Kessler Marcus M, Moussa Marwan, Bykowski Julie, Kirsch Claudia F E, Aulino Joseph M, Berger Kevin L, Choudhri Asim F, Fife Terry D, Germano Isabelle M, Kendi A Tuba, Kim Jeffrey H, Luttrull Michael D, Nunez Diego, Shah Lubdha M, Sharma Aseem, Shetty Vilaas S, Symko Sophia C, Cornelius Rebecca S
Principal Author, AllegiantMD, Tampa, Florida.
Research Author, University of Ankansas for Medical Sciences, Little Rock, Arkansas.
J Am Coll Radiol. 2017 Nov;14(11S):S584-S591. doi: 10.1016/j.jacr.2017.08.052.
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.
耳鸣是在没有外部声源的情况下对声音的感知。它是一种常见症状，可能与听力损失及其他良性病因有关。然而，耳鸣可能使人致残，并且可能是中枢神经系统疾病患者的唯一症状。病史和体格检查是确定是否需要进行影像学检查的关键首要步骤。CT和MRI在搏动性耳鸣的情况下有助于评估潜在的血管异常。如果伴有不对称听力损失、神经功能缺损或头部外伤，影像学检查应遵循各自相应的美国放射学会（ACR）适宜性标准文件，而非耳鸣的存在情况。对于未定位到单耳的主观性、非搏动性耳鸣，影像学检查通常并不适宜。美国放射学会适宜性标准是针对特定临床情况的循证指南，每年由多学科专家小组进行审查。指南的制定和修订包括对同行评审期刊上的当前医学文献进行广泛分析，以及应用成熟的方法（兰德/加州大学洛杉矶分校适宜性方法和推荐分级评估、制定与评价或GRADE）来评估特定临床场景下影像学检查和治疗程序的适宜性。在缺乏证据或证据不明确的情况下，专家意见可能会补充现有证据以推荐影像学检查或治疗。
