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Constant tapping in ear, no ear wax. What can it be?

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I have a constant tapping in my right ear, its like morse code. I have been to the doctor and she said there is no ear wax, and she said it doesen`t sound like tintinus sorry if that is spelt wrong. It is driving me mad, what can it be, further more is there a cure. please help me.
Posted Mon, 1 Oct 2012 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 1 hour later

Thank you for your query.

1. A constant tapping sound in one ear appearing around the age of 50 years may be due to the following reasons.

2. Vascular tinnitus must be ruled out. This tinnitus variant will match your heartbeat. High or Low Blood Pressure, atherosclerosis causing turbulent blood flow in the carotid arteries is only one of many causes of tinnitus. Get a lipid profile done. A Neck Vessel Doppler Study, following which an MRA (Angiogram) may be done, if indicated.

3. 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.

4. Hyperthyroidism is a cause for pulsatile tinnitus. Other common conditions which increase blood flow are anemia (low hemoglobin) and strenuous exercise.

5. Palatal Myoclonus is a rare cause such sounds. There are also two extremely small muscles attached to the tiny ear ossicles (bones). Myoclonus of the Tensor Tympani and/or the Stapedius muscles may also be a source of these sounds. Acoustic refles tests must also be done. Muscle relaxants may work here, though side effects is an issue.

6. A persistent Stapedial Artery, High Jugular bulb, Benign Intracranial Hypertension, Sigmoid Sinus Dehiscence or diverticulum are some conditions which will require an HRCT (High Resolution CT) Scan (on a multi-slice machine)and MRI Temporal Bones (3 Tesla) to rule out.

7. If the sound can be heard by others, it is known as objective tinnitus. The sounds of muscle contractions in palatal myoclonus may be heard by an observer. A nasal endoscopy may help observe the palate.

8. Decreased hearing also makes one more aware of tinnitus. Get a PTA (Pure Tone Audiogram) done. If you have a hearing loss, amplification may help mask the tinnitus. You may also get middle ear pressure checked (Impedance Audiometry). Eustachian Tube Dysfunction also produces ear sounds.

9. 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. There is no cure for tinnitus however in certain cases, it can be controlled. There are further treatment options.

Hope, I have answered your query. Please accept my answer in case you do not have further queries.

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