Clinical Neuroimaging in the Evaluation of Tinnitus

This chapter describes the imaging techniques used in neuroradiology to investigate patients with tinnitus in more detail. A radiological examination is not part of a routine evaluation, but is reserved for certain conditions. These may include cases of objective tinnitus, especially with pulse-synchronous sounds, in which vascular pathology is suspected. Another important point is the assessment of the middle ear and the cochlear and retrocochlear structures in cases of asymmetric hearing loss and tinnitus on the worse side. Mainly, techniques of computed tomography (CT) and magnetic resonance imaging (MRI) and MR angiography (MRA) are used. In addition to finding the underlying cause of the tinnitus, neuroradiological examination can then also point the way to adequate therapy. In some cases of pulsatile tinnitus, therapy of the tinnitus is possible with invasive neuroradiological techniques in the context of digital subtraction angiography (e.g. coiling, stenting and embolization).