HomeAnswersOtolaryngology (E.N.T)tinnitusMy tinnitus is triggered only by external sounds. Why?

How do I treat the recurring tinnitus to external high-frequency sounds?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At September 30, 2022
Reviewed AtSeptember 3, 2023

Patient's Query

Hello doctor,

I have a history of fungal infection of the ear, which has disappeared after applying the antifungal cream prescribed by the doctor four weeks ago. But later, I developed tinnitus a couple of days after the fungal infection. According to my observation, I only have tinnitus when I hear external sounds in the high-frequency range, and I do not have tinnitus at home. When the external triggering sound is stopped, the tinnitus also stops and it depends on the loudness of the external sound. Also, all of my hearing tests are normal. What could be the cause? Kindly help.

Hello,

Welcome to icliniq.com.

Thank you for your query. Can you upload the reports of your hearing tests and the picture of your eardrum? Also, have you done a pure tone audiogram, tympanogram, SISI (short increment sensitivity index), ABLB (alternate binaural loudness balance test), or otoendoscopy? Thank you.

Patient's Query

Hello doctor,

Thank you for your reply. I have attached the reports. Also, while I talk, I can hear the same high-pitched tinnitus sound in the right ear, but when I stop talking, the sound goes away. Even while sleeping, the high-pitched sound does not go away and keeps me awake. The only way to sleep soundly now is to not listen to anything. However, I occasionally swallow or move my head when tossing and turning, which triggers tinnitus; it is very torturing. Kindly help.

Hello,

Welcome back to icliniq.com.

I will review your reports and revert. Thanks and regards.

Patient's Query

Hello doctor,

Thank you for your reply. If my reports are normal, what could be the cause? The tinnitus started after my otomycosis. Kindly help.

Hello,

Welcome back to icliniq.com.

I reviewed your reports. In the first test report, that is plain audiometry is normal. But the second report is not clear (attachment removed to protect the patient's identity), so I cannot interpret it correctly. Have you done impedance audiometry and SISI (short increment sensitivity index) or ABLB (alternate binaural loudness balance test)? I hope this has helped you. Thank you.

Patient's Query

Hello doctor,

Thank you for your reply. No, I have not done these tests. I can control the tinnitus myself by swallowing or making sounds. However, if the exams were to be normal, what could cause my tinnitus? Kindly help.

Hello,

Welcome to icliniq.com.

If you can control the tinnitus yourself, then it is objective tinnitus mostly related to any palatal or tubal muscle. I hope this has helped you. Thank you.

Patient's Query

Hello doctor,

Thank you for your reply. Right now, tinnitus is triggered by external sounds only, and I can stop it by swallowing or making sounds myself. I have a few questions: 1. Can you explain how did the fungal infection cause the issue? 2. Could it be caused by a problem with my eardrum or middle ear muscle? 3. How long does it usually take to recover? 4.Is there anything I can do to speed up the healing process? Kindly help.

Hello,

Welcome back to icliniq.com.

I understand your concern. If the fungus entered the middle and inner ear after that, it could have caused tinnitus. Problems with the eardrum and middle ear muscles can result in tinnitus—especially the tensor tympani muscle, which moves during swallowing. Therefore, you must repeat the tympanogram test. Avoid smoke and dust pollution. Take a nasal decongestant and anti-inflammatory medications. I hope this has helped you. Thank you.

Patient's Query

Thank you doctor for the reply,

I went to do all the tests they can offer me here. Please see the seven photos I have attached. They suggested normal. Does this include the test you wanted to see? My follow-up questions are: 1. If my eardrum is intact, could the fungus reach the middle ear? My eardrum was inflamed at first but not perforated. Now the eardrum has healed a lot. The outer ear canal was also inflamed, and now I could still see a red bruise on the outer ear canal. 2. Would the tinnitus caused by the eardrum and the tensor tympani muscle be high-pitched or low-pitched? My tinnitus is a high-pitched electrical sound, and it only happens when I hear an external sound, talk, or make a sound with my mouth. However, it is loud enough to wake me up if I subconsciously swallow saliva or move my head too much during the light sleep transition. 3. What might have caused my tinnitus? 4. What over-the-counter anti-inflammatory drugs do you suggest using?

Hello,

Welcome back to icliniq.com.

I reviewed all the attachments (attachments removed to protect the patient's identity). Assuming the eardrum to have been intact all the while, the fungal infection could not have crossed into the middle ear through such a drum. I can see the bruise in the ear canal. It will heal with some supportive medications. I hope you are on some antibiotic or anti-inflammatory ear drops. External ear fungal infection takes a long time to heal. Even when you become asymptomatic, fungal spores and mycelia stay in the area for long durations, waiting for the smallest opportunity to invade again. So any cause that can remove or abrade the skin can help re-enter fungus into the subcutaneous tissue and infect the external ear. But the eardrum is made of three layers. So fungal infection of the external ear passing into the middle ear through an intact drum is rare. But if the drum also gets very badly infected, say bullous myringitis or so, then chances are that it will have micro-dehiscences which can transmit the fungus to the middle ear. It is unlikely that swallowing and talking will cause electrical tinnitus. For the same, we need tests like electrocochleography which can say clearly if there is any fluid imbalance in the inner ear. The inner ear and not the middle. With the update you gave, I cannot discern what could have caused the tinnitus. If the middle ear is infected due to any reason, we will have any or all of the following signs or symptoms: 1. Blockage or pain in the ear. 2. Decreased hearing. 3. Feeling of bubbles inside the ear, especially when you move the head. 4. Abnormal tympanogram. 5. Negative pressures or fluid in the middle ear as seen in the tympanogram. 6. Loss of cone of light of the eardrum or retraction of the ear drum. 7. Hearing loss of the conductive type as seen on pure tone audiogram.

Patient's Query

Thank you doctor for the reply,

Finally, I started to see improvement five days ago. The doctor applied Econazole with steroid cream on Monday, and I can feel improvements one to three hours after the application. As my high-pitched tinnitus became less frequent. The good effect lasted 40 hours before getting worse, so I went back, and the doctor applied some more of the cream, and I felt better in an hour. The tinnitus became less frequent, and the good effect lasted for 17 hours before it got worse again on Thursday morning, so I went back to get more of the cream, and it suddenly became much better after three hours of applying the cream. The past two weeks, I did not see much improvement upon applying the medication, but this week is the first time I started to see clear improvements upon applying the cream, and I am finally able to sleep. My tinnitus is still a high-pitched single-tone electrical sound, and it only happens when I hear external sounds, especially high-pitched sounds. I do not have tinnitus if I do not hear anything. If the external sound is not loud, the tinnitus will stop, but if the external sound is too loud or too close to my ear or if I make the sound with my mouth while swallowing, then the tinnitus might continue for three to ten seconds. Every time the doctor applied the Econazole with steroid anti-fungal cream this week, I started to feel better within one to three hours. Based on this information, what do you think is going on with my ear? What most likely is causing the tinnitus? I just bought some Clotrimazole solution (1 % in PEG 400) because this is what I read that doctors use for fungal ear infections. Do you suggest changing to this solution? How long do you think my tinnitus might last or take to recover?

Hello,

Welcome back to icliniq.com.

I think the fungus in the ear is responding to the cream the doctor is applying. Does he put it on a wick and insert the wick into the ear canal? I think you can use the solution you bought. However, it will help improve the fungal infection. Your tinnitus will recover since there is an improvement with medicines. It is a positive sign.

Patient's Query

Thank you doctor for the reply,

Yesterday morning I used a few drops of the 1 % Clotrimazole in PEG 400 solution while I still had leftover cream in my canal. I did not feel a big difference, so I went back to apply the cream in the afternoon. Would the two react with each other? I felt fine for the first 12 hours, but suddenly I started having severe tinnitus this morning, so I went to the hospital and found my eardrum covered with cream. The doctor suctioned out a lot which relieved my tinnitus, but there were still leftover things. Would the combination of the cream and solution eventually be absorbed or cleared away? How should I get the eardrum cleaned? Since I have been responding to the anti-fungal and steroid cream, how do you suggest resolving this completely? After applying topical medication, how do I make my ear canal dry? I sleep with earplugs now because the sound triggering my tinnitus would wake me up, so I use earplugs to cover sounds. What should I do?

Hello,

Welcome bback to icliniq.com.

I would not use water to clean the ear as the moisture will provide conducive grounds for the fungus to thrive. I am also against ear plugs as they will increase the moisture and sweat inside the canal, encouraging fungal growth. The cream and solution should not cause any issue. Because fungus takes a long time to resolve, I usually clean or suction the ear canal of my patients every few days and apply a wick with cream.

Patient's Query

Thank you doctor for the reply,

What kind of liquid solution do you suggest using when cleaning? The doctor used diluted hydrogen peroxide the first time and kept using saline water to clean. I am also concerned about the water moisture. How often should I apply the Econazole cream? I misunderstood the wick you mentioned. The doctor here actually did not use a wick. Instead, they used a cotton swab to apply the cream. Do you let the wick stay in your parent's ears for a few days? If the doctor here does not use a wick, how do you suggest applying, and how much to apply?

Hello,

Welcome back to icliniq.com.

It is not advisable to clean oneself at home. The best is to consult the ENT (ear, nose, and throat) doctor. When there is a risk of fungus, we do not use saline or syringing. We let the wick be there inside the ear for 24 to 36 hours and then remove it

Patient's Query

Thank you doctor for the reply,

So now the doctor does not clean my ear anymore because the ear looks clean with nothing visible to be auctioned. He applies a very thin layer of the cream into my eardrum and canal (using a swab) twice a day. Every time he applies. I feel my tinnitus became less in about three hours. I would only have tinnitus when I hear external sounds. What do you suggest I should do now? I want this to be fully recovered and not dependent on applying the cream twice a day forever since it also has steroids. It is also annoying to experience tinnitus when I hear external sounds, as I cannot even listen to music properly. I can tell that this past week was better than the previous two weeks since I could finally get some sleep.

Hello,

Welcome back to icliniq.com.

This is typically due to fungus. You must ask your doctor to keep a wick dipped in that ointment every time and go every two days for the same.

Patient's Query

Thank you doctor for the reply,

Below is what I can find without steroids. Please let me know which one I should go for. 1. Econazole cream without steroids. 2. Fluconazole eye drops (indicated for eyes). 3. 1 % Clotrimazole solution in PEG 400.

Hello,

Welcome back to icliniq.com.

I suggest you apply Clotrimazole 1 % solution. This is the best among the ones mentioned with the least side-effects.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Shyam Kalyan. N
Dr. Shyam Kalyan. N

Otolaryngology (E.N.T)

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