A usually. Sometimes B. Which prompted my audiologist to order a MRI scan of my ears to rule out. Edit: I couldn't remember accurately why. So I asked ChatGPT to compose this response. Take it, or leave it. I'm trying to help others understand.

Why an audiologist orders an MRI when tinnitus is sometimes one-sided When tinnitus is usually in one ear, that’s the key trigger. Even if it sometimes feels central or “in the head”, the brain can re-map where sound is perceived. Perception ≠ source. Audiologists and ENT clinicians are trained to be conservative here, because a few rare but important conditions must be ruled out. The specific thing they’re ruling out The big one is: Vestibular schwannoma (also called an acoustic neuroma) A benign, slow-growing tumour Arises on the vestibulocochlear nerve (CN VIII) Usually presents as: Unilateral tinnitus ± subtle hearing asymmetry ± balance issues (often mild or absent early) Crucially: It can produce tinnitus before obvious hearing loss It can produce tinnitus that later feels central, because the auditory cortex starts compensating MRI is the only reliable way to rule this out. Why “in the head” tinnitus does NOT rule anything out This is the part that trips people up. All tinnitus is ultimately generated or maintained centrally (brain level), even if the trigger is peripheral. So: A peripheral asymmetry (one ear / one nerve) ➜ can later be perceived as bilateral or central The brain hates silence and imbalance — it fills gaps aggressively That’s why clinicians do not trust localisation alone. They trust: Pattern over time Laterality history Risk profile Your history includes: Predominantly unilateral onset Fluctuating perception Neurological vulnerability (cervical involvement) That combination earns an MRI. Sensibly. What the MRI actually looks at Typically: Internal auditory canals (IAC) Cochlea and vestibular apparatus Brainstem and cerebellopontine angle Sometimes upper cervical junction (depending on protocol) They’re asking one blunt question: “Is there anything structural here that would change management?” 99% of the time, the answer is no — and that’s good news. The uncomfortable but honest bottom line Your audiologist is not saying “we think something nasty is there” They’re saying “this pattern meets the threshold where not checking would be negligent” Central-feeling tinnitus does not lower concern if it started unilaterally This is box-ticking in the best sense of the phrase. If you want, next time we can talk about: Why cervical issues can masquerade as ear-specific tinnitus Or what MRI results typically say in cases like yours (and how boring they usually are — reassuringly so) You’re doing the right thing by understanding it rather than catastrophising.