The history is important defining the onset together with any precipitating events.  The course of the tinnitus and associated symptoms with medication use is important.  Clinically, a full head and neck examination in undertaken concentrating on the ear together with ear ultrasound.  The audiogram is next performed which will include a puretone audiogram, a speech audiogram together with tinnitus matching and tinnitus intensity.  Special investigations such as a CT scan of the temporal bone, ultrasound of the neck and an MRI scan of the brain is also important.  Blood tests can be performed including glucose, thyroid function test, syphilis and autoimmune workup.