Tinnitus is a hearing condition characterized by hearing phantom sounds, without an external cause. While conditions of the ear are often associated with exposure to loud noises, age, or infection, there are far more potential causes at the root of the condition, including some behaviors or actions that can make existing tinnitus worse. Tinnitus can affect one or both ears, and may sometimes develop following traumas to the ears, including surgery. What is typically the root cause for people who develop tinnitus following surgery, and how can it be addressed? We will go into greater detail below.
What Are The Different Symptoms Of Tinnitus?
Although the symptoms of tinnitus are phantom sounds without an external source, exactly how those symptoms present varies from person to person. Severity is also highly subjective and liable to change, with some tinnitus patients experiencing severe symptoms that significantly impact day to day life, and others only experiencing minor irritation. The precise sound of tinnitus can also differ: although it is most often described as a ringing in the ears, it can also sound like buzzing, roaring, whistling, humming, clicking, hissing, or squealing in one or both ears.
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You can experience subjective tinnitus, or the type of tinnitus wherein only you are able to hear the sound, or objective tinnitus, wherein the sound is actually experienced or measured by others. The former is the most common type of tinnitus, and can be caused by everything from exposure to loud noises to the changes that come alongside age related hearing loss, while the latter is a rarer form of the condition and includes conditions like pulsatile tinnitus. Pulsatile tinnitus is caused by issues within the cardiovascular system, and patients experience a loud noise that sounds like a pulsing or thumping, in time with their heartbeat.
Treatment will differ depending on the origin of the issue–whether it involves the outer, inner, or middle ear–and how severe the symptoms are. Hearing aids are a common frontline treatment, and limiting exposure to loud sounds is strongly recommended both as a means of managing existing tinnitus, and preventing tinnitus development. Because symptoms reach further than hearing alone, treatment typically uses a comprehensive and multi-pronged approach.
Common Causes Of Tinnitus
Hearing loss is a common underlying cause of tinnitus–among the most common in fact. Typically sensorineural hearing loss, which stems from damage to the inner ear structures, is one of the most common causes of tinnitus. Exposure to loud sounds and age related loss (presbycusis) are among the more common types of sensorineural hearing loss, however, other types of hearing loss can result in tinnitus as well. For example, conductive or mixed hearing loss can result from damage to the inner ear, outer or middle ear infections, otosclerosis (abnormal bone growth in the middle ear), blockages to the outer or middle ear (earwax), and more. When ear wax accumulation is severe or extreme, it can occlude the ear, blocking auditory sounds from reaching the inner ear and auditory nerve. Ear infections can have a similar effect, as they can occlude the ear with fluid, swelling, and other symptoms of inflammation, leading to issues within the inner ear.
Medications are also a possible source of tinnitus; while they are used to address various ailments, medications have the potential to be ototoxic, or harmful to the auditory system. Medications can then lead to the loss of hearing, and/or tinnitus development.
Damage to blood vessels can also lead to reduced hearing health. High blood pressure, atherosclerosis, and other blood vessel damages can restrict blood flow and subsequently impair the ability to hear everyday sounds. Maintaining cardiovascular health is one of the ways that you can support healthy hearing.
Temporomandibular joint disorders (often called TMJ dysfunction), like head and neck injuries, can damage the body’s ability to hear in everyday life, including whether the brain interprets common sounds appropriately. TMJ typically can often result in eustachian tube dysfunction, where sounds are reduced as they travel through the ear resulting in diminished hearing ability, which can lead to tinnitus.
Additional disorders like Meniere’s Disease, vestibular schwannoma/acoustic neuroma, and autoimmune disorders can all impact the development of phantom sounds. All are chronic conditions and potential contributing factors to the onset of hearing disorders and concerns.
Post Traumatic Tinnitus
Tinnitus induced by trauma, known as post-traumatic tinnitus, can result from various forms of physical injury. Such injuries may encompass head trauma, concussions, brain damage, neck injuries, or surgical complications. The condition can manifest not only after major surgeries but also following minor medical procedures like ear syringing. While surgeries are frequently essential and can be life-saving, they inherently involve physical and psychological stress, which can subsequently trigger either acute or chronic symptoms of tinnitus.
Alcohol, caffeine, and smoking have all been linked to worsening tinnitus. Stress and anxiety, too, may be tied to an increased likelihood of developing the condition, just as excessive noise has been tied to it. High blood pressure, allergies, anemia, and other blood issues can contribute to its development, as can temporomandibular joint disorder (TMJ), diabetes, thyroid problems, obesity, and head injury. If you experience ringing in the ears and have any of these risk factors, you can seek medical advice for next steps.
How Is Tinnitus Diagnosed?
The first step in diagnosing the condition is seeking the help of a medical professional. A PCP, for instance, can look into the ear canal to see if fluid, excessive wax, or infection are present, and address those issues. From there, an audiologist can complete an audiometric evaluation, including an otoscope, tympanometry exam, and a general hearing test. An evaluation by an Ear Nose and Throat (ENT) specialist typically involves a medical history, a medical exam, and other hearing tests to find any underlying cause of tinnitus. Pulsatile tinnitus may require additional imaging studies, to help reveal whether a structural problem or underlying medical condition is causing tinnitus.
Postoperative Tinnitus: The Variables
Tinnitus is known to occur in 63-75% of patients with unilateral vestibular schwannoma, also known as an acoustic neuroma, or noncancerous tumor affecting cranial nerves. Typically, these tumors are slow-growing, and are linked to the balance and hearing nerves that supply the inner ear. Understandably, the growth of these tumors can affect auditory nerve and vestibular nerve function. This can result in unilateral hearing loss, tinnitus, and even changes to balance, including the onset of dizziness. Initially, these growths may go unnoticed, but as they grow, they can further impede hearing and make tinnitus symptoms worse.
Tinnitus is one of the most common symptoms complained of before and/or after the surgical removal of this type of tumor, with about 50% of patients complaining of symptoms. The aim of one study was to fully understand the different post-op factors that can impact hearing outcome following surgery. Tinnitus prior to surgery was the greatest predictor, but patients with hearing challenges prior to their operation were at a greater risk of having post-op tinnitus. Patients who had no symptoms of tinnitus prior and complete hearing loss prior to surgery were the least likely group to develop tinnitus.
Tinnitus After Anesthesia
Although tinnitus is not a common side effect of anesthesia, there have been some small reports of low frequency tinnitus combined with low frequency sensorineural hearing loss in individuals who have undergone spinal anesthesia. It is possible for reversible hearing disorders like tinnitus to develop following local anesthesia, but typically only occur as a result of central nervous system toxicity.
One study, in particular, demonstrated that hearing loss following non otologic surgery is highly uncommon, though patients who require subarachnoid anesthesia did have a slightly higher risk of hearing loss and cranial nerve palsy as a result of intracranial pressure drops. Hearing loss was reported in one individual who went under spinal and epidural anesthesia, but that loss was not accompanied by tinnitus. Although it does happen, postoperative sudden sensorineural loss is poorly understood, and could lead to an increase in or changes to symptoms like phantom sounds.
Surgeries Linked To Tinnitus
While surgery as a whole is not linked to hearing conditions, there are some surgeries in particular that may be considered peripheral causes of tinnitus.
Medial Temporal Lobe Surgery
Recent imaging studies found that non-auditory brain structures could also be involved in whether or not tinnitus develops or may make tinnitus worse. A dysfunctional neural “noise-cancellation” mechanism within the limbic system may lead to auditory symptoms like phantom sound. This issue can be related to aging and how it interferes with the function of the amygdala and hippocampus. The prevalence of tinnitus developing in patients who underwent unilateral MTL resection nearing the amygdala was much higher than in individuals who did not undergo surgery.
Surgery For Pulsatile Tinnitus
Narrowing of veins in the brain, called venous sinus stenosis, is known to be an underlying condition of pulsatile tinnitus. One trial showed that venous sinus stenting could help restore healthy blood flow, easing symptoms of the condition. The surgery involves inserting a catheter into the femoral vein in the leg, which is then threaded to the affected vein within the brain, thereby resolving stenosis. When this occurs, it may also effectively cure pulsatile symptoms without enlisting Tinnitus Retraining Therapy and other standard interventions.
Stapes Surgery For Otosclerosis
Otosclerosis is a disease involving the temporal bone. It is characterized by conductive hearing loss and tinnitus. One study looked at patients with preoperative tinnitus, to examine how the condition reacted to surgery. Patients with low-pitch symptoms experienced greater outcomes than those with high pitch tinnitus, suggesting that low pitch symptoms are more likely to resolve after stapes surgery. High-pitch symptoms may persist regardless of postoperative status.
Tympanoplasty And Tympanomastoidectomy Surgery
Patients with chronic otitis media (COM), or a condition involving persistent, recurring infection of the middle ear are at greater risk for developing tinnitus. A study evaluated whether or not COM patients experienced improvements to tinnitus symptoms after tympanoplasty and tympanomastoidectomy surgeries. In the study, a Tinnitus Handicap Inventory (THI) and Visual Analogue Scale (VAS) were filled out both before and two months following surgery. The severity of the condition was significantly decreased on both questionnaires, including symptoms like loudness, annoyance, life impact, and perception. Tympanoplasty proved less effective in resolving symptoms than tympanomastoidectomy.
Deep Brain Stimulation (DBS)
DBS (Deep Brain Stimulation) is a surgical procedure that involves implanting electrodes deep into the brain. It’s primarily employed to treat specific movement disorders and neuropsychiatric conditions. While further studies are required to confirm its efficacy in treating tinnitus, preliminary findings have shown promise.
How Is Tinnitus Treated?
There is no known cure for the condition, though there are plenty of established avenues through which to manage symptoms and prevent further exacerbation. Abstaining from loud noise such as loud music as a habit, for instance, can help reduce symptom severity. One of the first steps necessary to begin treatment is identifying possible underlying causes of tinnitus. From excessive earwax and infection to conditions like TMJ dysfunction, there are different medications and practices that can be used to manage an underlying condition and therefore address symptoms. A dental appliance or home exercise, for instance, can help address teeth clenching and grinding if TMJ disorder is at the root of symptoms. A hearing aid can also be used to address the loss of hearing that often accompanies phantom sounds. Sound therapy, Tinnitus Retraining Therapy (TRT), Cognitive Behavioral Therapy (CBT), and more can all be used as a tinnitus treatment to address symptoms and minimize their effects.
Although surgery does have the potential to cause tinnitus while addressing other health problems, it can also be used to help address an underlying health condition, thereby reducing tinnitus. More research is needed to determine whether surgery is a useful intervention; until more definitive conclusions are drawn, utilizing tried and true methods such as sound therapy can provide an effective treatment route toward making tinnitus a more bearable condition.