I have unilateral tinnitus. if l also hear slightly less well with that same ear, is acoustic neuroma still unlikely?

Rare: A good work up for tinnitus with unilateral hearing loss would include a test to r/o an acoustic neuroma (mri). It is doubtful, but the MRI would check for irregularities including ruling out an acoustic neuroma. Best wishes.

Acoustic Neuroma: An acoustic neuroma is a slow-growing tumor of the nerve that connects the ear to the brain. The symptoms vary based on the size of the tumor. Common symptoms include: abnormal feeling of movement (vertigo), hearing loss in the affected ear, ringing (tinnitus) in the affected ear, dizziness, headache, numbness in the face or one ear, pain in the face or one ear, and weakness of the face.

Possible: Need MRI for unilateral tinnitus and hearing loss. Chance that this represents acoustic neuroma is statistically small, but MRI should be done to rule out serious cause of the hearing loss and tinnitus.