Tinnitus and Ear Congestion: When to Seek Further Help

Tinnitus and ringing in the ears?

Hello Doctor, yesterday morning I suddenly felt a sensation of fullness in my right ear, accompanied by tinnitus (a buzzing sound).
When I hear higher frequency or louder sounds, I also experience a beeping sound, and I have difficulty hearing external sounds clearly.
After visiting an otolaryngologist in the evening, the doctor diagnosed me with acute hearing loss and recommended that I take medication temporarily, advising me to go to a larger hospital if there is no improvement within three days.
Today, the feeling of fullness is somewhat less severe, but I still have tinnitus and the beeping sound when I hear high-frequency noises, and sometimes I also feel slight pain.
Therefore, I immediately went to the hospital's otolaryngology department.
After assessing my hearing, the doctor felt there was no issue and believed that the tinnitus was merely caused by rhinitis.
He suggested that I take Mometasone nasal spray for two weeks and then reassess.
Since there is a significant difference between these two diagnoses, and if it truly is acute hearing loss, the treatment should ideally be initiated as soon as possible.
Should I wait to see if there is improvement after taking Mometasone for two weeks, or would it be better to seek a second opinion from another physician sooner? Thank you!

Niu Yi, 30~39 year old female. Ask Date: 2016/07/15

Dr. Ji Zhaoyun reply Otolaryngology

Hello, regarding the issues you mentioned, they could possibly be due to: 1) Eustachian tube dysfunction, 2) Sudden sensorineural hearing loss, or 3) Otitis media: a) Acute otitis media, which often occurs alongside upper respiratory infections (such as colds) and sinusitis, and in severe cases, may lead to ear discharge; b) Chronic otitis media with acute exacerbation, often due to a pre-existing perforation in the eardrum, which can become inflamed due to contaminated water or improper ear cleaning.
All of the above conditions can be appropriately managed with medication after consulting a healthcare provider.
If you have already undergone pure tone audiometry (which requires headphones in a soundproof room, where you press a button in response to sounds, rather than just using a tuning fork), and it has been confirmed that you do not have sudden sensorineural hearing loss, then medication may suffice.
However, if you have not had a pure tone audiometry test, it is advisable to visit a hospital for evaluation to rule out sudden hearing loss.
The optimal treatment window for sudden sensorineural hearing loss is within two weeks, and early treatment yields better outcomes.
Wishing you safety and good health.
Sincerely, Dr.
Chi Chao-Yun, Head of the ENT Department, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2016/07/15

More Info

Tinnitus and ear congestion can be distressing symptoms that significantly impact your quality of life. Based on your description, it seems you are experiencing a combination of ear fullness, tinnitus (ringing or buzzing in the ears), and sensitivity to certain frequencies, which can be indicative of several underlying issues.
Acute hearing loss, as diagnosed by your first doctor, can be caused by various factors, including sudden sensorineural hearing loss, which may require prompt treatment. The second opinion you received, suggesting that your symptoms may be related to nasal congestion or rhinitis, is also a valid consideration. The Eustachian tube, which connects the middle ear to the back of the nose, can become blocked due to nasal inflammation, leading to a sensation of fullness in the ear and contributing to tinnitus.

In your case, the recommendation to take a nasal steroid like mometasone (莫鼻卡) for two weeks is a common approach to reduce inflammation and potentially alleviate your symptoms. However, if you do not notice significant improvement within a few days, it is essential to follow up with your healthcare provider or seek a second opinion.
Here are some additional points to consider regarding your situation:
1. Monitoring Symptoms: Keep a detailed record of your symptoms, including when they occur, their intensity, and any factors that seem to worsen or improve them. This information can be invaluable for your healthcare provider in determining the best course of action.

2. Follow-Up Care: If your symptoms persist or worsen, do not hesitate to seek further evaluation. It may be beneficial to consult an otolaryngologist (ENT specialist) who can perform a comprehensive assessment, including audiometric testing and possibly imaging studies if indicated.

3. Potential Treatments: Depending on the underlying cause of your tinnitus and ear congestion, treatment options may include:
- Medications: In addition to nasal steroids, other medications may be prescribed to address inflammation or manage tinnitus symptoms.

- Sound Therapy: This involves using background noise or white noise to help mask the tinnitus sounds.

- Cognitive Behavioral Therapy (CBT): This can help manage the emotional response to tinnitus and improve coping strategies.

- Eustachian Tube Dysfunction Treatments: If your symptoms are related to Eustachian tube dysfunction, techniques such as the Valsalva maneuver or other methods to equalize ear pressure may be recommended.

4. Lifestyle Modifications: Reducing exposure to loud noises, managing stress, and avoiding caffeine and nicotine can also help manage tinnitus symptoms.

5. Hearing Aids or Sound Devices: If hearing loss is confirmed, hearing aids or sound-generating devices may improve your overall auditory experience and help mask tinnitus.

In conclusion, while the initial treatment with mometasone is a reasonable step, it is crucial to remain vigilant about your symptoms and seek further medical advice if necessary. Tinnitus and ear congestion can be multifactorial, and a thorough evaluation is essential to determine the most effective treatment plan. Your proactive approach to seeking help is commendable, and I encourage you to continue advocating for your health.

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