Thank you for your past excellent advise which dealt with the effect of allergies and infections on tinnitus. With additional testing and observation, I now have a better perspective of the tinnitus problem
A recent hearing and tympanogram test indicated good hearing and normal eustachian tube functioning. There was a slight loss of hearing at the higher frequencies, which was considered normal by the Otolaryngologist for a person of my age (50's). There has been no history of infections in the ears, nose, or sinuses. Although I experience some allergies, these are not severe. I am presently taking Vancenase and aspirin at night. These seem to help, but it is difficult to always know. Perhaps my description of a typical cycle of tinnitus generation will be helpful.
A typical cycle of tinnitus activity occurs every 5-6 days. Onset of tinnitus always occurs at night during sleep, following a day when the activity is very quiet. The tinnitus appears to occur quickly and spontaneously. I thought for a long time that the tinnitus occurred as a result of the supine position, but I now think that it occurs as a part of a sleep cycle. The tinnitus may be rather strong upon awakening. I feel tired and often my muscles in the neck and shoulder are extremely sore. It is not clear to me if the tinnitus resulted in a restless night with corresponding taut muscles; or if muscle spasms themselves somehow caused the tinnitus. The tinnitus stays around for the next 2-3 days, with each succeeding day a little quieter. Finally, after the tinnitus has declined to a near zero level, the cycle begins again during the next night. On some occasions, I feel some rhythmic pulsations in my ears just before a new tinnitus cycle begins. Medications which seem to have helped the most include aspirin and benzodiazepines (Lorazepam). Although benzodiazepines appear to dampen the tinnitus activity, it does not alter the basic cycle.
I will appreciate your opinions on the possible causes of the tinnitus. Could it be due to spontaneous otoacoustic emission? If so, would the source originate in the cochlea? Could it be due to muscle contractions or spasms? Do you have suggestions on further testing or medications?
Thank you very much.
Answer -------------
Otoacoustic emissions are defined as acoustical energy that is produced in the cochlea (inner ear) which can be recorded in the outer ear canal near the tympanic membrane (ear drum). This is the reverse of the normal path of sound conduction in which vibrational energy strikes the ear drum and is transmitted through the ossicles of the middle ear and into the fluids of the inner ear where it is transformed into electical impulses which are sent through nerves to the brain.
Otoacoustic emissions are categorized into 2 general forms - spontaneous and evoked. The evoked form is further categorized into the different types of stimulation required to produce the emission.
Certain types of evoked otoacoustic emissions can be found in virtually all normal-hearing human ears. Spontaneous otoacoustic emissions are found in 30-40% of the normal-hearing population.
Evoked otoacoustic emissions have been found to closely correlate with the function of the sensory-neural apparatus of the inner ear. Since otoacoustic emissions can't be detected in patients with hearing loss greater than 40 decibels, the measurement of these emissions has applicability as a screening measure for hearing loss, particularly in the screening of infants and young children.
The presence of spontaneous otoacoustic emissions has no known clinical signficance. Attempts have been made to correlate otoacoustic emissions with tinnitus, but no consistent relationship has been identified between the two.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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