Persistent Tinnitus: Seeking Help from Neurology or Neurosurgery? - Otolaryngology

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Persistent tinnitus, or chronic ringing in the ears, can be a frustrating and debilitating condition. Given your recent experience with fever and the subsequent onset of significant tinnitus, it is understandable that you are seeking further medical evaluation. The fact that both the ENT (ear, nose, and throat) specialists at Mackay Hospital and Gengxing Hospital did not find any issues during your hearing tests and endoscopy is a positive sign, as it suggests that there may not be any obvious structural problems in the ear or surrounding areas.

When considering whether to consult a neurologist or a neurosurgeon, it is important to understand the differences in their specialties. Neurologists focus on diagnosing and treating disorders of the nervous system, which includes the brain, spinal cord, and peripheral nerves. They are well-equipped to handle conditions that may cause tinnitus, such as neurological disorders, migraines, or even issues related to the auditory pathways in the brain. On the other hand, neurosurgeons specialize in surgical interventions for conditions affecting the nervous system, including tumors, vascular malformations, and other structural issues that may require surgical treatment.

In your case, since the tinnitus is persistent and has not improved despite ENT evaluations, it would be advisable to first consult a neurologist. They can perform a thorough assessment, which may include a detailed medical history, neurological examination, and possibly imaging studies such as an MRI of the brain. This evaluation can help determine if there are any underlying neurological causes for your tinnitus that may not have been identified in the ENT assessments.

If the neurologist finds that there is a structural issue that requires surgical intervention, they may then refer you to a neurosurgeon. However, it is more common for tinnitus to be managed through non-surgical means, such as medication, cognitive behavioral therapy, sound therapy, or other forms of rehabilitation.

In addition to seeking a neurologist's opinion, it may also be beneficial to explore other supportive therapies for tinnitus management. These can include:
1. Cognitive Behavioral Therapy (CBT): This type of therapy can help you manage the emotional response to tinnitus and reduce the distress it causes.

2. Sound Therapy: This involves using background noise or white noise to help mask the tinnitus sounds, making them less noticeable.

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

4. Lifestyle Modifications: Reducing caffeine and alcohol intake, managing stress, and ensuring adequate sleep can also help alleviate tinnitus symptoms.

5. Hearing Aids: If there is any degree of hearing loss, hearing aids can amplify external sounds and help mask the tinnitus.

In summary, I recommend that you consult a neurologist to explore the potential neurological causes of your persistent tinnitus. They will be able to guide you through the appropriate diagnostic tests and treatment options. If necessary, they can refer you to a neurosurgeon if any surgical intervention is deemed appropriate. In the meantime, consider exploring supportive therapies that may help you manage the condition more effectively.