ACR Appropriateness Criteria(R) Tinnitus

Marcus M. Kessler
Marwan Moussa
Julie Bykowski
Claudia F E Kirsch
Joseph M. Aulino
Kevin L. Berger
Asim F. Choudhri
Terry D. Fife, Barrow Neurological Institute
Isabelle M. Germano
A. Tuba Kendi
Jeffrey H. Kim
Michael D. Luttrull
Diego Nunez
Lubdha M. Shah
Aseem Sharma
Vilaas S. Shetty
Sophia C. Symko
Rebecca S. Cornelius


Tinnitus is the perception of sound in the absence of an external source. It is a common symptom that can be related to hearing loss and other benign causes. However, tinnitus may be disabling and can be the only symptom in a patient with a central nervous system process disorder. History and physical examination are crucial first steps to determine the need for imaging. CT and MRI are useful in the setting of pulsatile tinnitus to evaluate for an underlying vascular anomaly or abnormality. If there is concomitant asymmetric hearing loss, neurologic deficit, or head trauma, imaging should be guided by those respective ACR Appropriateness Criteria® documents, rather than the presence of tinnitus. Imaging is not usually appropriate in the evaluation of subjective, nonpulsatile tinnitus that does not localize to one ear. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.