Persistent High-Pitched Tinnitus After Ear Stone Displacement

Persistent high-pitched tinnitus as a sequela of otolith displacement?

Hello, doctor.
Initially, due to freediving, I noticed a sensation of hearing through a membrane after resting onshore.
After visiting the hospital, I was diagnosed with otolith dislodgement.
Although my dizziness improved after treatment, I still have the following issues: 1.
Persistent high-pitched tinnitus (ongoing for one month) 2.
Occasionally hearing a rolling sound in my right ear (the affected ear with the dislodged otolith) 3.
A pure tone audiometry test revealed poor high-frequency hearing in the affected ear 4.
It seems that my Eustachian tube function has significantly declined due to prolonged diving 5.
My next examination is a brainstem auditory evoked response test scheduled for January 24.
The doctor mentioned that I may not fully recover, but I still hold onto some hope of finding ways to improve or rehabilitate.
Additionally, the next appointment is a month away, and I am concerned about missing the critical window for treatment.
The doctor has not clearly explained the cause of my symptoms, so I am seeking medical knowledge and support.
Thank you.
One more thing, can I take a short flight of about 2-3 hours in this condition? Thank you for taking the time to respond.
I greatly appreciate it.

Juzi, 20~29 year old female. Ask Date: 2016/12/16

Dr. Ji Zhaoyun reply Otolaryngology

Hello, the issues you mentioned may be due to 1) Eustachian tube dysfunction: This can occur not only during flying, climbing, or diving, but also when forcefully blowing your nose or bending over.
2) Sudden sensorineural hearing loss: This is more in line with what you described.
3) Otitis media: a) Acute otitis media: Often occurs alongside upper respiratory infections (like colds) or sinusitis, and in severe cases, there may be ear discharge.
b) Chronic otitis media with acute exacerbation: This usually occurs when there is a pre-existing perforation in the eardrum, which can become inflamed due to unclean water or improper ear cleaning.
All of the above conditions can be appropriately treated with medication after consulting a healthcare provider.

If you have already undergone pure tone audiometry (which requires headphones in a soundproof room, where you respond to sounds by pressing a button, 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 hearing loss is within two weeks, and high-dose corticosteroids are recommended for better outcomes.

Based on your description, it seems that the duration of hearing loss may have exceeded two months, which could lead to a diagnosis of irreversible hearing loss.
There are some treatments involving corticosteroids, improving blood circulation, and oxygen supplementation, but these have not yet been widely validated for improving hearing.
Brainstem auditory evoked response testing is often conducted when there is a significant discrepancy in hearing between the two ears, as there is a 2% possibility that it could be caused by a brainstem tumor, which is why such tests are arranged.

As for whether you can take a short-haul flight, this should be assessed based on your current condition, so it is best to consult your treating physician.
Wishing you peace and good health.

Sincerely,
Dr.
Chi Chao-Yun,
Director of the ENT Department, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2016/12/16

More Info

Persistent high-pitched tinnitus following ear stone displacement can be a distressing condition, especially after experiencing symptoms like dizziness and a sensation of fullness in the ear. Your situation seems to involve a complex interplay of factors, including the displacement of otoliths (ear stones), potential inner ear damage, and possibly eustachian tube dysfunction, particularly given your history of free diving.

Tinnitus, particularly high-pitched ringing, can arise from various underlying issues. In your case, the initial displacement of the ear stones likely triggered a vestibular response, leading to dizziness and the sensation of pressure in the ear. While the dizziness may have improved post-treatment, the persistence of tinnitus and altered hearing could suggest ongoing issues with the inner ear structures or auditory pathways.

1. High-Pitched Tinnitus: This type of tinnitus is often associated with damage to the hair cells in the cochlea, which can occur due to various reasons, including exposure to loud noises, aging, or trauma. Given your history of ear stone displacement, it is plausible that the mechanical disruption caused by the otoliths could have led to temporary or permanent changes in the auditory system.

2. Hearing Loss: The fact that your hearing test indicated reduced sensitivity to high frequencies in the affected ear suggests that there may be some degree of sensorineural hearing loss. This type of hearing loss can be caused by damage to the inner ear or the auditory nerve, which may be exacerbated by the initial event of ear stone displacement.

3. Eustachian Tube Dysfunction: Your mention of decreased eustachian tube function is significant. The eustachian tube helps equalize pressure in the middle ear and can become dysfunctional due to various factors, including allergies, infections, or anatomical issues. Dysfunction can lead to a sensation of fullness, muffled hearing, and may contribute to the perception of tinnitus.

4. Potential for PPPD: Persistent Postural-Perceptual Dizziness (PPPD) is a condition that can develop after vestibular events, such as ear stone displacement. If you continue to experience dizziness in certain positions or movements, it may be worth discussing this possibility with your healthcare provider.

5. Next Steps: It is essential to follow up with your healthcare provider regarding the upcoming brainstem response test. This test can help evaluate the integrity of the auditory pathways and rule out other potential causes of your symptoms, such as neurological issues. If your symptoms persist or worsen, seeking a second opinion or additional evaluations may be beneficial.

6. Travel Considerations: Regarding your question about flying, it is generally advisable to consult your physician before traveling, especially if you are experiencing ongoing symptoms. Changes in air pressure during flights can affect the ears, particularly if there is existing dysfunction in the eustachian tube. If you feel stable and your doctor agrees, short flights may be manageable, but it’s crucial to be cautious and prepared for any discomfort.

In summary, persistent high-pitched tinnitus after ear stone displacement can stem from various factors, including inner ear damage, eustachian tube dysfunction, and potential vestibular disorders. Continued monitoring and appropriate medical evaluations are essential for managing your symptoms effectively. Always communicate openly with your healthcare provider about your concerns and any changes in your condition.

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