Tinnitus and Sinusitis: Causes, Diagnosis, and Treatment

Tinnitus and sinusitis?

Dear Doctor,
My mother developed tinnitus in early March, possibly due to excessive stress (I am not entirely sure of the exact cause).
She describes a buzzing sound, and when the noise is too loud, it makes her very uncomfortable.
During this period, she has visited various clinics and hospitals for examinations.
The doctors have all indicated that her tinnitus is due to menopause and age-related hearing loss.
Most of them prescribed similar medications aimed at nerve activation, but later she was also diagnosed with sinusitis (she has a history of nasal allergies).
About a month ago, she underwent laser surgery, and after visiting many clinics, she found one where her condition improved slightly.
However, she still wears earplugs daily (as she dislikes loud noises, which cause her ear pain), and recently, I noticed she has a hoarse voice when she first speaks (this may also be due to her job, which requires her to talk more during this period).
She continues to have follow-up appointments but is very afraid of misdiagnosis or that her condition may worsen without proper examination.
I would like to ask the doctor the following questions:
1.
Why has there been no significant improvement after taking tinnitus medication for six months?
2.
What diagnostic methods are used to evaluate sinusitis?
3.
Is there a possibility of nasopharyngeal cancer? (I have seen many similar symptoms related to head and neck issues, which makes me anxious, but the doctors do not seem to suspect this direction.)
4.
If there were a tumor during the evaluation for sinusitis and the laser surgery, would it have been detected? Was an endoscope used during the surgery? Can an endoscope through the nasopharynx rule out the possibility of a tumor?
5.
If the hearing loss is indeed caused by menopause, can it really lead to the symptoms mentioned above? How can it be improved?
6.
Is it possible that her symptoms are due to autonomic nervous system dysfunction? My mother experiences significant work and life stress.
Thank you very much for your thoughtful response.

Xiao Qi, 10~19 year old female. Ask Date: 2020/08/04

Dr. Ji Zhaoyun reply Otolaryngology

Hello,
1.
Why has there been no significant improvement in tinnitus after taking medication for six months? The issues you mentioned could be due to: 1) Eustachian tube dysfunction: This is the most common cause and can occur not only during flying, climbing, or diving but also when forcefully blowing the nose or bending over.
2) Sudden sensorineural hearing loss; auditory nerve damage in the ear.
3) Otitis media: a) Acute otitis media: often occurs alongside upper respiratory infections (colds) or sinusitis, and in severe cases, the ear may discharge fluid or pus.
b) Chronic otitis media with acute exacerbation: typically 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 treated with medication through medical consultation for appropriate improvement.
If you have already undergone pure tone audiometry (which requires headphones in a soundproof room, where sounds prompt you to press a button, rather than just using a tuning fork), and it has been confirmed that you do not have sudden sensorineural hearing loss (deafness), then medication alone may suffice.
However, if you have not undergone pure tone audiometry, it is advisable to visit a hospital for testing to rule out sudden deafness.
If there is long-term sensorineural hearing loss, treatment will depend on the specific situation.
2.
What diagnostic methods are used to evaluate sinusitis?
3.
Is there a possibility of nasopharyngeal cancer? (I see many symptoms overlap with head and neck conditions, which makes me anxious, but the doctors do not seem to think this is the case.)
4.
If a tumor is present, would it be detected during the examination for sinusitis or during laser surgery? Is an endoscope used during the surgery? Can the endoscope pass through the nasopharynx to rule out the possibility of a tumor? If it is indeed chronic sinusitis surgery, it currently involves endoscopic surgery under general anesthesia, requiring hospitalization.
It is advisable to confirm with the original surgeon whether it is sinusitis surgery or merely surgery for hypertrophy of the inferior turbinate due to nasal allergies.
Additionally, nasopharyngeal tumors can mostly be detected through nasopharyngoscopy, although there are rare exceptions.
5.
If the hearing loss is indeed caused by menopause, could the aforementioned symptoms occur? How can it be improved?
6.
Could it be caused by autonomic nervous system dysfunction? My mother experiences significant work and life stress.
It is recommended to first confirm the issues mentioned in point 1 before considering options 5 and 6.
Options 5 and 6 should generally be considered only after ruling out other structural diseases.
If symptoms persist, it may be beneficial to accompany your mother for her next follow-up consultation.
Wishing you peace, health, and well-being.
Director of the Department of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare, Chi Chao-Yun

Reply Date: 2020/08/04

More Info

Understanding tinnitus and sinusitis involves exploring the intricate relationship between these two conditions, their causes, diagnostic methods, and treatment options. Tinnitus, often described as a ringing or buzzing in the ears, can be a frustrating and distressing symptom, while sinusitis, an inflammation of the sinus cavities, can lead to a variety of symptoms including nasal congestion, facial pain, and pressure.

1. Why has tinnitus medication shown no significant improvement after six months?
Tinnitus can be a complex condition with various underlying causes, including hearing loss, exposure to loud noises, ear infections, and even stress. If your mother has been prescribed medications aimed at nerve activation or improving blood flow, it’s important to note that these treatments may not work for everyone. The effectiveness of tinnitus treatments can vary widely among individuals. Additionally, if the underlying cause of the tinnitus—such as sinusitis or allergies—has not been adequately addressed, the tinnitus may persist despite medication. It may be beneficial to consult with an audiologist or an ear, nose, and throat (ENT) specialist who can provide a comprehensive evaluation and explore other treatment options, such as sound therapy or cognitive behavioral therapy.

2. What diagnostic methods are used for sinusitis?
The diagnosis of sinusitis typically involves a combination of patient history, physical examination, and imaging studies. A healthcare provider may perform a nasal endoscopy to visually inspect the nasal passages and sinuses. Imaging techniques, such as a CT scan, can provide detailed images of the sinus cavities and help identify any blockages, inflammation, or structural abnormalities. In some cases, allergy testing may also be recommended, especially if allergic rhinitis is suspected to contribute to sinusitis.

3. Is there a possibility of nasopharyngeal cancer?
While it’s understandable to be concerned about the possibility of nasopharyngeal cancer, especially given the overlapping symptoms with sinusitis, it is essential to approach this with a level of caution. Symptoms such as persistent nasal obstruction, ear pain, and changes in voice can occur in various conditions, not just cancer. A thorough examination by an ENT specialist, including imaging studies, can help rule out malignancies. If there are specific risk factors or concerning symptoms, further evaluation may be warranted.

4. Can tumors be detected during sinusitis examinations or laser surgery?
During a sinus examination or laser surgery, if a tumor is present, it may be visible to the surgeon. Endoscopic techniques allow for direct visualization of the nasal passages and sinuses, which can help identify abnormal growths. However, not all tumors are easily detectable, and some may require biopsy for definitive diagnosis. If there are concerns about a potential tumor, discussing these with the surgeon prior to the procedure can ensure that appropriate measures are taken.

5. Can menopause lead to the symptoms described?
Menopause can lead to hormonal changes that may affect various bodily functions, including hearing. Some women report changes in their hearing or increased sensitivity to sound during this time. While hormonal changes alone may not directly cause tinnitus, they can exacerbate existing conditions or contribute to stress, which can, in turn, worsen tinnitus. Lifestyle modifications, stress management techniques, and possibly hormone replacement therapy may be considered to alleviate symptoms.

6. Could autonomic nervous system dysregulation be a factor?
Stress and anxiety can significantly impact the autonomic nervous system, potentially leading to symptoms such as tinnitus and throat discomfort. If your mother is experiencing high levels of stress, it may be beneficial to explore stress-reduction techniques such as mindfulness, yoga, or therapy. Addressing stress can sometimes lead to improvements in both tinnitus and sinusitis symptoms.

In conclusion, managing tinnitus and sinusitis requires a comprehensive approach that considers all potential underlying factors. Continuous follow-up with healthcare providers, open communication about symptoms, and a willingness to explore various treatment options are crucial for improving quality of life. If symptoms persist or worsen, seeking a second opinion or further evaluation may provide additional insights and treatment avenues.

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