Hi,

Thank you for your query.

1. Almost all people at some point in their lives experience tinnitus. It has tremendous nuisance value. In your case the tinnitus seems to have a different cause in the right and the left ear.

2. I am assuming that your Tympanogram (Impedance Audiogram) is within normal limits and that your tonsil and adenoid removal did not scar the nasal end of the eustachian tubes. An anatomically patent ET may not still not work physiologically. Also the inner end is cartilage and outer end is very hard bone. The main carotid artery canal may also be dehiscent. I am also assuming that neither of your two tinnitus subtypes is synchronous with your heartbeat (pulse).

3. Since the whooshing tinnitus in your right ear is intermittent, varies with head movement and jaw movements, you need a dental reference for TMD (Temporo-Mandibular Joint Disorders). Treatment usually involves wearing a dental splint to relax the jaw.

4. The high pitched tinnitus in your left ear is probably Cochlear Synaptic Tinnitus.
What is your exposure to occupational noise and loud music / earphones / mobile phones? Exposure to loud noise is also a leading cause for tinnitus.

5. Common tinnitus therapy includes ginkgo biloba, multivitamins and antioxidants. You may try Trans-tympanic steroids or Caroverine (Tinnex) injectable or capsules for the left ear under the supervision of an ENT Specialist. Ideally Caroverine (Tinnex) is for treatment of a type of Tinnitus known as Cochlear Synaptic Tinnitus. In this the middle ear should be normal.

6. A DNS causes nasal turbinate hypertrophy on the lateral walls of the nose and this in turn blocks the sinuses. Blocked sinuses are poorly ventilated and along with stasis of secretions, continuing infection and inflammation is common. This causes Eustachian Tube Dysfunction.

7. Regular steam inhalation is one of the best and simplest ways to keep the Eustachian Tubes healthy and functioning. If steam inhalation makes you uncomfortable, then your septal deviation and nasal obstruction is significant. A plain CT PNS (Para Nasal Sinuses) will definitely help understand your problem. The scan should be on a new generation multi-slice scanner with 1 mm coronal, axial and sagittal cuts.

8. Kindly let me know the results of your investigations. This will help in suggesting further treatment. I must emphasize that in a vast majority of patients of tinnitus, the cause is never found. However there are further treatment options depending on the type of tinnitus.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.

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Hi,

Thank you for writing back.

1. The tinnitus which varies with clenching the teeth or by moving the jaw requires dental treatment.

2. The component of Pulsatile Tinnitus is due to increased or turbulent blood flow in the vicinity of the inner ear. Activity causes dilatation of blood vessels, increasing the blood flow and hence tinnitus.

3. There are a number of reasons why you can hear your own heartbeat when you move your head or flex your neck. You must first check and rule out the the following conditions:
a. Blood pressure/ blood sugar variations and anemia (low Hb).
b. Routine ear examination to rule out earwax or fluid build up behind the ear drum.
c. Cervical spine X-rays to rule out cervical spondylosis.Cervical spondylosis usually affects the basilar arteries which travel through the cervical spine. If the sounds wake you in the morning, get cervical spine x-rays done and use a different pillow height and type to see whether the tinnitus changes / subsides.
d. Blood tests for thyroid hormones, cholesterol (lipid profile).
e. Temporal bone scans may pick up an aberrant blood vessel (rare).
f. Benign Intracranial Hypertension, XXXXXXX -Chiari Malformation (even rarer).

4. Treatment will depend on whether a cause is identified or not. You can upload your test results here under the “Upload your reports” section to discuss further treatment options. Tinnitus treatment is not easy. I must emphasize, again, that there is no cure for tinnitus. However in certain cases, it can be controlled.

5. Kindly let me know the results of your tests. This will help in suggesting further treatment.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.

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Hi,

Thank you for writing back.

1. An MRA will not miss an AVM. Hence a normal MRA will settle the issue. The chances of a structural anomaly existing is very low, but these cannot be identified without an MRI. AN MRI or MRA is advised so as to not miss anything serious.

2. Only a dentist who specializes in TMJ disorders or a Maxilo-facial Prosthodontist will be able to help.

3. Pulsatile Tinnitus is unlikely to be due to mouth (oral) problems unless there is a myoclonus of the palatal muscles.

4. The advantage of a thorough investigation is that if the cause is identified, then it may be treated. Otherwise, like a vast majority of Tinnitus sufferers, one has to earn to live with Tinnitus.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.

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