by Neil Bauman, Ph.D.
An audiologist wrote,
I am a newly qualified Audiologist who frequently sees patients that suffer from tinnitus. Most of the patients I see have had tinnitus for quite some time (more than 6 months). We have a very long waiting list at the hospital at which I work, and sadly patients suffering from tinnitus, as I’m sure you know, are missed, referred inappropriately or put off seeking treatment all together.
Many of my patients report that their tinnitus started after their ears were syringed, or after a middle ear infection. I am aware that the two are commonly linked, but I am not sure how to answer the patients’ questions about how and if there is some explainable physiological reason for the tinnitus beginning at this time. I have not been able to get any satisfactory information from the net, and my colleagues are also interested in finding out about this. I would appreciate it if you could enlighten me on this subject.
These are two good questions and I’ll certainly try to help you understand why tinnitus is associated with these two events. Let’s look at them separately.
First, why is tinnitus sometimes associated with syringing out a person’s ears?
Many people may be surprised to learn that having their ears syringed to remove wax can CAUSE tinnitus. The same is true if you shower and aim the shower-head directly into your ear canals.
John Currie at T-Gone in South Africa mentions that syringing out ears with too strong a stream of water can indeed cause tinnitus (and hyperacusis too).
I have not experienced any long-term tinnitus from doctors syringing my ears, although I’ve had doctors use so much force that the water hitting my eardrum temporarily wrecked my balance.
Since then, and for a couple of decades now, I let the water from a reduced-flow shower head spray into my ear canals each time I shower. This has not caused me any tinnitus or balance problems. My existing tinnitus never changes.
The trick in avoiding tinnitus is to use a gentle spray, not a high pressure jet of water, whether syringing or showering.
She then asked,
What I’m still not entirely clear on is what is happening in the ear as a result of this syringing which would result in tinnitus. Does it have something to do with the tensor tympani going into spasm?
I doubt it is any of the tiny ear muscles going into spasm as the tinnitus lasts for weeks or months and I’d think a spasm would be of short duration. Rather, what I think happens is that the sudden “wham” of the water hitting the eardrum gives a similar reaction as a loud noise like a gunshot would—and that often results in tinnitus.
Actually, anything that violently moves the eardrum whether water pressure or air pressure (from a loud noise) can result in tinnitus, hearing loss, hyperacusis and temporary balance problems.
That is why, for some people, syringing or showering is the root of their tinnitus. John Currie recommends taking out wax using other means—not water and not suction—so you don’t push (or pull) the eardrum too much, and thus cause tinnitus.
Now to answer the second part of your question, “Why do middle ear infections often leave people with tinnitus, even after the infection clears up?”
You further explained, “What I found interesting is that even once the ear infection had cleared up and PTA [pure tone averages] revealed hearing within normal limits they were left with tinnitus. Could it be that the temporary threshold shift had made them aware of the tinnitus and even once their hearing returned they had formed a negative association with the sound and became fixated on it, or could there actually be some physiological damage to the middle ear during the infection which would cause this.”
I think there are two different factors. First, since ear infections cause some hearing loss, and since tinnitus often accompanies hearing loss (about 70% of the time), it should be no surprise that tinnitus can be associated with ear infections as a secondary cause.
Although your conventional testing revealed that hearing had returned to normal, this may not be entirely true because you typically only test hearing to 8,000 Hz., and not up to the upper limit of hearing around 20,000 Hz. Thus you don’t know how much hearing was lost and not recovered in the very high frequencies. Hearing loss in those high frequencies can also cause tinnitus.
Since tinnitus supposedly is often at the same pitch as the person’s greatest hearing loss, if a person has high-pitched tinnitus, I’d check their very high-frequency hearing to see if that might be the cause. (When you only test to 8 K, you could give a person a clean bill of health hearing-wise—and yet they could have severe hearing loss above 8,000 Hz—resulting in tinnitus.)
Second, and I think you hit the nail on the head when you mentioned a person fixating on their tinnitus, is that when a person fixates on their tinnitus, their limbic (emotional) system flags the sound. As a result, the tinnitus sound seems to become louder and even more intrusive, and consequently harder to ignore. At the same time, as I understand it, the brain grows “connections” that “lock in” the tinnitus.
Thus, whatever caused tinnitus in the first place starts the ball rolling—but the ball continues to roll on, even if the original cause is taken away. That is why it is so important for people that get tinnitus not to form any negative emotional attachments to their tinnitus. This only makes the “connections” stronger and much harder to break. It is ever so much better to nip this in the bud before these connections form.