Tinnitus After Middle Ear Effusion: Causes and Treatments

Q: Tinnitus After Middle Ear Effusion: Causes and Treatments

Hello, 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 your nose or bending over. <br>2) Sudden sensorineural hearing loss (commonly

Tinnitus after middle ear effusion?

Hello, Doctor.
Recently, I experienced fluid accumulation in my middle ear.
After about a month of medication treatment without improvement, I underwent tympanocentesis on my left ear twice (with a one-week interval).
The doctor mentioned that the fluid in the middle ear has resolved, but I occasionally experience tinnitus, especially in quiet environments or during noisy situations (this has happened once or twice).
The tinnitus resembles a persistent sound that occurs in extremely quiet conditions, and it lasts for a while, gradually increasing in volume until it becomes very uncomfortable before stopping.
Occasionally, I also experience tinnitus in my right ear, but it is different and disappears after a while in the same environment.
During my follow-up visit, the doctor suggested it might be a residual effect.
Later, I experienced persistent ringing throughout the night, so I visited another clinic where the doctor conducted a pure tone audiometry test (my left ear showed slight weakness at 250/500/4K, but all results were below 10, and the tinnitus nearly masked the test sounds).
I was prescribed chronic medication, and after taking the medication from the clinic, the ringing was somewhat reduced (but still ongoing), so I returned to the original medication prescribed by the hospital, which continued the tinnitus, and it sometimes becomes very loud, particularly when I am sleeping on my left side.
When the tinnitus reaches a certain level, I become particularly sensitive to it or other sounds (the hospital's secondary diagnosis indicated earwax blockage and otitis externa, with medications including Ginkgo biloba and antihistamines).
Here are my questions for the doctor:
1.
One day during this period, I woke up with dizziness that lasted for half a day, and I felt like I was leaning to one side, but it resolved later.
Should I get this checked? (I will ask the doctor during my visit)
2.
What could be the possible causes of this tinnitus?
3.
If it is a residual effect, how long might it last?
4.
If, after providing this information and undergoing related treatments, there is still no improvement, what other areas should I consider for examination or treatment? (I thought about using music to mask the tinnitus, but sometimes it still doesn't help, and I feel very uncomfortable with the music)
5.
The hospital mentioned that I have a deviated septum.
Is surgery really necessary, or can I just observe it for now? (I currently don't have much time to address this)
Thank you, Doctor, for your response.

Niming, 20~29 year old female. Ask Date: 2023/11/18

Dr. Ji Zhaoyun reply Otolaryngology

Hello, 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 your nose or bending over.
2) Sudden sensorineural hearing loss (commonly referred to as sudden deafness).
3) Otitis media: a) Acute otitis media: Often occurs alongside upper respiratory infections (such as colds) and 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.
c) Middle ear effusion.
All of the above conditions can be appropriately treated with medication after consulting a physician.
If you have already undergone pure tone audiometry (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 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 deafness, as early treatment tends to yield better outcomes.
Regarding the symptoms of tinnitus and dizziness mentioned, there are numerous potential diagnoses for dizziness alone: 1) If accompanied by a dull pain at the back of the head, it may suggest poor blood circulation in the head and neck.
2) If there is also ear fullness, pressure, or hearing loss, it may indicate sudden deafness, Meniere's disease, or acute labyrinthitis.
3) If turning the head exacerbates the symptoms, it may suggest benign paroxysmal positional vertigo (BPPV).
Other potential diagnoses for dizziness include vestibular neuritis, migraine-associated vertigo, orthostatic hypotension, hyperlipidemia, and brain lesions, among others.
It is recommended to seek further evaluation and treatment from an otolaryngologist or neurologist.
Wishing you peace and good health.

Reply Date: 2023/11/18

More Info

Tinnitus, or ringing in the ears, can be a distressing condition, especially following middle ear effusion (MEE), which is the accumulation of fluid in the middle ear. Understanding the causes and treatments of tinnitus in this context is essential for managing symptoms and improving quality of life.

Causes of Tinnitus After Middle Ear Effusion
Tinnitus can arise from various factors, particularly after experiencing MEE. When fluid builds up in the middle ear, it can affect the normal functioning of the auditory system, leading to changes in hearing and the perception of sound. Here are some potential causes of tinnitus in your situation:
1. Eustachian Tube Dysfunction: The Eustachian tube helps equalize pressure in the middle ear. If it does not function properly, it can lead to fluid retention and pressure changes, which may trigger tinnitus.

2. Hearing Loss: Even slight changes in hearing sensitivity, as indicated by your audiometric tests, can lead to tinnitus. The brain may amplify sounds that are not present, resulting in the perception of ringing or buzzing.

3. Inflammation: Inflammation from infections or allergies can affect the middle ear and inner ear, contributing to tinnitus.
4. Nerve Damage: If the auditory nerve has been affected during the episode of MEE, it may lead to persistent tinnitus.

5. Psychological Factors: Stress and anxiety can exacerbate tinnitus perception. If you are experiencing stress due to your symptoms, it may worsen the condition.

Treatment Options
1. Medical Management: Continue with the medications prescribed by your physician. These may include corticosteroids to reduce inflammation or antihistamines if allergies are a contributing factor.

2. Sound Therapy: Using background noise or music can help mask the tinnitus. This is particularly useful at night when the sounds may be more pronounced.

3. Cognitive Behavioral Therapy (CBT): If tinnitus is causing significant distress, CBT can help you manage your reaction to the sound and reduce its impact on your life.

4. Tinnitus Retraining Therapy (TRT): This combines sound therapy with counseling to help you habituate to the tinnitus.

5. Regular Follow-ups: Since your symptoms are fluctuating, regular follow-ups with your ENT specialist are crucial. They can monitor your condition and adjust treatments as necessary.

Prognosis and Duration of Tinnitus
If your tinnitus is a result of MEE, it may improve as the underlying condition resolves. However, if it is a post-viral or post-traumatic effect, it could persist for a longer duration. Some individuals experience tinnitus for weeks to months after the initial event, while others may find it becomes a chronic issue.

Further Investigations
If your symptoms do not improve with conservative management, further evaluations may be warranted:
1. Imaging Studies: An MRI or CT scan may be necessary to rule out structural abnormalities or other underlying conditions.

2. Vestibular Assessment: Given your experience with dizziness, a vestibular evaluation may help determine if there are balance issues contributing to your symptoms.

3. Allergy Testing: If allergies are suspected, testing may help identify triggers that could be contributing to your ear problems.

Nasal Septum Deviation
Regarding your nasal septum deviation, surgical intervention is typically considered if it significantly impacts breathing or contributes to recurrent sinus infections. If your symptoms are manageable and not causing significant issues, observation may be appropriate. However, if you find that nasal congestion is exacerbating your ear problems, discussing surgical options with an ENT specialist may be beneficial.

Conclusion
Tinnitus following middle ear effusion can be multifactorial and may require a comprehensive approach to management. Regular communication with your healthcare provider is essential to navigate this condition effectively. If symptoms persist or worsen, do not hesitate to seek further evaluation and treatment options. Your well-being is paramount, and addressing both the physical and psychological aspects of tinnitus can lead to better outcomes.

Similar Q&A

Understanding Tinnitus: Causes, Treatment Options, and Sleep Impact

Hello, doctor. I keep hearing a sound that resembles "ee ee ee," which I believe is a phenomenon of tinnitus. I wonder if this condition is related to an incident during my military service when I experienced temporary hearing loss in both ears for 2-3 days after shooti...

Dr. Ji Zhaoyun reply Otolaryngology
Hello, 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 your nose or bending over. 2) A history of sudden sensorineural hearing loss....

Living with Tinnitus: My 10-Year Journey After Ear Infections

Hello, I had an episode of acute otitis media in elementary school, and I first visited a clinic for treatment. Later, I was referred to the ENT department at a hospital, where they confirmed that the otitis media had resolved. However, since then, I have been experiencing tinnit...

Understanding Tinnitus: Causes, Treatments, and When to Seek Help

Hello Doctor: Three months ago, I occasionally experienced a low rumbling sound in my right ear, which would resolve after a while. Later, I began to hear a high-pitched sound in my left ear, resembling an ambulance siren, which has been constant for 24 hours. I usually cannot he...

Dr. Ji Zhaoyun reply Otolaryngology
Hello, 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 your nose or bending over. This is likely related to nasal congestion. 2) Sud...

Understanding Tinnitus: Causes and Solutions for Ear Issues

Hello, doctor: Recently, I've been feeling a cool sensation on the top of my head, and I've also been experiencing a buzzing sound in my ears. What could be the cause of this?