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Audiology/Otolaryngology/could my tinnitus be non-neurological

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I'm 60 years old and I've had tinnitus in my left ear for two years now. It seems to be around 12khz, but I think it's a collection of tones rather than just one (though it's hard to tell at such a high frequency). I also have sinus problems, and catarrh (I can feel thick stuff sliding down my throat when I swallow hard).

This tinnitus actually goes away sometimes. A typical scenario is this: I wake up with it really loud, then I get up and wash up the previous night's dishes, then brush my teeth, and then suddenly (after about 10 - 15 minutes) I realise I can't hear it anymore.

To check, I turn off the radio and listen very carefully, and it's definitely gone. Often I'll be walking somewhere, suddenly realise I can't hear it, then stop and listen (I live in the country, where it's very quiet) and it's definitely gone.

For this reason, I'm hoping that it's caused by something like blocked sinuses, and that it goes when 'things shift around', as it were. I know that if it's neurological, nothing can be done about it, but perhaps if it's something else, some kind of treatment might be possible.

I live in the UK, and can't afford private medicine, so I have to take pot-luck, and up to now, it hasn't been encouraging. The first visit I made to my local hospital, I wasn't seen by the consultant I was meant to see, and the man who did see me just tested my hearing, found it to be normal, then said, "If you've got tinnitus, just keep your radio on at night to help you sleep." And when I told him I'd expected him to try to find the cause, he just said, "Well, tinnitus isn't something you can see". Apart from the hearing test, I was in there for about 5 minutes.

At the second hospital I went to, I again was seen by someone different than the consultant I was down for, and she just dismissed my theory of it being something to do with sinuses by saying, "If it were, it would keep changing". She didn't give me time to tell her that sometimes it actually went away. She put an instrument into my ear, but that was all. Again, the examination took no more than five minutes.

So, my main question is this: is there any chance that this tinnitus could be non-neurological, and therefore treatable (by clearing the sinuses or something like that)?

And a secondary question: if I manage to see a specialist, what tests should I expect him/her to make in order to pin down the cause of this tinnitus? I do realise from what I've read that it's often hard to get to the cause of tinnitus, but up to now, I feel that no-one has even tried.

I'd be most grateful for whatever thoughts you have on this - as a lifelong music lover, this tinnitus has stolen so much of my quality of life.

Thank you.

Answer
Malcolm,

You ask a very complex question, but the short answer is "yes, your sinus problems could be the cause (or at least contributing)".

The longer answer is that tinnitus is very complex and often thought of as a spectrum disorder, which includes many different causes (even multiple contributors).  Some example causes include impacted earwax, eardrum and middle ear damage or disorder, Eustachian tube dysfunction, hearing loss, medication side effects, vascular disorder, migraines, fatigue, stress, musculoskeletal problems (especially with the head and neck), TMJ, or peripheral/central nervous system sources.

Many people experience tinnitus, often paying no attention thinking that "doesn't everyone hear some low noise?"  In other cases, people have it, but generally assign no negative emotional reaction and pay little attention to it.

If your tinnitus is loud, then disappears as you mention, you may in fact have a form that could be more treatable if the cause is known and addressed.  Sinuses could be one possibility or even clenching/grinding teeth at night.  Both might explain why it is stronger when you first wake.

You may want to start logging data on your experience to find the pattern.  This will help add support to any theories you might have and this can be presented to any specialist you may see.  If you have a known sinus problem, it would make sense to have this addressed (as you probably would want to anyway) and then see if it helps your tinnitus as well.

Diagnosing the cause of tinnitus is not straight-forward (like diagnosing why someone has chronic pain) and is sometimes impossible since there are so many causes, many of which cannot be tested.  A complete history, otoscopy, audiogram, and tympanogram should be completed with any additional testing as recommended based on your history and results.  The combination of seeing an audiologist and otolaryngologist (ENT) is probably your best bet for where to start.

If an underlying cause is not found or not treatable (the majority of cases), then management becomes the primary focus.  In other words, identifying things you can control which help reduce the level of tinnitus and impact it has in your daily life.

I hope this is helpful and I wish you well.

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Dr. Clint D. Keifer, Audiologist

Expertise

I am qualified to answer all questions related to the diagnosis and rehabilitative treatment of hearing and balance disorders. This includes evaluation of hearing and balance, counseling, amplification (hearing aids and assistive devices), tinnitus (noises in head) evaluation and management, cochlear implants, and audiology in general.

Experience

I started my career as a hearing instrument specialist (on a trainee license) in 1998. After almost 2 years, I decided that I needed to pursue higher education if I was to provide the best care to hearing impaired patients that I could. In 2007, I completed my Doctor of Audiology and have been providing audiological care for almost 5 years. I have vestibular, cochlear implant, and pediatric experience along with prescribing, fitting, and verification of hearing aid amplification as part of comprehensive hearing loss rehabilitation.

Organizations
Audiology doctor and owner at Great Lakes Audiology in Toledo, OH. phone: 419 327-2273 website: www.GLAudiology.com American Academy of Audiology American Speech-Language Hearing Association Ohio Academy of Audiology

Education/Credentials
Bachelor of Science (B.S.), Western Michigan University, Speech Pathology and Audiology Doctor of Audiology (Au.D.), Ohio State University Certificate of Clinical Competence in Audiology (CCC-A)

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