The tinnitus evaluation should include a comprehensive medical history including current medications, sound/noise exposure history, a discussion related to the initial onset of tinnitus and the progression of the symptoms, subjective evaluation of the impact of tinnitus, an objective measure of the impact of tinnitus on daily life such as the Tinnitus handicap inventory, THI and more specifically any medications that have changed around the time of the initial tinnitus symptoms. After the history there should be a physical evaluation of the ear using otoscopy looking for any visual anomalies of the ear. If anomalies are noted then a medical referral is recommended to rule out any medical contribution to the tinnitus symptoms.
A comprehensive Audiologic evaluation should include routine audiometry which may include high frequency audiometry, Tympanometry if indicated to evaluation middle ear function, Distortion Product OtoAcoustic Emissions testing, DPOAE, to evaluate the outer hair cell function of the cochlea using at least ten points per octave and a range of frequencies from 1000 to 10,000 Hz. Tinnitus loudness and pitch match as well as minimum lasting levels are routinely done in a comprehensive evaluation. Loudness sensitivity should be ruled out as it is often an issue that is routinely associated with bothersome and non-bothersome tinnitus.