History	Comments
Onset	Progressive hearing loss with tinnitus and advancing age suggests presbycusis. Precipitous onset can be linked to excessive or loud noise exposure or head trauma.
Location	Unilateral tinnitus can be caused by cerumen impaction, otitis externa, and otitis media. Tinnitus associated with unilateral sensorineural hearing loss is the hallmark of acoustic neuroma.
Pattern	Continuous tinnitus accompanies hearing loss. Episodic tinnitus suggests Meniere's disease. Pulsatile tinnitus suggests a vascular origin.
Characteristics (i.e., pitch, complexity)	Low-pitched rumbling pattern suggests Meniere's disease, high-pitched pattern suggests sensorineural hearing loss.
Associated vertigo, aural fullness, hearing loss	Meniere's disease
Exposure to ototoxic medications/factors	Noise-induced or medication-induced hearing loss
Exacerbating/alleviating factors	Tinnitus of patulous eustachian tube is alleviated by lying down with head in dependent position.
Hyperlipidemia, thyroid disorder, vitamin B12 deficiency, anemia	Can be potential contributing causes.
Other	Significance to the patient. Management depends on how the tinnitus affects the patient's quality of life.