A good tinnitus assessment is mostly about your hearing, not the noise itself. The point is to find any treatable cause, measure your hearing accurately, rule out the rare red flags — and then set a realistic plan rather than chase a scan.
The audiogram (pure-tone plus speech testing) is the single most important test. It finds the hearing loss that underlies most tinnitus even when your hearing 'feels' fine, and extended high-frequency testing can reveal loss a standard audiogram misses. Otoscopy and tympanometry check for wax and middle-ear problems — occasionally the whole story is a plug of cerumen. Evidence ●●●●○
An MRI (with contrast) is warranted for asymmetric or one-sided tinnitus/hearing loss, to rule out a vestibular schwannoma. Pulsatile tinnitus warrants a vascular workup (MRA/CTA/MRV and related studies). But for the common symmetric, non-pulsatile kind, guidelines specifically advise against routine imaging — it rarely finds anything and mostly adds cost and anxiety. Evidence ●●●●○
Pitch and loudness matching and the minimum masking level can characterise the sound, though they're imperfect and loudness barely predicts distress. What actually tracks how much tinnitus affects you are validated questionnaires — the Tinnitus Handicap Inventory (THI) and Tinnitus Functional Index (TFI). They measure impact, not volume, and they're how treatments are judged in trials and in the clinic.
A hearing test and a plan, not a scan and a prescription
The AAO-HNS clinical guideline recommends against routine imaging, routine blood tests, and routine drugs or dietary supplements for uncomplicated tinnitus. For most people the highest-value workup is a good audiogram plus a management plan — not an MRI and a pill.
The Tinnitus Guide