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What Causes Subjective Tinnitus?

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Posted on Wed, 15 Feb 2017
Question: Hello, I understand from my prime physician I'm about to describe a form of subjective tinnitus (S.T.). I realize if that's accurate there is no known cure. My question, if you agree I'm describing a form of S.T., is its nature require sub-specialist training to help with managing the symptoms? I ask because I've never heard anyone else describe it quite like I have. BTW I am a 74 yo male, in good health. Have been on low level statin treatments for cholesterol. By my Dr's direction, I am in a brief hiatus from the statin because of muscle stiffness affecting my sleep. At my annual physical last week, a slightly elevated thyroid reading was noticed. We will recheck that reading about 4 weeks after my hiatus from the statin is complete. I'm taking OTC Calcium and D-3. No other meds on a regular basis. Occasional pain pill, occasional decongestant for allergies. Occasional= 1 at a particular night. Not both on the same day.
The sound is like a buzz, but not a constant buzz. Rather an external sound triggers a proportionally loud buzzing. Eg: No sound, no discernable buzz. The external sound is always "heard" louder than the buzz. At light-volume conversational levels, the buzz is hardly noticeable. At my church, with many voices singing the buzz becomes annoying. If music is very loud, at times the buzz could range from distracting to shy-of- "painful".
This type of buzz imitated suddenly,last year. I noticed it immediately at the end of an ear wax removal session at an Otolaryngologist's office. He used a suction device to remove loose fragments from the hairy jungle inside my ears. I could hear or sense fragments passing out of my ear, sometimes hitting or bouncing off (?? hairs or skin within ??) the inside. The suction technique had been used in previous visits without ill effects, and had been used several times that day without noticeable change to my hearing. But on the last suction, the change occurred immediately after a "pop" sound. No physical rupture was found by a subsequent ear examination. At the time, the buzzing was stronger then than today, except for very soft conversation (which hasn't registered then or now). The buzz is only my right ear, where the suction was being applied.
A few audio tests were performed (voice, pressure, tones), not revealing any objective difference, BUT the voice and tone tests were at relatively low volumes, thus not triggering the buzz.
Is there a clinical name for this type of tinnitus, if it is tinnitus?
Note I have two other levels of tinnitus, existing now and prior to the above version. The first was a faint, high pitch - it began decades ago. The second is more like the sound of cicadas. Often I don't "notice" the "cicadas". Since the latter's onset, I haven't noticed the first. Maybe the first is being masked by or has morphed to louder "cicadas". That sound is neither 100% steady nor as a cyclical wave - more like minor, random variances of intensity. These first two sounds were or are in both ears.
--- Thanks for considering all I've said.

XXXXXXX XXXX
doctor
Answered by Dr. Sumit Bhatti (8 hours later)
Brief Answer:
Hyperacusis following acoustic or barotrauma.

Detailed Answer:
Hi,

Thank you for your query.

1. This seems to be hyperacusis following acoustic or barotrauma following the ear wax suction. Drug induced tinnitus is a second possibility. Many people with tinnitus and hearing loss have hyperacusis or a 'recruitment' phenomenon.

2. It would have been best treated with steroids within 4-6 weeks. Since it is one sided, get an HRCT Temporal Bone Scan done. Rule out Superior Semicircular Canal Dehiscence (SSCD).

3. Use of ear plugs will help.

4. Treatments that are possible now are TRT (Tinnitus Retraining Therapy), A digital programmable hearing aid, Trans-Tympanic Steroids and HyperBaric Oxygen Therapy (HBOT). The problem is unlikely to be cured, but can be controlled.

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

Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

Answered : 2685 Questions

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What Causes Subjective Tinnitus?

Brief Answer: Hyperacusis following acoustic or barotrauma. Detailed Answer: Hi, Thank you for your query. 1. This seems to be hyperacusis following acoustic or barotrauma following the ear wax suction. Drug induced tinnitus is a second possibility. Many people with tinnitus and hearing loss have hyperacusis or a 'recruitment' phenomenon. 2. It would have been best treated with steroids within 4-6 weeks. Since it is one sided, get an HRCT Temporal Bone Scan done. Rule out Superior Semicircular Canal Dehiscence (SSCD). 3. Use of ear plugs will help. 4. Treatments that are possible now are TRT (Tinnitus Retraining Therapy), A digital programmable hearing aid, Trans-Tympanic Steroids and HyperBaric Oxygen Therapy (HBOT). The problem is unlikely to be cured, but can be controlled. I hope that I have answered your query. If you have any further questions, I will be available to answer them. Regards.