Unilateral High-Frequency Tinnitus: Causes and Tests

Is there any recommended testing for unilateral high-frequency tinnitus?

Hello Doctor: About six months ago, after catching a cold, I developed right ear otitis media (ear fullness, pain, and hearing loss) along with chronic sinusitis symptoms.
Initially, the doctor only prescribed antibiotics and did not address the nasal inflammation, so neither the ear nor the sinus issues improved significantly.
However, a month ago, I switched doctors, who managed the nasal inflammation, and I have seen improvement in my right ear's hearing and fullness.
But two weeks ago, I suddenly started experiencing persistent high-frequency tinnitus in my left ear, which is noticeable in quiet places, especially at night, disrupting my sleep and waking me up.

I have a few questions:
1.
When I pinch my nose and blow, my left eardrum can bulge, but my right eardrum cannot.
Previously, I sometimes felt a sensation in my left ear in the morning similar to being on a plane, but it would disappear after a while.
The doctor mentioned this is due to poor Eustachian tube function.
Could my unilateral tinnitus be related to the poor Eustachian tube function? If it is due to Eustachian tube dysfunction, how long might it take for the tinnitus to resolve?
2.
The doctor recently prescribed Ibuprofen to help alleviate the ear inflammation, and I experienced tinnitus during the treatment.
I used it for a total of seven days, but it has been ten days since I stopped taking it, and the tinnitus has not diminished.
Could this be a side effect of the medication? If it is a medication side effect, how long does it typically take to resolve?
3.
Do you recommend any further examinations? I had a hearing test two days before the onset of the tinnitus, which showed no issues.
Should I undergo any additional tests? Thank you!

Yunfei, 30~39 year old female. Ask Date: 2020/09/14

Dr. Zheng Jueyi reply Otolaryngology

Hello,
1.
Tinnitus may be related to poor Eustachian tube function, but the recovery time for Eustachian tube function can vary, ranging from several days to several weeks.

2.
The occurrence of tinnitus due to ibuprofen is very rare, and it is not associated with long-term use or drug side effects.

3.
If the hearing test shows no issues, you may continue with the medication treatment.
However, if the symptoms persist without improvement, you should continue to follow up for further evaluation.
Wishing you peace and health,
Dr.
Cheng Jue-Yi,
Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2020/09/14

More Info

Understanding unilateral high-frequency tinnitus can be quite complex, especially when it follows a history of ear infections and sinus issues. Your symptoms and medical history provide important clues for understanding the potential causes and necessary evaluations.

1. Eustachian Tube Dysfunction and Tinnitus: It is indeed possible that your unilateral tinnitus is related to Eustachian tube dysfunction (ETD). The Eustachian tube helps equalize pressure in the middle ear and drains fluid. When it is not functioning properly, it can lead to a sensation of fullness or pressure in the ear, which may contribute to tinnitus. The fact that you can make your left eardrum move by pinching your nose and blowing indicates that the Eustachian tube on that side is functioning better than the right. If your tinnitus is related to ETD, the duration of the tinnitus can vary. Some patients experience improvement within days to weeks once the Eustachian tube function is restored, while others may take longer, especially if there are underlying issues like chronic sinusitis or inflammation that need to be addressed.

2. Ibuprofen and Tinnitus: Regarding the use of Ibuprofen, while it is generally well-tolerated, some individuals may experience tinnitus as a side effect of non-steroidal anti-inflammatory drugs (NSAIDs). If your tinnitus began during the course of taking Ibuprofen and has persisted after stopping, it could be related to the medication. Typically, if the tinnitus is indeed a side effect, it may resolve within a few days to weeks after discontinuation of the drug. However, since your tinnitus has not improved after stopping the medication for ten days, it may be more related to your underlying ear condition rather than the Ibuprofen itself.

3. Further Evaluations: Since you have already undergone a hearing test that showed normal results, it may not be immediately necessary to repeat that test unless your symptoms change or worsen. However, if your tinnitus persists or if you develop additional symptoms (such as hearing loss, dizziness, or pain), further evaluations may be warranted. This could include imaging studies like an MRI or CT scan to rule out structural issues or other conditions such as acoustic neuroma, especially given your history of ear infections and the recent onset of tinnitus. Additionally, a consultation with an otolaryngologist (ENT specialist) may provide more tailored management options, including treatments for Eustachian tube dysfunction or other underlying conditions.

In summary, your unilateral high-frequency tinnitus could be linked to Eustachian tube dysfunction, especially given your history of ear and sinus issues. While Ibuprofen may have contributed to the onset of your tinnitus, it is more likely that the underlying ear condition is the primary cause. Monitoring your symptoms and seeking further evaluation if they persist or worsen is advisable. Always consult with your healthcare provider for personalized advice and treatment options.

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