Tinnitus: Insights from ENT Specialists in Taiwan

Reply to the doctor's question - Thank you for your assistance?

Your question: Since elementary school, I have experienced a crackling sound in my left ear when exposed to loud noises (similar to the sound of a radio without a signal), but I didn't think much of it.
Recently, in my second year of high school, I noticed that this crackling sound, which used to require a loud noise to trigger, now occurs even with softer sounds.
Additionally, during hiccups and yawning, the crackling sound appears with minimal noise.
(Recently, I have been increasingly unable to hear sounds when yawning.) I visited Yadong Hospital and saw two doctors.
One said it was just sensitivity to noise and advised me to avoid loud places, while the other suggested it was tinnitus and seemed reluctant to listen to my detailed symptoms, dismissing me quickly! After returning home, I searched online for information but found nothing conclusive, only some forums with users experiencing similar symptoms, but they also reported that their doctors could not provide effective treatment.

Response from Dr.
Chen Jian-Zhi, an ENT specialist: Dear inquirer, may I ask which ear is experiencing the tinnitus? Have you undergone a hearing test? What was the diagnosis from the treating physician?
Dr.
Chen's response: Tinnitus can occur in both ears and is typically noticeable in quiet environments.
The hospital conducted a hearing test, and the doctor stated that my hearing is normal (I was in a soundproof room in front of a machine, pressing a button whenever I heard a sound).
I repeatedly told her that loud noises cause crackling in my left ear, but the doctor insisted it was also tinnitus.

The first consultation was with Dr.
Zhao Ting-Kuan, who addressed:
1.
Sinusitis, nasal polyps, allergic rhinitis, and endoscopic nasal surgery.

2.
Minimally invasive surgery, cold touch vaporization surgery, snoring, and sleep apnea.

3.
Otitis media, hearing impairment, otosclerosis, and cochlear implants.

4.
Implantable bone conduction hearing aids and acoustic neuroma.

5.
Pediatric ENT diseases and head and neck tumors.

6.
Laser surgery for laryngeal lesions.

7.
Voice disorders and general ENT issues.

8.
Dizziness, tinnitus, and inner ear disorders.

The second consultation was with Dr.
Huang Cong-Wei, who addressed snoring and sleep apnea, nasal congestion, nasal polyps, allergic rhinitis, and sinusitis, as well as laser and minimally invasive endoscopic surgery for inferior turbinate reduction, otitis media, hearing impairment, vertigo, tinnitus, voice disorders, and laryngeal endoscopic surgery, along with pediatric ENT conditions, pediatric otitis media, and pediatric sinusitis.

I primarily consulted them because they specialize in hearing impairment and tinnitus.

Lü, 10~19 year old female. Ask Date: 2010/05/02

Dr. Chen Jianzhi reply Otolaryngology

Dear Inquirer,
Tinnitus is indeed a challenging issue to address.
Most patients worry about the possibility of an undetected serious underlying condition, and the diagnosis and treatment often test the physician's capabilities.
Here, we must honestly and humbly inform you that most otolaryngologists, including myself, feel quite helpless when it comes to tinnitus.
However, there is a physician, Dr.
Lai Ren-Tsung, the head of the ENT department at Shalu Guangtian Hospital, who is very passionate and proactive in researching tinnitus.
I recommend that you seek consultation with him.
Sincerely,
Dr.
Chen Jian-Zhi, Lecturer at Fu Jen Catholic University and Physician at Taoyuan General Hospital, Department of Health

Reply Date: 2010/05/02

More Info

Tinnitus, often described as a ringing, buzzing, or hissing sound in the ears, is a common condition that can significantly impact an individual's quality of life. Your experience of hearing a "shh" sound in your left ear, particularly when exposed to loud noises or during actions like yawning or hiccupping, is indicative of tinnitus. It’s important to understand that tinnitus is not a disease itself but rather a symptom of an underlying condition, which can range from hearing loss to ear infections or even exposure to loud noises.

In your case, the fact that you have experienced this symptom since childhood and that it has progressively worsened suggests that it may be related to changes in your auditory system. The fact that you can hear the sound in quieter environments may indicate that your brain is more attuned to these internal sounds when external noise is reduced. This phenomenon is often referred to as "masking," where external sounds can mask the perception of tinnitus.

The two ENT specialists you consulted provided differing opinions, which can be common in medical practice, especially with conditions like tinnitus that can be subjective and vary greatly from person to person. One doctor suggested avoiding loud environments, which is a standard recommendation since exposure to loud sounds can exacerbate tinnitus. The other doctor diagnosed you with tinnitus, which aligns with your symptoms.

It’s crucial to note that tinnitus can be associated with various conditions, including:
1. Hearing Loss: Age-related hearing loss or noise-induced hearing loss can lead to tinnitus. The auditory system may become more sensitive, leading to the perception of sounds that are not present.

2. Earwax Blockage: Excessive earwax can block the ear canal, leading to pressure changes and tinnitus.

3. Middle Ear Issues: Conditions like otitis media (middle ear infection) or Eustachian tube dysfunction can also contribute to tinnitus.

4. Neurological Conditions: In some cases, tinnitus can be linked to neurological disorders, including acoustic neuroma, a benign tumor on the auditory nerve.

5. Stress and Anxiety: Psychological factors can exacerbate tinnitus, making it more noticeable during stressful times.

Given that your hearing tests returned normal results, it may be beneficial to explore other potential causes. You might consider seeking a comprehensive evaluation from an audiologist or a specialized tinnitus clinic, where they can provide more targeted assessments and management strategies.

Management of tinnitus often includes:
- Sound Therapy: Using background noise or white noise machines can help mask the tinnitus sounds.

- Cognitive Behavioral Therapy (CBT): This can help manage the emotional response to tinnitus.

- Hearing Aids: If hearing loss is present, hearing aids can amplify external sounds, which may help mask tinnitus.

- Lifestyle Changes: Reducing caffeine and nicotine, managing stress, and ensuring good sleep hygiene can also be beneficial.

In conclusion, while your experience with tinnitus is understandably concerning, it is a common condition that can often be managed effectively. Seeking further evaluation and treatment options from specialists who focus on tinnitus may provide you with relief and a better understanding of your condition. If you continue to experience distressing symptoms, do not hesitate to seek a second opinion or further evaluation.

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