By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

AFTER READING COLUMN, CONSULT DOCTOR AGAIN ABOUT EAR NOISE

Question: I have been having loud noises in my ears for over a year. I was told I had tinnitus and there was nothing that could be done for it. The noise seems worse when I’m overheated and is also louder when I lie down. I am worried about this because there seems to be no let-up, and I’m wondering if you could give me some additional information.

Answer: Tinnitus is defined as ringing in the ears that is not related to outside or external sounds. There are several types of tinnitus and many different causes. This can be a difficult problem to diagnose and sometimes even more difficult to treat. I think the best way to handle such a broad question is to give you a general overview of the various forms of tinnitus as well as its causes and treatments.

The most common type of tinnitus is a high frequency ringing in the ears. It can be due to problems in the inner ear and is usually associated with medications that can be toxic to the ear -- “ototoxic” in doctor jargon. One very common drug that’s ototoxic is aspirin, but most people don’t experience much of a problem unless they are on a high dose regimen, such as is common in treating some types of arthritis.

Some people experience a pulsating type of sound. This is called pulsatile tinnitus. If the pulsations are in rhythm with the heartbeat, this is a good clue that the cause may be a heart murmur or obstruction in the carotid artery. On the other hand, a pulsating sound that is not “in sync” with the heart, may indicate fluid in the middle ear or a loss of motion in the ear bones, a condition called otosclerosis.

There can be a fluttering type of tinnitus. This is associated with a spasm of the muscle that tenses up the ear drum (tensor tympani).

If the tinnitus is crunching in nature, it may be due to a problem in the temporomandibular joint (TMJ) or may be due to something rubbing against the eardrum, like a piece of hair.

When the tinnitus is related to hearing loss in one ear, it may be due to an acoustic neuroma. When the hearing loss is associated with dizziness, it may be due to Meniere’s disease.

It is essential to have a thorough examination of the ear, blood tests and a simple hearing test to rule out other medical problems. A good medical history is vital as well. I assume, at a minimum, your doctor had these tests done. To pinpoint the problem, doctors also sometimes request full hearing tests as well as CT scans or magnetic resonance imaging (MRI) scans.

So as you can see, there are many types of tinnitus. If an underlying cause is found, it should be treated. Frequently, no significant cause is found. In these cases, using a fan or “white noise” device at night can often be beneficial. Some people get help from antidepressant medication.

I hope what I’ve said in this column has been helpful and that one of the “scenarios” I’ve presented seems to fit your case. Armed with this additional information, I would urge you to consult your physician again and see if a treatment might now be available.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.