Brief Answer: Meningioma's, MS and Tinnitus (Hissing) Detailed Answer: Hi there XXXXX, Thanks for coming to HealthCareMagic. I want to summarize your past and present medical issues just so that I am sure I am not missing anything. So, to my mind, the main reason that your are posting is query is because of the hissing in your ear. The technical term for that is called tinnitus. That sounds about right? So a couple of quick questions about the hissing? When did it start? When does it get really bad? Is there any time of day or particular activity which makes it better? Your other medical issues, past and present include 1) Fibromyalgia - Are you taking treatment? Lyrica maybe? 2) Meningioma - Has there been any surgery since first diagnosis? Can you upload the scans? 3) MS - How is your neurologist managing this right now? 4) Diabetes - How are you manageing this at the moment? 5) Hydrocephalus with Active Shunt, I see the latest shunt series shows that it is working. Very good. Could you tell me if this is a programmable shunt or a fixed one? Now what could be the cause of the hissing/tinnitus? In order of most likely (in my head) least likely I would have to say: MS, Meningioma, Diabetes (yes Diabetes can cause that hissing in late stage(. So now, what can you do about it? I'm sure you have gone over the basics of the issue with your primary doctor, so i'm going to try and give you an idea of what the current therapies are and see if there is anything that might be able to help you in the long run. 1) Neuromonics: Neuromonics tinnitus treatment uses spectrally modified music in an acoustic desensitization approach in order to help patients overcome the disturbing consequences of tinnitus. Studies go either way with this. but I have seen plenty of patients where this has helped. 2) Repetitive transcranial magnetic stimulation: Transcranial magnetic stimulation (TMS) is a method of stimulating the brain through the intact scalp without causing pain at the surface. It is a minimally invasive method for depolarizing cortical neurons and is based on the principle of electromagnetic induction. The rhythmic application of a series of single stimuli is referred to as repetitive TMS (rTMS), a method that has been demonstrated to induce long-term potentiation (LTP) or long-term depression (LTD)–like changes of cortical excitability, which outlast the stimulation period. rTMS has been investigated as a therapeutic tool for depression, schizophrenia, and stroke. Recently, multiple studies have shown that the technique can alleviate tinnitus by modulating the excitability of neurons in the auditory cortex. The main caveat here is finding someone in your area who does this treatment. I do think that this therapy would hold great promise for you. 3) Drug therapy: Meds can help in the treatment of tinnitus for the 80% of patients who endure related depression (i'm not saying you are depressed, but i wouldn't be surprised given your medical history, it may be something to think upon). Administration of nortriptyline (50 mg at bedtime) is the most helpful treatment. Nortriptyline may induce dry mouth, often causing patients to terminate treatment before achieving therapeutic effect. Often, 3-4 weeks of therapy are necessary before benefits appear. Other antidepressants may be useful in treating tinnitus.. like Selective serotonin reuptake inhibitors (SSRI's) are considered to have a better safety profile compared with tricyclic antidepressants. Paroxetine (Paxil) in low doses of 10 mg at bedtime has recently been shown to be helpful. Also, sertraline (Zoloft), at a fixed dose of 50 mg/d, demonstrated a significant reduction in tinnitus severity, as well as a reduction in anxiety and depressive symptoms. Many physicians have used benzodiazepines to treat tinnitus. The theory has been that this is an anxiety disorder and the benzodiazepines should help. Unfortunately, because depression and obsessive-compulsive disorders predominate in this group, the benzodiazepines can cause more harm than good. Thus, they should be avoided as initial therapy. There have been a few studies as recent as 2009 where they studied the effectiveness of Alprazolam (Xanax) in treating tinnitus and it seems to have helped in those studies. 4) External Devices like Hearing aids, tinnitus maskers have been used with some success These are the big 4 in my opinion. I think one of these therapies would probably work for you. A good ENT doctor is the person to go to who can help you the most with this. Though I am always around to help you understand what is going on and for you to bounce ideas off of. I hope this helps. Looking forward to your reply. In general, any info ou can give me will be helpful. I practice in a Neurociritcal Care unit by day, so this timing for me is rare. It's just that it's sunday. But expect me to be able to get back to you in the evenings (Indian Standard Time). That should be day time for you. Vinay

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