Dr Abrol explains this sound, "A ringing, buzzing or hissing sound maybe associated or accompanied by hearing loss but it is not a sign of hearing loss. In medical terminology all these symptoms of ringing sounds in the ear are called 'Tinnitus'. These have to be differentiated from hallucinations sounds, which are commonly of psychogenic origin.
He further says, "Tuneful or rhythmic sounds may indicate temporal lobe epilepsy or other focal lesions. Vascular bruits must be excluded which could be due to vascular defects like A-V fistula."
Tinnitus is of two types:
1. Subjective: which is heard by the patient only and not by the examiner.
2. Objective: Klicks or buzzing maybe heard by the examiner, which could be due to contractions of the middle ear and palatable muscles, mainly tensor tympani.
Nature of Tinnitus:
Tinnitus associated with deafness: Some measurable hearing loss is present in majority of patients, even when he/she is not conscious of it or appreciates difficulty in hearing.
Tinnitus may be an accompaniment of any hearing loss but it is more troublesome in ageing deafness (Presbycusis & Meniere's Syndrome).
It may be the first warning symptom of ototoxicity due to medications or acoustic trauma due to blast injuries or noise induced hearing loss due to industrial or environmental noise. Unilateral tinnitus is often the first symptom of acoustic neuroma (A benign tumour of VIII and balance).
Nature of Tinnitus:
Tinnitus without Deafness
One may not find any cause but certain extra aural lesions should be suspected. For e.g., focal sepsis, carious or impacted wisdom teeth, severe anaemia, cerebral vascular disease or intra-cranial vascular tumours. Auscultation of the skull may detect an audible sound or bruit. Hypertension or Hypotension can both cause Tinnitus.
Treatment of Tinnitus
It may often disappear when the causative ear condition responds to appropriate medical or surgical treatment but when this is impossible or ineffective the noises usually persists. In such cases assurance or re-assurance about the harmless nature and explanation of the cause of the symptom may enable the patient to accept it and he/she may have to learn to live with it.
The patient should be encouraged to avoid undue stress and tension as it is harmless
Tranquilizers seldom help but a sedative, Tinnitus masker may be prescribed when the noises interfere with sleep.
Section of the Cochlear division of VIIIth cranial nerve may alter the character of Tinnitus by only rarely abolishes it.
PAIN
Ear pain and itching cannot be entirely attributed to hearing loss. These may be co-existent with hearing loss. Itching happens due to irritation, inflammation or injury of the skin of the external ear canal caused by ear buds or other articles like match sticks, tooth pricks, hair pins, keys, pencils or pens, etc. or it may be associated with dandruff on the scalp, which may get transferred to its neighbour, the ear canal. The ear ache may be either due to the disease in the ear itself or it maybe transferred from neighbouring structures or stimulation of nerves associated with the ears and called 'Referred Otalgia'.
The liquid oozing from the ear need not be associated with hearing loss as it could be due to injury or inflammation of the external ear canal.
Vertigo is a symptom often associated with dizziness, giddiness, instability etc However, it can be associated with vertigo caused by diseases in the middle ear, inner ear or due to medication that contains ototoxic drugs.
One must get himself/herself thoroughly examined and investigated whenever he/she suspects hearing loss as it may be a simple condition or sometimes a serious disease like Acoustic Neurone (tumour of the VIII cranial nerve - associated with hearing and body balance - or brain abscess of otogenic origin or toxicity due to drugs.
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