What’s that I hear?

Noises in my ear... Photo:   | Photo Credit: mail grjgm

Tinnitus — described as ringing or noise in the ear — is purely a subjective experience because no such sound exists in the environment.

Symptoms may include buzzing, roaring, ringing, whistling or hissing sounds perceived in the ear. These sounds may be intermittent, continuous or pulsatile.

Tinnitus may interfere with normal activities and sleep and may cause an associated decrease in the ability to hear conversations or other sounds in the environment.

The problem

The inner ear is structurally very close to the middle ear. So the commonest cause is disease of the middle ear, which extends to the inner ear. Usually an ENT surgeon can diagnose this easily. Such patients may have a history of ear pain, discharge, recurrent nasal or throat infections and/or deafness.

However, in a majority of cases, the ear drum (Tympanic membrane) and middle ear are structurally normal. In such cases, where possibilities of damage to inner ear are direct, it could be due to a local cause or due to generalised diseases, metabolic disorders, vascular causes or toxic.

Objective Tinnitus occurs when both the patient and the Ear Surgeon can hear. This is caused by palatal myoclonus or myoclonus of small muscles of the middle ear, vascular abnormalities and tumours called glomus jugulare and aneurysms. Any disease or condition in the external, middle, inner ear and nervous connections to the brain may produce a sound.

The patient will have to undergo certain investigations like audiometry, impedance audiometry, acoustic reflexes, reflex decay, rustachian tube function tests, SISI test, tinnitus matching and tinnitus grading tests. Of course, a complete ENT examination is a must. The diagnosis may also include x-rays of mastoids, CT scan, MRI and Doppler studies.

The patient’s general health history — including BP measurements, thyroid function — and the medication he/she is taking will also be necessary for diagnosis.


Often, other than linking tinnitus to sensory hearing loss, specific causes are very difficult to identify. Understanding tinnitus and learning to live with it is the best option. In most cases, there is no specific, tried-and-true treatment.

If an otolaryngologist finds a specific cause for the tinnitus, there may be a specific treatment to eliminate the noise. Although there is no specific medication, some may help to reduce the noise.

For those with deafness, a programmable digital hearing aid will solve both problems. It not only improves the hearing but also masks tinnitus. Stapedotomy for deafness due to otosclerosis cures both deafness and tinnitus.

An alternative option is tinnitus retraining therapy (TRT), which diverts the brain’s attention from Tinnitus by a specific method.

Psychotherapy and hypnosis are also recommended in difficult cases. Yoga and meditation also help in managing tinnitus.

In cases of objective tinnitus due to palatal myoclonus, an injection of Botulinum A toxin in the palatal muscles brings temporary relief. It may need to be repeated at intervals of six months.

If the problem is due to vascular tumours, these can be removed.



Wax in the ear

Perforation of tympanic membrane due to infection or trauma

Collection of fluid in the middle ear causing muffling of voice with low pitched tinnitus. This is usually intermittent

Age-related deafness and tumour of the hearing nerve can lead to high pitched tinnitus, ringing in character

Exposure to loud noise may produce tinnitus that lasts for a short time

Meniere’s disease is characterised by a combination of low pitched fluctuating tinnitus, which becomes louder during attacks, fluctuating hearing loss and vertigo


Drugs like aspirin, quinine, salicylates, streptomycin, dihydrostreptomycin, neomycin, gentamicin are ototoxic drugs causing high pitched tinnitus

Vascular causes like atherosclerosis, hypertension cause high pitched tinnitus. In hypertension tinnitus is fluctuating

Anaemia and low BP causes low intensity tinnitus

General diseases like Paget’s disease, syphilis, multiple sclerosis

TM joint problem

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Printable version | Mar 4, 2021 2:27:18 AM |

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