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The differential for what causes tinnitus is actually large, but most people (and many clinicians) fail to recognize that it is important to differentiate subjective tinnitus (what you the patient appreciates) versus objective tinnitus (something that can actually be heard by something else like another person or more likely sensitive otoacoustic equipment). Otologic: Long-term noise exposure, presbycusis (natural aging of the ear), cerumen impaction (ear wax), Meniere's disease, etc. Muscular: Palatal myoclonus (usually due to brainstem damage causing this secondarily), spasms of the stapedius or tensor tympani muscle (the tiniest muscles in the ear than normally protect the ear from noises too loud), etc. I like this drawing below, because it shows some of the pathologies mentioned above that can cause tinnitus and their locations (compared to the brain and nose's location). Normally, tinnitus has a straight forward cause and easy to diagnose a cause through our discussion and exam, even if I order some additional test to rule out one of the more serious possible causes (since we don't want to miss these of course). When people do have tinnitus, 22% experience it in both ears equally, 34% only in one ear, and the remainder in both ears but with one ear being louder.
Do you have a history of noise exposure, ear infections, ear surgeries, ear deafness in the past, head injuries, recent medication changes, other things that happen at the same time?
Tricyclic antidepressants ( amitriptyline and nortriptyline) These have been used with some success.
Alprazolam (Xanax) may help take the edge off the symptoms, but side effects can include drowsiness and nausea, and they can become habit-forming, or increase fall risks in the elderly. Noise suppression to "out compete" the tinnitus, such as white noise machines (falling rain, city traffic, ocean waves).Hearing aids if it present in people with associated hearing loss. Despite numerous trials utilizing ginkgo biloba, no firm conclusion regarding efficacy is yet reached.
I created this on my own time as an educational source for whoever wants my explanation on these topics.
I have found that patients are good stewards of their own health if they have the knowledge to do so. This is because the actual diagnoses that fit into subjective versus objective tinnitus differ. Sometimes, in the elderly, there can be narrowing in the vessels leading to the head, or in the head itself, which can cause a whooshing sound due to turbulent flow of the blood. The first drawing is a small one showing you the ear and some the basic anatomy so you can compare it. But these medications are generally used for only severe tinnitus, as they can cause side effects like dry mouth, blurred vision, constipation, heart problems, and confusion in the elderly. Masking aids worn in the ear which essentially are white-noise-machine-meets hearing-aid and produce a low-level white noise in the ear during the day.Tinnitus retraining which is a wearable device that plays tonal music that over time helps one not to focus on the tinnitus. It is relatively benign at usual treatment doses and a dose 120-160mg should be tried if desired.
That does not mean there is a tumor in that one ear or something happening only in that ear; we just have to consider that possibility.
I completed my Neurology Residency in the vast medical center in Houston at Baylor College of Medicine and completed my Sleep Medicine Fellowship at Duke University in Durham.



Ear plugs train noise reduction
Hearing white noise in right ear kopfh?rer
Stadium noise earthquake
Noise cancelling earbuds for running 2014




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