Diagnosis and Flowchart

1. Tinnitus can be a symptom of a wide range of different underlying pathologies and be accompanied by many different comorbidities, indicating the need for comprehensive multidisciplinary diagnostic assessment. 2. Exact diagnosis is required in each patient in order to provide the best management of tinnitus. 3. It is especially important to identify patients (a) Who can be treated by specific interventions. (b) Those in which tinnitus is a symptom of a severe underlying disease. (c) Those patients who require immediate therapeutic action. 4. Basic diagnostics should include a detailed case history, assessment of tinnitus severity, clinical ear examination, and audiological measurement of hearing function. 5. For a considerable number of patients, these first diagnostic steps in combination with counseling will be sufficient. 6. Further diagnostic steps are indicated if the findings of basic diagnostics reveal (a) relevant subjective impairment, (b) acute tinnitus onset together with acute hearing loss, (c) posttraumatic, (d) acute pulsatile tinnitus, as these characteristics point to a potentially dangerous underlying condition (e.g., carotid dissection). 7. All diagnostic and therapeutic steps should be accompanied by empathic and insightful counseling. 8. The goal of therapeutic management is maximal relief from tinnitus complaints. This requires exact knowledge, which symptoms are perceived as bothersome by the individual patient.