transient tinnitus?

[PoorMD]

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is some tinnitus reversible? Can acute sinusitis cause ringing in the ears? possibly otitis media?

also, are all cases of otitis media purulent? Or can you have clear colonization within the tympanic membrane or even deeper inside the oval window? causing a ringing?

tthanks

PoorMD..

 

[resxn]

is some tinnitus reversible? Can acute sinusitis cause ringing in the ears? possibly otitis media?

also, are all cases of otitis media purulent? Or can you have clear colonization within the tympanic membrane or even deeper inside the oval window? causing a ringing?

tthanks

PoorMD..

1 - Some tinnitus is reversible. Stress, caffeine, NSAID's, ASA especially, many other meds are all potentially reversible causes of tinnitus.
2 - Acute sinusitis cannot directly cause tinnitus by any mechanism of which I'm aware. However, as the nose goes, so does the ears so if there is fluid in the ears or any inflammation really, sometimes, not always, it can cause tinnitus
3 - yes, possibly otitis media, more unlikely than likely from my experience
4 - not all causes of OM are purulent. Acute OM is purulent by definition. OME (otitis media with effusion) by definition is not purulent, it is serous.
5 - Within the TM? Did you mean within the middle ear space? Yes, one theory of AOM/OME development is colonization of the ME space with pathologic bacteria prior to the development of an effusion. (the other theory is that negative pressure creates a transudate that then secondarily becomes infected). Inside the OW? I'm not sure what that means. The window itself? The ME space? Or the perilymphatic/endolymphatic fluid? If the latter, then yes, bacteria can infect this area and yes that can certainly cause tinnitus among significant other problems such as extreme vertigo and hearing loss.

 

[PoorMD]

1 - Some tinnitus is reversible. Stress, caffeine, NSAID's, ASA especially, many other meds are all potentially reversible causes of tinnitus.
2 - Acute sinusitis cannot directly cause tinnitus by any mechanism of which I'm aware. However, as the nose goes, so does the ears so if there is fluid in the ears or any inflammation really, sometimes, not always, it can cause tinnitus
3 - yes, possibly otitis media, more unlikely than likely from my experience
4 - not all causes of OM are purulent. Acute OM is purulent by definition. OME (otitis media with effusion) by definition is not purulent, it is serous.
5 - Within the TM? Did you mean within the middle ear space? Yes, one theory of AOM/OME development is colonization of the ME space with pathologic bacteria prior to the development of an effusion. (the other theory is that negative pressure creates a transudate that then secondarily becomes infected). Inside the OW? I'm not sure what that means. The window itself? The ME space? Or the perilymphatic/endolymphatic fluid? If the latter, then yes, bacteria can infect this area and yes that can certainly cause tinnitus among significant other problems such as extreme vertigo and hearing loss.

thank you for the response. I am curious if any of ENT residents have experience in clinical trials for treating tinnitus, say via stapedotomy or treatment with acamprosate (usually used for alcoholics, but has shown significant tinnitus reduction in pilot studies). These two treatments showed the most promise, according to some pubmed searches I did.

I am interested in this because it is a scourge on the population and truly disabling. Some people don't have it so bad. Most everyone has it a little bit at some point in their life. It is one of those symptoms that is usually shrugged off by layperson because it doesn't seem life threatening like, say, malaria or AIDs. But at times I would rather be deaf than live like this forever. thats pretty severe to me..

 

[resxn]

I'm no longer a resident, but I can say that the stapedotomy option is very sketchy with mixed results at best. Now for CHL with tinnitus, it has helped decreased tinnitus in several small studies. However, as a stand-alone tx it seems to be a fairly sizeable commitment for this symptom. I'm not aware of any described mechanism other than it works similarly to how hearing aids would work to decrease tinnitus in some.

As far as acamprosate, the only place I've seen that done is in Brazil. In the US, I havn't seen any studies on it. Also, I think if you read the study from Brazil you will find several weaknesses why this has not yet been aggressively pursued in the US.

At the recent AAO-HNS meeting in Toronto I listened to a very nicely performed study out of Germany that is working with magnetic stimulation to decrease tinnitus. They have had some remarkable results with their intervention. I think there may be some real benefit in this modality, but currently in the US there are only 8 centers that have the appropriate equipment although it is so favored by neurologists for other reasons that there are probably plans for several centers to acquire them soon.

As far as I know, currently the most consistent results for the treatment of tinnitus is with Tinnitus Retraining Therapy. Most studies show up to 85% improvement with this multi-armed modality but that many people recur after a couple of years. Also, purchasing the masking device can be expensive, so it's not for everyone.

Just my 2 bits.