Brief Answer:
Most likely causes: MS, drug induced, age related.

Detailed Answer:
Hi,

Thank you for your query.

1. In your case, the most likely causes for tinnitus are the MS, drug induced (notably topiramate and duloxetine) and presbyacusis.

2. Almost all people at some point in their lives experience tinnitus. Tinnitus does not have a cure, however, it may be controlled. How severe is your tinnitus on a scale of 1 to 10?

3. Get your ears examined to rule out any ear wax which is one of the commonest causes of Tinnitus. Also rule out any perforation of the ear drum. 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 your middle ear pressures checked (Impedance Audiometry or Tympanometry).

4. The exact cause of Tinnitus is unknown. However one of the the agreed pathologies 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.

5. What is your exposure to occupational noise and loud music / earphones / XXXXXXX phones? Exposure to loud noise is also a leading cause for tinnitus.

6. If your Tinnitus increases on clenching the teeth, it may require dental bite correction.

7. 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.

8. 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.

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

10. I must emphasise that in a vast majority of patients of tinnitus, the cause is never found, nor is it of any clinical significance. However there are further treatment options depending on the type of tinnitus.

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

Regards.

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