Brief Answer:
explained

Detailed Answer:
Hello and Welcome

I appreciate your concern.

The ringing in the ear is called tinnitus.
Tinnitus is a symptom that requires further investigation to determine origin. Often, the origin may be a sensorineural hearing loss. Certain types of tinnitus signify other problems. Unilateral or pulsatile tinnitus and tinnitus associated with vertigo or conductive hearing losses are examples. Tinnitus therapy is as multifaceted as the origins of tinnitus. . A combination of sound-based therapy with medical therapy of anxiety, depression, or insomnia does help.

The vertigo in addition to your elevated BP ( though now its quite low and the low BP may even be causing the dizziness) warrants a neurological exam to differ whether it is central or peripheral vertigo. If its central then an MRI or CT is indicated. If a central cause is ruled out then peripheral causes can be treated symptomatically

If peripheral, then the most common causes include

Menierre s Disease
BPPV ( Benign Positional Paroxysmal vertigo)
Labyrinthitis

Because of the vast array of potential diagnoses related to tinnitus, each patient requires a thorough history and physical evaluation. Such an evaluation requires attention to detail, including all medical problems and associated treatments and any pharmacologic therapy. Many patients are depressed or very anxious about the problem. Therefore, the use of various psychological evaluation techniques is required.

Because most cases of tinnitus are related to hearing loss, questions attempt to determine the presence, development, time course, and severity of any hearing loss. The presence of vertigo, otalgia, otorrhea, or temporomandibular joint disease can relate to tinnitus

Tinnitus is one of the side effects of nonsteroidal anti-inflammatory drugs in nearly every case. However, as with aspirin, this effect seems to be dose related. Diuretics (eg, ethacrynic acid, furosemide) may also produce a dose-related tinnitus. This particular effect may be reversible with these drugs, but it may be permanent in others. Permanent hearing loss and accompanying tinnitus is frequently observed with ototoxic chemotherapeutic agents such as the various platinum compounds. The XXXXXXX Tinnitus Association (ATA) distributes an extensive list of medications associated with tinnitus. The exact cause of the tinnitus in these pharmacologic etiologies remains obscure

Each patient with the symptom of tinnitus deserves complete audiologic testing with pure-tone air, bone, and speech discrimination scores. Order or perform these tests even if (as is common) the patient is unaware of hearing loss. During the audiometric evaluation, the audiologist can complete the subjective tinnitus matching evaluation to gain better understanding of the patient's symptom. Such thoroughness is often reassuring to the patient because the physician is taking the condition seriously.

Both pitch and loudness matching should be assessed. However, the examiner should remember that 90% of patients with tinnitus match their tinnitus at 20 dB or less and 84% match their tinnitus at 9 dB or less; thus, the reported severity of the condition may seem to be out of proportion to the measurement. Minimum masking levels should also be obtained if treatment with ear level devices is being considered.




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