Expert: Daniel J. Bosnyak, PhD - 10/26/2009

Question
QUESTION: I had middle ear surgery/Ossiculoplasty in Dec. 2008.  Ever since, I have had a ringing in the same ear that wasn't there before.  It is constant.  I have been back to my ENT several times complaining and they cannot determine what is causing it.  Any suggestions?

ANSWER: Tim,

I have seen a very similar case just recently.  The constant ringing is known as tinnitus.  Although the repair to the bones of the middle ear likely restored some of your hearing, some was likely still lost.  In many cases such loss triggers the tinnitus for reasons that are still not completely clear.  We are currently working on a study of people in similar circumstances to try to see why some get tinnitus and some do not.  Since it has been quite some time since the surgery it is unlikely that your hearing will recover any further and the tinnitus is likely permanent.  There are a number of treatment options for tinnitus, depending on its severity.  None of them are likely to make the tinnitus completely go away at this point.  Most treatments are aimed at making the tinnitus more bearable.  Even if you were able to somehow restore perfect hearing to that ear the tinnitus might not completely recede after having been there for so long - although in theory restoration of hearing should help reverse the changes that caused the tinnitus.

---------- FOLLOW-UP ----------

QUESTION: Thanks for the thorough and detailed explanation!!!  What treatments would be the most beneficial for my case?  I am sure the origin of the tinnitus has some impact on how well different treatments work.  Thanks again for you help!

Answer
First I cant really recommend a specific treatment without knowing a lot more about your situation.  There are tinnitus treatment clinics scattered around the US and the best thing would be for you to visit one.  I can only discuss tinnitus treatments in general given my lack of knowledge about your specific case.

There are really three classes of tinnitus treatments.  One type of treatment tries to lessen the tinnitus sensation.  These treatments might include such things as surgery (usually brain surgery), some experimental drug treatments (eg gabapentin) or possibly training the brain in certain sound discrimination tasks.  Most of these treatments are experimental and none is really well established.  There may be some dietary or lifestyle changes that can have some positive effects on the sensation as well.

The second class of treatment tries to lessen the impact of the tinnitus sensation by weakening the link between the tinnitus sound and the distress that it causes.  The most widely recognized therapy of this type is Tinnitus Retraining Therapy or TRT but there are others, such as the Neuromonics device.  Most tinnitus clinics also provide various types of individual or group counseling with the same goal in mind.  I wouldn't want people to think that this type of treatment is inferior because it is only 'psychological' rather than being aimed at removing the actual tinnitus sensation.  The real clinical problem of tinnitus is not the sound itself but rather the distress it causes you.  I am sure that many people know from firsthand experience that there are some sounds that can really drive one person crazy (like fingernails on chalkboard) while leaving another person mostly unaffected.  The goal here is to try to make sure that the tinnitus sound doesn't 'drive you crazy' and there are some fairly effective ways to change your reaction to the sound if you have the patience and commitment to try them.  None of them can be really 'guaranteed' to work though so keep this in mind.  In general, the more distressed you are the more likely it is that such therapies can help, unless there are other co-morbidities involved.

The third class of treatments are really best for people who are not highly distressed by their tinnitus but rather find it annoying only in some situations, such as when it is time to fall asleep.  These 'treatments' are usually some form of masking sound that you listen to that partially or totally blocks out the tinnitus sound.  The trick here is to find a type of sound that does this but is not more annoying than the tinnitus itself.  There are many different people who will try to give you or sell you such sounds; many of them are available online.  I don't think there is any magic here so don't get taken in by any overly expensive masker generation program.  Also, the optimal masker depends on the situation.  For example, music might work well under some conditions but not others.  Of course people who are really distressed by their tinnitus might also benefit from maskers but this is sort of controversial.  TRT I believe specifically advises against the habitual use of maskers (except under specific circumstances) but I am not a trained TRT practitioner so I may be wrong.  You can also buy wearable devices that provide masking sounds continuously.  This might be a good option if maskers are particularly effective for you.