How can one check that someone truly has tinnitus, without relying on their claims?

Question

I read on https://www.johnfoy.com/faqs/whats-wrong-with-3m-companys-dual-ended-combat-arms-earplugs-version-2-caev2/ (mirror):

To be eligible for the CAEv2 lawsuit specifically, you’ll need to have:[...] Been diagnosed with tinnitus or hearing loss.

And https://veteranshelpgroup.com/tinnitus-proving-something-only-i-can-hear/ (mirror):

If you have regular or recurrent tinnitus 10% is given—currently, 10% warrants $140.05 a month. Any additional hearing loss or other hearing conditions can be separately rated and combined. Because this is the most commonly claimed condition, veterans often start their claim journey by claiming tinnitus first. Don’t forget to consider all other service-connected conditions too!

This made me wonder: How can one check that someone truly has tinnitus, without relying on their claims?

I searched for tinnitus diagnosis tests and all I could find seemed to rely on the claims of the patient, which I think, perhaps erroneously, could easily dupe a medical provider. For example, https://veteranshelpgroup.com/tinnitus-proving-something-only-i-can-hear/ indicates:

Because usually only the person impacted can hear the sound, the VA requires hearing and tests to confirm the diagnosis. Next, you should write your statement explaining the nexus between your condition and when in service you experienced the loud noise or another condition of which tinnitus is a symptom. Finally, gather and include documents like your medical records and a written physician’s opinion to support your claim.

which sounds easily fakable.

Answer 1

There are no diagnostic tests that can objectify/confirm the experience of subjective tinnitus, other than searching for an underlying cause of tinnitus. In fact, if you ask me, there are generally no medical tests that can confirm the sensation of a symptom. As a parallel, if someone could objetify the experience of pain and quantify it with some kind of test, this would be big news in the scientific world. Most tests are designed to diagnose underlying conditions that may lead to specific symptoms.

Tinnitus is particularly tricky because it can occur even in the absence of a detectable disease. Additionally, we still lack sufficient answers regarding how or where tinnitus arises in healthy individuals. (Other than it is most often associated with factors such as acoustic trauma, presbyacusis.) Does the sensation of sound originate from the inner ear, or somewhere along the neural pathway to the auditory cortex? While many theories exist, none are conclusive.

This is not to say there aren't several conditions known to cause tinnitus. These conditions can often be more or less confirmed through various tests or imaging techniques (e.g., vestibular schwannomas, meningiomas, Ménière’s disease, glomus tumors, large vestibular aqueduct, bone dehiscence around the inner ear, tensor tympani syndrome, and vascular abnormalities).

In clinical practice, I believe there is no need for an objective test to verify the sensation of tinnitus, except in cases where "objective tinnitus" is suspected, such as with tensor tympani syndrome.

Your question, however, relates to cases where individuals might seek financial compensation for tinnitus resulting from acoustic trauma. I am also surprised by how this is handled, as tinnitus can indeed be easily "faked". If a person says that they experience tinnitus it is not possible to refute this even though a thourough medical examination (physical exam, audiometry, MRI, CT etc.) returns without pathological findings.

However, audiometric testing can aid in differentiating hearing loss caused by acoustic trauma from presbycusis (age-related hearing loss). A typical audiometric pattern in cases of acoustic trauma shows worse hearing around 4000 Hz (it looks like a spike down in the audiogram, google it!). While audiometric testing is not entirely objective (it is called psychoacoustic testing for a reason), it is much harder to fake. If a person has a typical audiogram pattern of acoustic trauma while experiencing tinnitus, it would be easier to conclude that the tinnitus might be caused by the acoustic trauma.

https://www.ncbi.nlm.nih.gov/books/NBK578179/

https://www.ncbi.nlm.nih.gov/books/NBK430809/

Answer 2

The study {1} mentions:

Imaging can identify the cause and evaluate the extent of disease for surgical planning. The common causes of tinnitus and hearing loss without a mass include otospongiosis, labyrinthitis ossificans, superior semicircular canal dehiscence, and enlarged vestibular aqueduct syndrome.

nyulangone.org mentions cranial nerve issue as another potential cause:

An MRI scan may reveal a growth or tumor near the ear or the eighth cranial nerve that could be causing tinnitus.

{2} mentions more imaging options. So images could help detect fraudsters to some extent.

mayoclinic.org outlines typical tinnitus tests:

To help identify the cause of your tinnitus, your doctor will likely ask you about your medical history and examine your ears, head and neck. Common tests include:

• Hearing (audiological) exam. During the test, you'll sit in a soundproof room wearing earphones that transmit specific sounds into one ear at a time. You'll indicate when you can hear the sound, and your results will be compared with results considered normal for your age. This can help rule out or identify possible causes of tinnitus.

• Movement. Your doctor may ask you to move your eyes, clench your jaw, or move your neck, arms and legs. If your tinnitus changes or worsens, it may help identify an underlying disorder that needs treatment.

• Imaging tests. Depending on the suspected cause of your tinnitus, you may need imaging tests such as CT or MRI scans.

• Lab tests. Your doctor may draw blood to check for anemia, thyroid problems, heart disease or vitamin deficiencies.

The audiologist may detect fraudsters if they give atypical answers, but it seems that a well-informed individual may be able to fake the condition as there is no definitive, objective test.

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References:

• {1} Hoang JK, Loevner LA. Evaluation of Tinnitus and Hearing Loss in the Adult. 2020 Feb 15. In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Brain, Head and Neck, Spine 2020–2023: Diagnostic Imaging [Internet]. Cham (CH): Springer; 2020. Chapter 15. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554328/ doi: 10.1007/978-3-030-38490-6_15
• {2} Khan, R.A., Sutton, B.P., Tai, Y. et al. A large-scale diffusion imaging study of tinnitus and hearing loss. Sci Rep 11, 23395 (2021). https://doi.org/10.1038/s41598-021-02908-6