General category	Finding	Comments
Associated events	Hearing change, previous chronic noise exposure, acoustic trauma, otitis media, head or neck trauma, dental treatment	Hearing loss and noise exposure are the most consistent risk factors associated with tinnitus^3,16
		Head injury,⁴³ whiplash,³ dizziness,³ and otosclerosis⁴ are risk factors for incident tinnitus
		Dental treatment may produce somatosensory tinnitus via temporomandibular joint disorders or neck stress
	Use of a medication known to cause tinnitus	More than 130 agents are reported to cause tinnitus or hearing loss (Table 2)²⁵
Associated symptoms	Headaches	Spontaneous intracranial hypotension can cause tinnitus with orthostatic headache,¹¹ whereas obesity, headache, and tinnitus suggest idiopathic intracranial hypertension^2,13; both are indications for neuroimaging, lumbar puncture, or myelography ^2,11
	Hearing loss	Most common risk factor for tinnitus, occurring in at least one-third of patients³
	Noise annoyance, intolerance, or pain	Hyperacusis is present in up to 40% of patients with tinnitus⁴⁴
	Temporomandibular joint or neck pain	May be associated with tinnitus²⁷; therapy for pain may improve tinnitus
	Vertigo	Suggests Meniere disease especially if unilateral, episodic, and associated with hearing loss,^30,31 although vestibular schwannoma can also produce vertigo⁴⁵
Description of tinnitus	Fluctuation, pitch, quality, loudness	Ringing, buzzing, or cicada-like sound is most common⁴⁶; low frequency most typical of Meniere disease³⁰; persons with unilateral pulsatile tinnitus are 80 times more likely to have a vascular loop adjacent to cranial nerve VIII than those without that symptom⁴⁷
Family history of tinnitus, hearing loss, or neurofibromatosis	—	Meniere disease and otosclerosis are heritable, but overall, tinnitus has a very small genetic component⁴⁸
Impact of tinnitus	Percent of time the patient is aware of or annoyed by tinnitus (e.g., interference with daily activities, sleep, work, or leisure; auditory perceptual difficulties; effects on general health⁶)	Helps assess severity and subjective impact of tinnitus
Location	Unilateral or bilateral	Two-thirds of patients have bilateral tinnitus⁴⁶; unilateral is more likely somatosensory, vestibular schwannoma, or Meniere disease
Onset	Gradual or abrupt	Abrupt onset is more likely with somatosensory etiology and less likely to be vestibular schwannoma³²
Timing	Intermittent or continuous	—