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Dr. Andrew Rynne

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Experiencing hissing sound in ear after ears syringed for ear wax. Remedy?

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Dr. Sumit Bhatti

ENT Specialist

Practicing since :1991

Answered : 2563 Questions

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Posted on Fri, 26 Jul 2013 in Ear, Nose and Throat Problems
Question: Greetings. I am trying unsuccessfully to understand the physiological nature of tinnitus.
About 2 months ago I had my ears syringed for ear wax, and since that time I have experienced varying degrees of a soft high frequency hissing sound in my right ear. I have had my ears syringed a number of times in the past, and this time I did not experience any discomfort.
Over the two months the soft hissing (sounds like air escaping from a ball or similar) has in fact diminished, and for a number of days I have had no symptoms at all (today I had some symptoms again).
I visited two otolaryngologists who I felt did not satisfactorily explain the physiology to me very well, although one said he removed a hair against my eardrum. I assume that if there were actual damage the symptoms would be constant rather than intermittent and fluctuating. I did not experience loud noise or infection, and my eardrum was not injured so I am still unclear as to why there is this intermittent hissing.
I would describe it as mild (on a scale from 0 to 10, usually 1-2), and sometimes sense the soft hissing more when I am walking on the street or with the air conditioner on (I know that it is said that tinnitus is less prominent with background noise). Many times in the last week or so there have been no symptoms at all. For the first several weeks it would increase up to a 5 or 6. To make it more interesting, my mother (who is 77) began experiencing tinnitus in both ears about 5 years ago.
I am attaching the two hearing tests I had from the two otolaryngologists for your review. I look forward to your comments. Thank you.
doctor
Answered by Dr. Sumit Bhatti 2 hours later
Hi,

Thank you for your query.

1. You have a high frequency Sensori-Neural Hearing Loss (SNHL) and a mild age related (SNHL) sloping to the left in the attached Audiograms. The former is usually associated with NIHL (Noise Induced Hearing Loss). What is your occupational exposure to noise?

2. This may be the cause of your Tinnitus. The syringing may have drawn your attention to the Tinnitus.

3. The exact cause of Tinnitus is unknown. However one of the the agreed pathology is damage to or loss of to hair cells in the inner ear. The role of the brain in the perception of Tinnitus also exists. For example, some people have been relieved of Tinnitus after a cerebral stroke, while some continue to hear it even after the Cochlear (Hearing) Nerve is cut.

4. There are also types of Tinnitus which occur with normal or Conductive Hearing Loss (CHL). Objective Tinnitus may be heard by others and Pulsatile or Vascular Tinnitus is related to increased or turbulent blood flow. You may get a Neck Vessel Color Doppler done.

5. If your Tinnitus increases on clenching the teeth, it may require dental bite correction. I have noticed patients who have increased Tinnitus when they are stressed, have fluctuations of blood pressure, low hemoglobin, low blood sugar levels and so on.

6. 'Recruitment' is a phenomenon that gives rise to an abnormal increase in loudness of high pitched sounds when intact hair cells next to damaged hair cells are 'recruited' for hearing. This may explain why the Tinnitus increases with loud sounds.

7. Cochlear Synaptic Tinnitus may be treated in up to 50% people with Caroverine infusion followed by capsules for two months. Other treatments such as transtympanic steroids, gingko biloba, multi-vitamins and anti-oxidants may also help in reducing Tinnitus.

8. Have you shifted your residence in the last decade? What is your exposure to mobile phone radiation? Traffic noise and earphone volumes are potential causes.

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

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 37 minutes later
Thank you, Dr. Bhatti. I have had no special exposure to loud noise recently that would have been a cause (other than the usual street traffic), and it seemed to have started only after this latest syringing. Yet my left ear is totally normal.
I don't understand why only one ear would be affected.

And if I have no occupational hearing loss what would account for the SNHL in one ear (or is it both)? Is it likely that my hearing loss in general will increase as I get older?

The issue of recruitment is interesting in regard to being out on the street or being exposed to a room full of people.Yet as I mentioned the intensity seemed to have diminished since it began so that most of the time it is at a level of 1-2. Right now as I write after returning from outside shopping it is definitely a 2 or even a 3. But why is it that if there is permanent damage the tinnitus fluctuates and is even absent?

As I mentioned, my mother has not been exposed either and 6 years ago at age 70 developed it in both ears, which she thinks is a function of having had a case of Bell's Palsy, which I have not had
doctor
Answered by Dr. Sumit Bhatti 19 hours later
Hi,

Thank you for writing back.

1. Exposure to street noise above 80 dB for more than 8 hours a day may damage hearing.

2. Your hearing loss is more in your Right ear, hence the Tinnitus is worse in one ear.

3. Presbyacusis occurs with age and progresses as we age.

4. The exact cause and factors involved in Tinnitus are not known. Fluctuations may occur due to many disease processes. In the absence of an active cause for fluctuations it may be due to changing levels of perception in the brain during any distraction or activity.

5. Bell's Palsy affects only the Facial (7th Cranial Nerve) and not the Acoustic (Hearing or 8th Cranial Nerve) and hence is unlikely to be a cause. Viral infections such as Herpes Zoster tend to involve both nerves. At the age of 70, it is more likely to be Presbyacusis.

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

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 9 minutes later
This is extremely interesting and mysterious, Dr. Bhatti. Do you mean that my hearing test would suggest tinnitus in the left ear although I don't perceive anything?
Does "everybody" eventually get presbyacusis? I have no other relatives with any tinnitus other than my mother of any age.

My wife had suffered some herpes in her eye but has not shown any signs of tinnitus. I also have not been exposed to street sounds for 8 hours. Only like the average ordinary person who goes out shopping, etc. etc. So it would be a mystery where either my mother or I have encountered this problem!

I have begun using Lipo-Flavonoids. A homeopathic product company has told me that eastern medicine does not believe that tinnitus is incurable, and in fact people have had improvement with such products. Then of course there are sound modulators that I have found online. But since my symptoms are mild I am not now too worried about all this (YET).
doctor
Answered by Dr. Sumit Bhatti 16 minutes later
Hi,

Thank you for writing back.

1. If placed in a sound proof room, even people with normal hearing may experience Tinnitus.

2. Everyone experiences Tinnitus at some point in their lives. Presbyacusis affects all (just like Presbyopia or failing near eyesight). In both cases the exact causes and factors are not known and hence it differs in different individuals and also may differ among the sides in the same individual.

3. If it is not noise induced (including sudden loud noise), then it is age induced.

4. I have had success in half the patients I treat with usually a reduction in the Tinnitus. Most people with a Scale of 1 or 2 (On a scale of 1 to 10) would not treat it further. Since your Tinnitus is mild at present, you need not treat or mask it. There are hearing aids available with built in maskers and XXXXXXX (unpredictable) music which masks the Tinnitus.

5. You do seem to get an increased Tinnitus on a scale of 5 to 6 at times which is significant and annoying.

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

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 8 minutes later
Do you believe that I would follow the path of my mother and grandparents to gradually lose hearing, and follow my mother over the years with worsening tinnitus related to hearing loss (as opposed to noise, etc.)??
You are correct, at time I do get an increase in soft hissing (usual a high pitched soft hissing). Yesterday was at least a 3, while today is now a 2. Do I understand correctly that the fact that the tinnitus at times disappears has to do with brain perception if there is ongoing permanent damage in the inner ear itself? Most morning when I wake up for several hours I don't perceive any hissing at all. Yet when in a room full of people it does increase and can go down later on.
doctor
Answered by Dr. Sumit Bhatti 21 hours later
Hi,

Thank you for writing back.

1. The gradual loss of hearing may follow a similar pattern, however the exact deterioration is unpredictable and different for different individuals.

2. Changing the perception of the Tinnitus in the brain is the basis of TRT (Tinnitus Retraining Therapy).

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

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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