Tinnitus is the perception of sound in one or both ears when no external sound is present. While it commonly affects both ears, this article focuses on ringing occurring in only one ear, known as unilateral tinnitus. Though often benign, unilateral tinnitus may indicate an underlying medical issue that warrants attention.
Specific Causes of Unilateral Ringing
Unilateral ringing in the ear can stem from various causes, from common conditions to more serious ones requiring medical evaluation. One frequent cause is impacted earwax, where a buildup can create pressure or block sound transmission, leading to a perceived ringing in that ear. Noise-induced hearing loss, particularly from a loud event affecting only one side, can also result in unilateral tinnitus, as can chronic exposure to loud noises in one ear.
Middle ear issues like infections (chronic otitis media) or a ruptured eardrum can cause ringing in one ear due to fluid buildup or damage. Ménière’s disease, an inner ear disorder characterized by fluid imbalance, often affects one ear. This condition presents with episodes of vertigo, fluctuating hearing loss, and a sensation of ear fullness in addition to tinnitus.
Temporomandibular joint (TMJ) disorders, affecting the jaw joint, can contribute to unilateral tinnitus due to pressure or nerve irritation from jaw misalignment or muscle tension. Otosclerosis, a condition involving abnormal bone growth in the middle ear, can lead to unilateral ringing and hearing loss, as it restricts the movement of sound-transmitting bones. While it often begins in one ear, otosclerosis can affect both ears over time.
Serious, less common causes include acoustic neuroma, also known as vestibular schwannoma. This benign tumor grows on the nerve connecting the inner ear to the brain, and unilateral tinnitus, often described as high-pitched, is a common early symptom, frequently accompanied by hearing loss in the affected ear. Vascular conditions can cause pulsatile tinnitus, a rhythmic whooshing or throbbing sound that synchronizes with the heartbeat, and this can also be unilateral, indicating a potential issue with blood vessels near the ear. Other rare causes include cholesteatoma, an abnormal skin growth behind the eardrum, and semicircular canal dehiscence, where a thin bony canal in the inner ear causes sound and pressure sensitivity.
How a Diagnosis is Made
Determining the cause of unilateral ringing involves a diagnostic process by a healthcare professional. This begins with a thorough medical history, where the doctor inquires about the tinnitus’s nature, onset, duration, and any associated symptoms like dizziness, hearing loss, or pain. A detailed review of current medications is also important, as some drugs can be ototoxic, meaning they can cause or worsen tinnitus.
Following the history, a physical examination of the ear, head, and neck checks for visible issues like earwax impaction, infection, or structural abnormalities. Audiometric testing, or a hearing test, assesses hearing thresholds and identifies any hearing loss, especially asymmetrical loss, which can provide clues to the underlying cause.
If a more serious underlying condition is suspected, imaging studies may be necessary. Magnetic Resonance Imaging (MRI) of the head and auditory canal, sometimes with contrast, is frequently used to evaluate for conditions like acoustic neuroma or other masses, particularly when tinnitus is unilateral, non-pulsatile, or accompanied by neurological symptoms or asymmetric hearing loss. Computed Tomography (CT) scans may also be used, especially if bony abnormalities are suspected or for evaluating vascular causes of pulsatile tinnitus.
When to Consult a Healthcare Professional
While some instances of unilateral ringing may resolve on their own, certain symptoms warrant medical evaluation. Consult a healthcare professional if the ringing in one ear has a sudden onset, especially if accompanied by sudden hearing loss. Other concerning “red flag” symptoms include associated dizziness, vertigo, or issues with balance.
Facial numbness, weakness, or changes in facial sensation on the same side as the tinnitus require medical attention. If the ringing is pulsatile, meaning it beats in time with your heartbeat, this requires evaluation to rule out vascular conditions. Persistent or worsening unilateral tinnitus, even without other severe symptoms, also warrants a medical assessment to identify any treatable underlying conditions.
Approaches to Management
Once a diagnosis for unilateral ringing is established, management strategies focus on addressing the underlying cause. For instance, if earwax impaction is the cause, professional earwax removal can alleviate symptoms. If an infection is identified, appropriate medical treatment, such as antibiotics, would be prescribed. In cases where a specific cure for the underlying condition is not available, such as with some forms of hearing loss or Ménière’s disease, symptomatic management becomes the primary approach.
Sound therapy is a common technique, using external sounds like white noise or maskers to distract from or cover the perception of tinnitus. Hearing aids can also be beneficial, especially if there is associated hearing loss, as amplifying external sounds can make the tinnitus less noticeable. Cognitive behavioral therapy (CBT) can assist individuals in coping with the distress and impact of tinnitus on their daily lives by changing their reaction to the sound.
Lifestyle adjustments can also play a role in managing tinnitus symptoms. These may include stress reduction techniques, as stress can exacerbate tinnitus. Maintaining a healthy diet, ensuring adequate sleep, and regular exercise can contribute to overall well-being and potentially reduce the impact of tinnitus. Avoiding exposure to loud noises and protecting the ears can also prevent worsening symptoms.