Differences in Hearing, Balance, and Quality-of-Life Outcomes in Petroclival Versus Nonpetroclival Posterior Fossa Meningiomas.

OBJECTIVE: To compare hearing, tinnitus, balance, and quality-of-life treatment outcomes of petroclival meningioma and nonpetroclival cerebellopontine angle meningioma cohorts. STUDY DESIGN: A retrospective cohort study of 60 patients with posterior fossa meningiomas, 25 petroclival and 35 nonpetroclival, who were treated at a single tertiary care center between 2000 and 2020. INTERVENTION: A survey battery that included the Hearing Effort of the Tumor Ear, Speech and Spatial Qualities of Hearing, Tinnitus Functional Index, Dizziness Handicap Inventory (DHI), and Short Form Health Survey. Petroclival and nonpetroclival cohorts were matched for tumor size and demographic features. MAIN OUTCOME MEASURES: Differences between groups in hearing, balance outcomes, and quality of life and patient factors that influence posttreatment quality of life. RESULTS: Petroclival meningioma patients reported poorer audiovestibular outcomes with a higher rate of deafness in the tumor ear (36.0% versus 8.6%, p = 0.032) and lower functional hearing by the Hearing Effort of the Tumor Ear, Speech and Spatial Qualities of Hearing (76.6 [6.1] versus 82.0 [4.4], p < 0.001). Current dizziness rate was higher (48.0% versus 23.5%, p = 0.05), with more severe dizziness by DHI (18.4 [4.8] versus 5.7 [2.2], p < 0.001). Both cohorts had similar high quality of life and low tinnitus severity indices. Quality-of-life Short Form Health Survey predictors were tumor size ( p = 0.012) and DHI ( p = 0.005) in multivariable analysis. CONCLUSIONS: Hearing and dizziness treatment outcomes of petroclival meningioma are poorer relative to other posterior fossa meningiomas. Despite audiovestibular outcome distinctions, the overall posttreatment quality of life was high for both petroclival and nonpetroclival meningioma.

Protective Effect of Resveratrol in an Experimental Model of Salicylate-Induced Tinnitus.

To date, the effect of resveratrol on tinnitus has not been reported. The attenuative effects of resveratrol (RSV) on a salicylate-induced tinnitus model were evaluated by in vitro and in vivo experiments. The gene expression of the activity-regulated cytoskeleton-associated protein (ARC), tumor necrosis factor-alpha (TNFα), and NMDA receptor subunit 2B (NR2B) in SH-SY5Y cells was examined using qPCR. Phosphorylated cAMP response element-binding protein (p-CREB), apoptosis markers, and reactive oxygen species (ROS) were evaluated by in vitro experiments. The in vivo experiment evaluated the gap-prepulse inhibition of the acoustic startle reflex (GPIAS) and auditory brainstem response (ABR) level. The NR2B expression in the auditory cortex (AC) was determined by immunohistochemistry. RSV significantly reduced the salicylate-induced expression of NR2B, ARC, and TNFα in neuronal cells; the GPIAS and ABR thresholds altered by salicylate in rats were recovered close to their normal range. RSV also reduced the salicylate-induced NR2B overexpression of the AC. These results confirmed that resveratrol exerted an attenuative effect on salicylate-induced tinnitus and may have a therapeutic potential.

Tinnitus Triggered by a Cerebellopontine Arachnoid Cyst in an Adolescent.

BACKGROUND Tinnitus can be a symptom of a wide range of disorders. The identification and treatment of the underlying condition is essential for management of tinnitus in children. Tinnitus can occur with medical conditions other than sensorineural hearing loss. Cerebellopontine arachnoid cysts are rare and can cause tinnitus and hearing loss in adults. Tinnitus caused by an arachnoid cyst has not been reported in an adolescent. We report clinical and radiological features of a teenager with bothersome tinnitus caused by an arachnoid cyst. CASE REPORT A 14-year-old girl with unilateral tinnitus for 10 months presented to the Pediatric Otolaryngology Clinic. The loudness and duration of tinnitus had progressed gradually. Turning the head to the right induced right otalgia and tinnitus. The patient denied hearing loss, vertigo, exposure to loud noise, feeling of fullness in ear, otorrhea, facial weakness, numbness, dysphagia, changes in smell or taste, and problems with the jaw or temporomandibular joint. The focused neurological examination and head and neck examination were within normal limits. The patient had normal hearing on audiometry. T1-weighted, T2-spin-echo, T2-FLAIR, and diffusion-weighted magnetic resonance imaging sequences were obtained, revealing a right cerebellopontine angle arachnoid cyst. After arachnoid cyst marsupialization, the patient's tinnitus and otalgia resolved. CONCLUSIONS This case highlights the importance of suspecting identifiable nonauditory system disorders as causes of tinnitus in children. Thorough analysis of clinical findings and timely use of imaging is critical to prevent delay in diagnosis and treatment of children with bothersome tinnitus caused by rare medical conditions.

Brain herniation (encephalocele) into arachnoid granulations: prevalence and association with pulsatile tinnitus and idiopathic intracranial hypertension.

PURPOSE: Brain herniation into arachnoid granulations (BHAG) of the dural venous sinuses is a recently described finding of uncertain etiology. The purpose of this study was to investigate the prevalence of BHAG in a cohort of patients with pulsatile tinnitus (PT) and to clarify the physiologic and clinical implications of these lesions. METHODS: The imaging and charts of consecutive PT patients were retrospectively reviewed. All patients were examined with MRI including pre- and post-contrast T1- and T2-weighted sequences. Images were reviewed separately by three blinded neuroradiologists to identify the presence of BHAG. Their location, signal intensity, size, presence of arachnoid granulation, and associated dural venous sinus stenosis were documented. Clinical records were further reviewed for idiopathic intracranial hypertension, history of prior lumbar puncture, and opening pressure. RESULTS: Two hundred sixty-two consecutive PT patients over a 4-year period met inclusion criteria. PT patients with BHAG were significantly more likely to have idiopathic intracranial hypertension than PT patients without BHAG (OR 4.2, CI 1.5-12, p = 0.006). Sixteen out of 262 (6%) patients were found to have 18 BHAG. Eleven out of 16 (69%) patients had unilateral temporal or occipital lobe herniations located in the transverse sinus or the transverse-sigmoid junction. Three out of 16 (19%) patients had unilateral cerebellar herniations and 2/16 (13%) patients had bilateral BHAG. CONCLUSION: In patients with PT, BHAG is a prevalent MRI finding that is strongly associated with the clinical diagnosis of IIH. The pathogenesis of BHAG remains uncertain, but recognition should prompt comprehensive evaluation for IIH.

Cortical and subcortical gray matter changes in patients with chronic tinnitus sustaining after vestibular schwannoma surgery.

Tinnitus is attributed to partial sensory deafferentation resulting in a central maladaptive neuroplasticity. Unfortunately, the agent of deafferentation is usually unknown or irreversible. In patients with unilateral vestibular schwannoma (VS), however, the auditory nerve is affected by a benign tumor. Hence, removal of the tumor can cease the tinnitus. In turn, sustaining complaints after surgery indicate cortical neuroplasticity. The present study is a cross sectional study which aims to track cortical structural changes by surface-based morphometry in 46 VS patients with sustained (i.e. centralized) or ceased (i.e. peripheral) tinnitus after surgery. A volumetric analysis of cortical and subcortical gray matter (GM) anatomy was performed on preoperative high-resolution MRI and related to the presence of hearing impairment, pre- and/or postoperative tinnitus. Patients with sustained (i.e. chronic) tinnitus showed an increased GM volume of the bilateral caudate nucleus, the contralateral superior colliculus, the middle frontal and middle temporal gyrus, the fusiform gyrus as well as the ipsilateral pars orbitalis when compared to those patients in whom tinnitus ceased postoperatively. Chronic tinnitus in VS patients is associated with characteristic structural changes in frontal, temporal and subcortical areas. Notably, a significant GM change of the caudate nucleus was detected providing further support for the striatal gaiting model of tinnitus.

Macrostructural Changes of the Acoustic Radiation in Humans with Hearing Loss and Tinnitus Revealed with Fixel-Based Analysis.

Age-related hearing loss is the most prevalent sensory impairment in the older adult population and is related to noise-induced damage or age-related deterioration of the peripheral auditory system. Hearing loss may affect the central auditory pathway in the brain, which is a continuation of the peripheral auditory system located in the ear. A debilitating symptom that frequently co-occurs with hearing loss is tinnitus. Strikingly, investigations into the impact of acquired hearing loss, with and without tinnitus, on the human central auditory pathway are sparse. This study used diffusion-weighted imaging (DWI) to investigate changes in the largest central auditory tract, the acoustic radiation, related to hearing loss and tinnitus. Participants with hearing loss, with and without tinnitus, and a control group were included. Both conventional diffusion tensor analysis and higher-order fixel-based analysis were applied. The fixel-based analysis was used as a novel framework providing insight into the axonal density and macrostructural morphologic changes of the acoustic radiation in hearing loss and tinnitus. The results show tinnitus-related atrophy of the left acoustic radiation near the medial geniculate body. This finding may reflect a decrease in myelination of the auditory pathway, instigated by more profound peripheral deafferentation or reflecting a preexisting marker of tinnitus vulnerability. Furthermore, age was negatively correlated with the axonal density in the bilateral acoustic radiation. This loss of fiber density with age may contribute to poorer speech understanding observed in older adults.SIGNIFICANCE STATEMENT Age-related hearing loss is the most prevalent sensory impairment in the older adult population. Older individuals are subject to the cumulative effects of aging and noise exposure on the auditory system. A debilitating symptom that frequently co-occurs with hearing loss is tinnitus: the perception of a phantom sound. In this large DWI-study, we provide evidence that in hearing loss, the additional presence of tinnitus is related to degradation of the acoustic radiation. Additionally, older age was related to axonal loss in the acoustic radiation. It appears that older adults have the aggravating circumstances of age, hearing loss, and tinnitus on central auditory processing, which may partly be because of the observed deterioration of the acoustic radiation with age.

Middle-ear or mastoid granulation pathology associated with retraction of the pars flaccida and low-pitched tinnitus.

OBJECTIVE: This study aimed to evaluate the clinical features and outcomes of patients with middle-ear granulation pathologies associated with attic retractions. METHOD: The clinical records of adult patients with middle-ear granulation pathologies and attic retractions confirmed via computed tomography and surgical exploration between January 2012 and January 2019 were retrospectively reviewed. RESULTS: A total of 59 patients were included. Endoscopic examination showed a normal pars tensa but retraction of the pars flaccida in all patients. No granulation tissue or debris were observed. Low-pitched tinnitus was the principal complaint of 55 patients (100 per cent), followed by ear fullness (14 patients, 23.7 per cent). Of the 59 patients, 52 patients (88.1 per cent) underwent canal wall up mastoidectomy and 7 patients (11.9 per cent) underwent endoscopic endaural atticoantrotomy. No ossicular chain destruction was evident. All patients were followed up for 12 months. Tinnitus disappeared completely in 48 patients (81.4 per cent), improved significantly in 9 patients (15.3 per cent) and improved mildly in 2 patients (3.3 per cent). CONCLUSION: A granulation tissue pathology should be considered when a patient complains of low-pitched tinnitus and exhibits retraction of the pars flaccida. Computed tomography and surgical exploration should be scheduled.

Dural Venous Sinus Stenosis: Why Distinguishing Intrinsic-versus-Extrinsic Stenosis Matters.

BACKGROUND AND PURPOSE: Dural venous sinus stenosis has been associated with idiopathic intracranial hypertension and isolated venous pulsatile tinnitus. However, the utility of characterizing stenosis as intrinsic or extrinsic remains indeterminate. The aim of this retrospective study was to review preprocedural imaging of patients with symptomatic idiopathic intracranial hypertension and pulsatile tinnitus, classify the stenosis, and assess a trend between stenosis type and clinical presentation while reviewing the frequencies of other frequently seen imaging findings in these conditions. MATERIALS AND METHODS: MRVs of 115 patients with idiopathic intracranial hypertension and 43 patients with pulsatile tinnitus before venous sinus stent placement were reviewed. Parameters recorded included the following: intrinsic or extrinsic stenosis, prominent emissary veins, optic nerve tortuosity, cephalocele, sella appearance, poststenotic fusiform enlargement versus saccular venous aneurysm, and internal jugular bulb diverticula. χ2 cross-tabulation statistics were calculated and recorded for all data. RESULTS: Most patients with idiopathic intracranial hypertension (75 of 115 sinuses, 65%) had extrinsic stenosis, and most patients with pulsatile tinnitus (37 of 45 sinuses, 82%) had intrinsic stenosis. Marked optic nerve tortuosity was more common in idiopathic intracranial hypertension. Cephaloceles were rare in both cohorts, with an increased trend toward the presence in idiopathic intracranial hypertension. Empty sellas were more common in idiopathic intracranial hypertension. Cerebellar tonsils were similarly located at the foramen magnum level in both cohorts. Saccular venous aneurysms were more common in pulsatile tinnitus. Internal jugular bulb diverticula were similarly common in both cohorts. CONCLUSIONS: In this cohort, most patients with idiopathic intracranial hypertension had extrinsic stenosis, and most patients with pulsatile tinnitus had intrinsic stenosis. Awareness and reporting of these subtypes may reduce the underrecognition of potential contributory stenoses in a given patient's idiopathic intracranial hypertension or pulsatile tinnitus.

Radiologic Features of Spontaneous Regression of Vestibular Schwannomas.

BACKGROUND: Vestibular schwannoma (VS) is the most common benign tumor originating in the cerebellopontine angle. In most cases, tumors tend to grow and deserve proper treatment. Sometimes they stabilize, and rarely they decrease in size spontaneously. METHODS: We evaluated retrospectively the images of patients with spontaneous tumor regression. We describe the common neuroimage findings of patients with spontaneous tumoral regression. RESULTS: Four patients with diagnosis of VS were followed with magnetic resonance imaging (MRI). There were some relevant features in MRI: a heterogeneous contrast enhancement in the outer layer of the tumor and presence of a cerebrospinal fluid column between the tumor and the entrance of the internal auditory canal. The percentage of tumor diameter reduction ranged from 20% to 40%. CONCLUSIONS: Some MRI features may demonstrate a spontaneous involution of VS and may be closely followed in asymptomatic or oligosymptomatic patients.

Skull base imaging, anatomy, pathology and protocols.

The skull base is the major bony and soft tissue interface for the intracranial and extracranial compartments. Its anatomy is complex, containing multiple traversing foramina that act as conduits for various neurovascular structures. The optimum imaging modality depends on the specific diagnostic question and area of interest; both CT and MR have complementary roles. This article focuses on the applied compartmental anatomy of the skull base and specific imaging protocols, and discusses the range of pathologies that neurologists will encounter.

Jugular Bulb Resurfacing With Bone Cement for Patients With High Dehiscent Jugular Bulb and Ipsilateral Pulsatile Tinnitus.

OBJECTIVE: To discuss the possible pathophysiologic mechanism of pulsatile tinnitus (PT) perception due to high jugular bulb with bony dehiscence (HJBD) and its improvement after the dehiscent jugular bulb (JB) resurfacing using bone cement, and to describe the efficacy of an objective measure of PT using transcanal sound recording and spectro-temporal analysis (TSR/STA). STUDY DESIGN: Retrospective case series study. SETTING: A university-based, tertiary care cancer center. PATIENTS: Three PT patients with HJBD. MAIN OUTCOME MEASURE(S): All patients underwent transtympanic resurfacing after the source of PT was confirmed by temporal bone imaging and TSR/STA. Improvement of symptom and the changes in the TSR/STA were analyzed. RESULTS: In the first case, a revision operation was performed due to slightly improved but persistent PT after initial resurfacing with bone pate and a piece of conchal cartilage. Revision transtympanic JB resurfacing was performed in this case using bone cement, and PT resolved immediately after the surgery. In the second and third cases, PT resolved completely, or was much abated, immediately after transtympanic resurfacing with bone cement. The TSR/STA also revealed improvement of PT. The median follow-up duration was 28 months, and all three patients remained asymptomatic or much improved compared with their preoperative status. CONCLUSIONS: Transtympanic resurfacing with bone cement, reinforcing the dehiscent JB to reduce focal turbulent flow, is a simple and effective surgical treatment option in patients with PT due to HJBD. In patients with HJBD, the objective measurement of PT by TSR/STA may be of help in selecting appropriate surgical candidates and objective evaluation of the treatment outcome.

Prevalence and relationship of olfactory dysfunction and tinnitus among middle- and old-aged population in Korea.

Olfactory dysfunction and tinnitus are age-related otorhinolaryngological disorders with a high prevalence in the elderly population and share several common clinical features. However, there is no study investigating the relationship between these two diseases. We studied the prevalence of olfactory dysfunction and tinnitus among Koreans and studied the relationship between these two diseases based on the Korean National Health and Nutrition Examination Survey. The subjects of this study were enrolled from the Fifth Korean National Health and Nutrition Examination Survey (2010-2012, n = 25,534). Data of subjects aged 40 years and older who underwent physical examination and completed a self-reported questionnaire and other anthropometric variables were statistically analyzed. Odds ratios were calculated to identify the relationship between olfactory dysfunction and tinnitus, using multiple logistic regression models. Older males, non-smokers, non/lower alcohol drinker groups exhibited the relationship between olfactory dysfunction and tinnitus. Metabolic syndrome and mental health problems were associated with both olfactory dysfunction and tinnitus. After adjusting for confounding factors, olfactory dysfunction was significantly associated with tinnitus (OR 1.318). There was a dose-response relationship between tinnitus severity and the odds of olfactory dysfunction (ORs for mild, moderate and severe tinnitus were, respectively, 1.134, 1.569 and 2.044). Additional molecular genetics and animal studies are needed to determine the shared pathophysiology of the two diseases.

[Diagnosis of Cochleovestibular Neurovascular Compression Syndrome:A Scoring System Based on Five Clinical Characteristics].

The optimal method for diagnosing cochleovestibular neurovascular compression syndrome(CNVC)remains controversial, and the aim of this study is to develop a standard diagnostic instrument for the condition. The clinical features of 53 sides of 50 patients with a combination of vertigo, tinnitus, and/or hearing loss were retrospectively evaluated. The following five clinical features were evaluated and given a score of 1 or 0:1)a long history of recurrent vertigo, tinnitus, or hearing loss;2)neurological findings related to positional vertigo, nystagmus, tinnitus, or hearing loss;3)neuro-otological findings involving tinnitus, audiometry, or vestibular testing;4)auditory brainstem response(ABR)evaluation with the detection of a low 25-75% II wave amplitude on the contralateral side and delayed interpeak latency in the I-III or I-V waves(usually low II wave amplitude combined with double peaks and a wide-based form)during ABR evaluation using 80 and 90dB clicks;and 5)the detection of vascular contact with the eighth cranial nerve on magnetic resonance imaging-constructive interference in steady state or air computed tomography imaging. Finally, the sum of these scores was evaluated. For cases in which more than one of the features of the items 1), 2), or 3) were present, the score was evaluated based on the most representative of the items. RESULTS: The patients were divided into those with scores of 4-5 and those with scores of 2-3. All the patients with scores of 4-5 exhibited CNVC, while those with scores of 2-3 had other diseases. Therefore, CNVC should be suspected in patients with scores of 4-5, but can be ruled out in those with scores of 2-3.

[Real Time Fuctional Magnetic Resonance Imaging Biofeedback: a New Generation of Neurotherapy].

The review summarizes the data related to the potential of the real time fMRI biofeedback (the rt-fMRI), a novel technology implementing instructing patients to modify the neural activity in the certain brain regions related to the disordered function. The recent positive results were gained for a treatment of the post-stroke impairments, the Parkinson disease, the pain syndrome, the tinnitus, the alcohol and nicotine abuse, the major depression, and phobias of contamination and spiders. The intervention Was found to be less promising for schizophrenia and nearly ineffective for the criminal antisocial personality disorder. The reliability of the results is mostly poor due to suboptimal study designs, lack of the control groups, and insufficient sample sizes. The article deals with biological basis of the technology, its current applications and perspectives; and also its method- ologicdl and methodical problems.

A mutation of the succinate dehydrogenase B gene in a Korean family with paraganglioma.

Familial paraganglioma (PGL) is a dominantly inherited disorder characterized by development of PGLs in the head and neck region. Germline mutations in genes coding for succinate dehydrogenase (SDH) subunits D, B, and C (SDHD, SDHB, SDHC) are found in almost all familial PGL patients. A 19-year-old female presented with pulsatile tinnitus and a reddish pulsating mass in the external auditory canal, and her mother complained of similar symptoms. Paraganglioma was found in both patients and was surgically removed. We report a case of germline SDHB mutation. This mutation was a deletion of thymine at nucleotide position 757 in exon 7 of the SDHB gene (c.757delT).

[Character of early tinnitus about sudden deafness].

OBJECTIVE: To study the clinical characteristics of early tinnitus in patients with sudden deafness. METHOD: Forty-seven patients with sudden deafness and early tinnitus recieved subjective review and filled out classified questionnaire of tinnitus. By pure tone audiometry and tinnitus matching test, we obtain the distribution, quantity and matching loudness of tinnitus patients. RESULT: (1) Objective examination: the most common frequencies of tinnitus were 8000 Hz and 4000 Hz. The most common numbers were two frequencies. The matching loudness was (16.63 ± 8.37) dB. (2) Subjective examination: the tinnitus was monotone (74.0%), sustained (89.0%), third level loudness (45.0%), third level annoying (60.0%), high frequency (83.0%), sound of cicadas (66.7%). The most influencing factors were hearing (28.2%) and mood (29.5%). (3) Relationship between tinnitus and pure tone hearing threshold curve: there was a significant correlation between the frequency of pure tone audiometry and the matching loudness of tinnitus (r = -0. 370, P < 0.01). There was no significant correlation between the frequency of pure tone tinnitus and the matching loudness of tinnitus (r = -0.083, P > 0.05). CONCLUSION: (1) The results of subjective examination were consistent with those of objective examination. (2) The tinnitus should be considered in the early treatment of sudden deafness.

Salud pública y propiedad intelectual en Cuba: mapa conceptual / Public health and intellectual property in Cuba: a conceptual map

OBJETIVO:El objetivo de este estudio es el análisis del marco legal de salud y propiedad intelectual en Cuba y su incidencia en las condiciones de acceso de la población a los recursos de salud y el papel de los diferentes actores sociales. METODOLOGÍA: Se utilizó la metodología desarrollada por la Organización Panamericana de la Salud para la ejecución del Proyecto Mapa Conceptual sobre Salud Pública y Propiedad Intelectual. RESULTADOS: La información recobrada en específico sobre el marco legal y su evolución en el tiempo en Cuba relacionado con el Sistema Nacional de Salud, el Sistema de Propiedad Intelectual y el fortalecimiento de la industria biofarmacéutica del país, fue procesada y analizada generando el Mapa Conceptual sobre Salud Pública y Propiedad Intelectual de Cuba. CONCLUSIONES: El análisis de la experiencia cubana en la adecuación de su marco legal y la evaluación de la interrelación de los actores sociales permite observar cómo la voluntad política existente a lo largo de varias décadas ha impactado de manera positiva en el acceso a la salud de la población.

OBJECTIVE: The objective of this study is to analyze the legal framework for health and intellectual property in Cuba and its impacton people's access to health resources and on the roles of different social actors. METHODS: The methods used were those developed by the Pan American Health Organization to implement the project of the Conceptual Map on Public Health and Intellectual Property. RESULTS: Information retrieved specifically on the legal framework for the National Health System, the Intellectual Property System and the strengthening of the country's biopharmaceutical industry-and on the framework's development over time-was processed and analyzed to generate Cuba's Conceptual Map on Public Health and Intellectual Property. CONCLUSIONS: Analysis of Cuba's adaptation of its legal framework and assessment of the interaction between the social actors involved show how the political will that has prevailed over several decades has had a positive impact on people's access to health resources.

Incidence of Retrocochlear Pathology Found on MRI in Patients With Non-Pulsatile Tinnitus.

OBJECTIVE: To identify the incidence of retrocochlear pathology on MRI in patients with non-pulsatile tinnitus. STUDY DESIGN: Retrospective review. SETTING: Tertiary referral center. PATIENTS: Adults with MRIs performed between March 1, 2008 and February 1, 2014 for non-pulsatile tinnitus with or without hearing loss. INTERVENTION: MRI. MAIN OUTCOME MEASURE: Incidence of retrocochlear pathology. RESULTS: Of the 218 patients who met inclusion criteria, 198 (91.3%) had unremarkable MRIs. Six patients (2.7%) had MRI findings that accounted for their tinnitus. Of these patients, five had unilateral tinnitus with asymmetric hearing loss because of acoustic neuroma found on MRI. One patient presented with bilateral tinnitus with asymmetric hearing loss and was found to have a right acoustic neuroma. Twenty (9.2%) patients had bilateral or unilateral tinnitus without hearing loss, all with unremarkable MRIs. Fourteen patients (6.4%) had incidental findings including two acoustic neuromas that were identified contralateral to the side of presenting tinnitus. CONCLUSIONS: Imaging should be used judiciously in the evaluation of tinnitus. Patients with unilateral tinnitus and asymmetric hearing loss were most likely to have abnormal findings. The majority of MRIs performed for tinnitus were normal in our study. Given the low incidence of MRI findings in the workup of tinnitus, every effort should be made to optimize screening protocols. Noncontrasted fast spin-echo T2-weighted MRI should be used to assess patients with tinnitus when there is low suspicion for retrocochlear pathology. Patients with unilateral non-pulsatile tinnitus with symmetric hearing may be observed, but clinical judgement should determine the need for further imaging.