Does Eustachian Tube Dysfunction Cause Tinnitus? Your Symptoms

Can persistent Eustachian tube dysfunction lead to tinnitus?

Hello, Doctor.
I have been experiencing unilateral tinnitus in my left ear for over six months, characterized by a high-frequency E sound.
In early August 2015, I had a wound in the external auditory canal of my left ear, possibly from accidentally scratching it.
A few days before the onset, I went swimming, and my ear might have gotten a little water in it.
There is a small hole in my left ear; when I pinch my nose and blow, air can pass through, but the ENT doctor said this is considered normal.
Hearing tests indicated poorer high-frequency hearing in my left ear (which might actually be masked by the tinnitus, so I can't hear it...), and this is deemed normal.
On the day of onset, August 5, 2015, my left ear experienced a persistent patulous Eustachian tube (not closing properly, leading to the sensation of hearing my own voice), and I didn't pay much attention to my hearing at that time, feeling it should be normal.
However, I usually experience this issue in my right ear during exercise or significant temperature changes, and it alleviates when I lower my head below my heart.
But at that time, the situation in my left ear did not improve when I bent down, and the next day I woke up with tinnitus.
I would like to ask if the occurrence of tinnitus is related to the persistent opening of the Eustachian tube at that time? Has my auditory nerve been damaged as a result? Currently, the tinnitus fluctuates in intensity; it is usually quieter in the morning when I sleep on my left side, but sometimes it becomes slightly louder by evening, and occasionally it spikes suddenly around noon (the loud tinnitus feels prickly, about a level 4 on the tinnitus scale).
It is less common, but there are instances during the day when the sound decreases to about levels 1-2, while most of the time it is at levels 2-3.
Recently, on February 22, I visited an ENT specialist, who prescribed "Rifampicin," a benzodiazepine.
I have heard that long-term use can lead to withdrawal issues.
Does this medication have therapeutic effects, or is it just for temporary symptom relief? I have taken it a few times, and the improvement feels moderate, but I do not experience insomnia at night.
Should I continue taking Rifampicin? I plan to return for an ABR test on March 7, but the doctor, after reviewing my hearing test data, believes my brainstem response should be normal, yet still arranged for the examination.
Since the onset, I have been taking B vitamins and medications to improve peripheral blood circulation, and I have been exercising regularly for the past two months, but the effects have not been significant so far.
Should I continue taking B vitamins and medications for peripheral blood circulation and keep exercising? I have many questions, and I greatly appreciate your time in answering them!

Xiao Jie, 40~49 year old female. Ask Date: 2016/02/26

Dr. Zheng Jueyi reply Otolaryngology

Hello, you can complete the relevant examinations.
If there are no obvious abnormalities, it is mostly benign tinnitus.
It is recommended to try to ignore it or use music to mask the tinnitus.
As for medications such as B vitamins and those that improve peripheral blood circulation, you may continue using them if you notice improvement.
If there is no significant change, observation is suggested.
Additionally, if you do not experience insomnia at night, there is no need to continue using Rifampicin.
Wishing you peace and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2016/02/26

More Info

Eustachian Tube Dysfunction (ETD) can indeed contribute to the experience of tinnitus, which is often described as a ringing, buzzing, or hissing sound in the ears. In your case, the left ear's persistent high-frequency tinnitus, coupled with the history of Eustachian tube dysfunction, suggests a potential link between these conditions.

The Eustachian tube serves as a passageway that connects the middle ear to the back of the throat, helping to equalize pressure and drain fluid. When this tube does not function properly—either remaining open (patulous Eustachian tube) or blocked—it can lead to various auditory symptoms, including tinnitus. In your situation, the sensation of your Eustachian tube being open, which you described as hearing your own voice unusually loud, indicates that the normal pressure regulation in your ear may be disrupted. This dysfunction can lead to abnormal auditory perceptions, such as tinnitus.

The timeline you provided, with the onset of symptoms following an incident of potential ear trauma and swimming, is also significant. Water exposure can lead to inflammation or infection in the ear, which may exacerbate Eustachian tube dysfunction. Additionally, the injury to the outer ear canal could have contributed to changes in how sound is processed in that ear, potentially affecting the auditory nerve.

Regarding your concerns about the auditory nerve being damaged, while it's possible that prolonged Eustachian tube dysfunction and associated inflammation could affect hearing, the results of your hearing tests will provide more clarity. If your hearing tests show only mild high-frequency loss, it may not necessarily indicate significant damage to the auditory nerve itself. However, the fluctuating nature of your tinnitus, with variations in intensity throughout the day, can be indicative of underlying issues that may require further investigation.

As for the medication you mentioned, "利福全" (likely referring to a benzodiazepine), it is typically used for anxiety and can have a calming effect, which may help with the perception of tinnitus. However, benzodiazepines are not a long-term solution for tinnitus and can lead to dependency if used for extended periods. It’s essential to discuss with your doctor whether this medication is appropriate for your situation, especially since you do not experience insomnia. If you find that it does not significantly alleviate your symptoms, it may be worth exploring other treatment options.

Continuing with B vitamins and medications aimed at improving peripheral circulation can be beneficial, as some studies suggest that these may help with tinnitus symptoms. Regular exercise is also a positive step, as it can improve overall circulation and potentially reduce the perception of tinnitus.

In summary, your tinnitus may indeed be related to Eustachian tube dysfunction, and while the medication you are taking may provide temporary relief, it is crucial to have a comprehensive discussion with your healthcare provider about the best long-term management strategies. The upcoming Auditory Brainstem Response (ABR) test will be an important step in assessing the function of your auditory pathways and determining if there is any underlying neurological issue that needs to be addressed.

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