matching is measuring the loudness of tinnitus, minimal masking level is threshold to mask the tinnitus and residual inhibition is presenting masking stimuli at the pitch and intensity of the tinnitus in order to relieve tinnitus.