 Introduction/Background Tinnitus is a symptom defined by the perception of sound in the absence of external stimuli. It affects more than 50 million Americans, equally among men and women, and is most commonly noted in patients between 40 and 70 years of age [1]. Tinnitus may range from innocuous to devastating, with significant negative impacts on psychosocial well-being and quality of life. In a survey conducted in 2008, approximately 10% of the United States adult population experienced endorsed at least 1 episode of tinnitus lasting more than 5 minutes in the preceding year [2]. It is important to know the otoscopy examination findings in patients with PT because it guides the imaging algorithm. In the setting of PT, the possibility of a vascular retrotympanic lesion leads to a different set of differential diagnostic considerations compared to the absence thereof and therefore influences the decision for which imaging studies to pursue and in what order. However, the detection of retrotympanic lesions can be difficult without appropriate equipment. The American Academy of Otolaryngology and Head and Neck Surgery Foundation (AAO-HNS) guidelines recommend targeted history and clinical examination as the initial evaluation and determination as to whether the tinnitus is bothersome or not, before any imaging. The guidelines also recommend a prompt and comprehensive audiological examination in patients with hearing problems or with unilateral persistent tinnitus. The guidelines make a strong recommendation against any imaging studies of the head and neck for the subset of patients in whom tinnitus does not localize to 1 ear, is nonpulsatile, and is not associated with focal neurological abnormalities or an asymmetric hearing loss. The guidelines also suggest that some patients with severe anxiety, depression, or psychological disturbances may need prompt identification and intervention [6,7]. aMetroHealth Medical Center, Cleveland, Ohio.
Tinnitus.  Introduction/Background Tinnitus is a symptom defined by the perception of sound in the absence of external stimuli. It affects more than 50 million Americans, equally among men and women, and is most commonly noted in patients between 40 and 70 years of age [1]. Tinnitus may range from innocuous to devastating, with significant negative impacts on psychosocial well-being and quality of life. In a survey conducted in 2008, approximately 10% of the United States adult population experienced endorsed at least 1 episode of tinnitus lasting more than 5 minutes in the preceding year [2]. It is important to know the otoscopy examination findings in patients with PT because it guides the imaging algorithm. In the setting of PT, the possibility of a vascular retrotympanic lesion leads to a different set of differential diagnostic considerations compared to the absence thereof and therefore influences the decision for which imaging studies to pursue and in what order. However, the detection of retrotympanic lesions can be difficult without appropriate equipment. The American Academy of Otolaryngology and Head and Neck Surgery Foundation (AAO-HNS) guidelines recommend targeted history and clinical examination as the initial evaluation and determination as to whether the tinnitus is bothersome or not, before any imaging. The guidelines also recommend a prompt and comprehensive audiological examination in patients with hearing problems or with unilateral persistent tinnitus. The guidelines make a strong recommendation against any imaging studies of the head and neck for the subset of patients in whom tinnitus does not localize to 1 ear, is nonpulsatile, and is not associated with focal neurological abnormalities or an asymmetric hearing loss. The guidelines also suggest that some patients with severe anxiety, depression, or psychological disturbances may need prompt identification and intervention [6,7]. aMetroHealth Medical Center, Cleveland, Ohio.