Unexplained Unilateral Tinnitus: Causes and Next Steps for Relief

Unexplained unilateral tinnitus?

Hello Doctor: I have been experiencing unilateral tinnitus (on the right side) for almost three months now.
Yesterday, I visited an ENT specialist at a hospital, and after examination, the doctor said my ear was clean and there were no issues.
He also checked my nose and found no abnormalities.
After conducting a hearing test, the results showed that my hearing is good! Therefore, the doctor mentioned that he is currently unsure of the cause of the tinnitus and advised me to adjust my daily routine.
He said to seek medical attention again if the tinnitus persists.
This week, I started experiencing dizziness, sometimes feeling like I might faint, but fortunately, I haven't.
Initially, the tinnitus was only at night, but now it has become constant throughout the day! I am also beginning to feel some blurriness in my vision.
Could the issue be related to another organ? If I observe this situation for another week and it continues, which department should I consult? Thank you!

Mila, 10~19 year old female. Ask Date: 2016/10/14

Dr. Ji Zhaoyun reply Otolaryngology

Hello Mila,
The issues you mentioned could potentially 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, can lead to ear discharge; b) chronic otitis media with acute exacerbation, which usually involves a pre-existing perforation of the eardrum, potentially caused by unclean water or improper ear cleaning, leading to inflammation.

All of the above conditions can be appropriately managed with medication through medical consultation.
If you have already undergone a pure-tone audiometry test (which requires headphones in a soundproof booth, where you respond to sounds by pressing a button, rather than just using a tuning fork), and it has confirmed that you do not have sudden sensorineural hearing loss, then medication alone may suffice.
However, if you have not had a pure-tone audiometry test, I recommend visiting a hospital for evaluation to rule out sudden hearing loss, as the golden treatment window for sudden sensorineural hearing loss is two weeks, and early treatment yields better outcomes.

Additionally, you mentioned that "this week I started feeling dizzy, sometimes feeling like I'm about to faint, but fortunately I haven't.
Initially, I only had tinnitus at night, but now it has become constant throughout the day." Given that your symptoms seem to be worsening, I recommend returning to the hospital for another pure-tone audiometry test to rule out sudden sensorineural hearing loss.
Since you also experience blurred vision, it would be advisable to consult both an otolaryngologist and a neurologist.

Wishing you good health,
Dr.
Chi Chao-Yun,
Director of the Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare

Reply Date: 2016/10/14

More Info

Unilateral tinnitus, especially when it persists for several months, can be concerning and may indicate an underlying issue that requires further investigation. Given your symptoms, including the recent onset of dizziness and visual disturbances, it is essential to approach this situation with a comprehensive understanding of potential causes and next steps for relief.

Possible Causes of Unilateral Tinnitus
1. Eustachian Tube Dysfunction: This can lead to pressure imbalances in the ear, causing tinnitus. It may also contribute to feelings of dizziness.

2. Vestibular Disorders: Conditions such as Meniere's disease can cause unilateral tinnitus, hearing loss, and vertigo. This might explain your dizziness and the sensation of near-fainting.

3. Acoustic Neuroma: This benign tumor on the vestibulocochlear nerve can lead to unilateral tinnitus, hearing loss, and balance issues. While it is less common, it is a serious condition that should be ruled out.

4. Cervical Issues: Problems in the cervical spine can sometimes lead to tinnitus and dizziness due to nerve compression or vascular issues.

5. Neurological Conditions: Conditions affecting the central nervous system, such as multiple sclerosis, can present with tinnitus and visual disturbances.

6. Stress and Anxiety: Psychological factors can exacerbate tinnitus and may lead to dizziness and visual disturbances.

Next Steps for Relief
1. Follow-Up with an ENT Specialist: Since your initial visit did not yield a clear diagnosis, consider returning to an ENT specialist for further evaluation. They may recommend imaging studies, such as an MRI or CT scan, to rule out structural issues like an acoustic neuroma.

2. Neurological Evaluation: Given your new symptoms of dizziness and visual disturbances, it may be prudent to consult a neurologist. They can assess for any neurological conditions that might be contributing to your symptoms.

3. Audiological Assessment: A more comprehensive audiological evaluation may be necessary to assess for any subtle hearing changes that might not have been detected in the initial hearing test.

4. Lifestyle Modifications: Adjusting your daily routine, managing stress, and ensuring adequate hydration can sometimes alleviate symptoms. Avoiding caffeine and loud noises may also help.

5. Physical Therapy: If your dizziness is related to vestibular dysfunction, vestibular rehabilitation therapy may be beneficial. This therapy focuses on exercises that help improve balance and reduce dizziness.

6. Monitoring Symptoms: Keep a diary of your symptoms, noting when they occur, their intensity, and any potential triggers. This information can be invaluable for your healthcare providers in diagnosing and managing your condition.

Conclusion
Unilateral tinnitus, especially when accompanied by dizziness and visual disturbances, warrants further investigation. It is crucial to consult with specialists who can provide a thorough evaluation and appropriate diagnostic tests. While some cases of tinnitus may resolve on their own, persistent symptoms should not be ignored, as they may indicate a more serious underlying condition. By taking proactive steps and seeking the right medical advice, you can work towards finding relief and addressing any potential health issues.

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