Can You Help Me Decipher My MRI Result and Could My Wisdom Tooth Be a Cause for My Tinnitus?

[Deniseh]

Hi Dr Nagler,

Thank you in advance for answering my 2nd question.

I acquired tinnitus in late July 2019, presented initially with feeling of mild imbalance although no dizziness. Audiologists reported no hearing loss and ENT consultant reported possible cause as silent reflux/b12 deficiency advised definitely not Vertigo. Was also advised MRI showed I had a 'loop in the blood vessel close to left hearing nerve (this is the ear I have tinnitus in) however there is no compression so is of no consequence'. Now I have 2 separate questions if that's ok.

1) What does the above quote mean and could this be causing the noise in my ear (sounds like a drone/wind noise which used to be there constantly but now comes and goes, typical tinnitus sound is only there intermittently and also it can sound like an engine softly revving up and down)?

and

2) My ET tubes constantly pop (more so on the left) and it feels as if deep in my ear there's a blockage which feels almost like inflammation as if something is stuck. I have a broken / very sensitive lower wisdom tooth on that same side which had an abscess last year 2018 and excruciating jaw pain (really need extracting) so could this be contributing to the tinnitus??

Thank you so much for giving your personal time to answering these questions.

Kindest Regards,

Denise

 

[Dr. Nagler]

I acquired tinnitus in late July 2019, presented initially with feeling of mild imbalance although no dizziness. Audiologists reported no hearing loss and ENT consultant reported possible cause as silent reflux/b12 deficiency advised definitely not Vertigo. Was also advised MRI showed I had a 'loop in the blood vessel close to left hearing nerve (this is the ear I have tinnitus in) however there is no compression so is of no consequence'. Now I have 2 separate questions if that's ok.

1) What does the above quote mean and could this be causing the noise in my ear (sounds like a drone/wind noise which used to be there constantly but now comes and goes, typical tinnitus sound is only there intermittently and also it can sound like an engine softly revving up and down)?

The anterior inferior cerebellar artery is one of the blood vessels perfusing the brain. Its course is somewhat variable, and occasionally it forms a loop in the region of the auditory nerve (VIII), the facial nerve (VII), or the trigeminal nerve (V). It is important to understand that these vascular loops are normal variations. Nothing is wrong or broken if you have a vascular loop. Now sometimes a loop comes so close to the nerve that it actually compresses the nerve. When the facial nerve is involved, the result can be hemifacial spasm. When the trigeminal nerve is involved, the result can be severe pain in the distribution of that nerve. And some folks are of the opinion that when a loop compresses the auditory nerve, it can cause tinnitus. So in the latter part of the twentieth century a neurosurgeon named Peter Jannetta developed an operation in which he would place a pledget (a small wad of cotton or Teflon) between the loop and the nerve to relieve the compression in the hopes of eliminating the associated symptom. The results, at least in terms of the auditory nerve and tinnitus were inconsistent. OK enough of a history lesson.

To your question ...

A loop in the blood vessel that does not actually compress the auditory nerve is a normal variation that has no clinical significance and is unrelated to tinnitus. [That is what your report means.] And even if your study revealed that the loop did in fact compress your auditory nerve, the results of surgical decompression are unpredictable in such a setting.

2) My ET tubes constantly pop (more so on the left) and it feels as if deep in my ear there's a blockage which feels almost like inflammation as if something is stuck. I have a broken / very sensitive lower wisdom tooth on that same side which had an abscess last year 2018 and excruciating jaw pain (really need extracting) so could this be contributing to the tinnitus??

Denise, I tend to look at this sort of question from a pragmatic standpoint. It is difficult to know whether or not your wisdom tooth problem is contributing to your tinnitus - but the only reason it would be important to know if it was contributing to your tinnitus is if you are contemplating having your wisdom tooth removed strictly because of your tinnitus. But that is not the case! If I am understanding your post correctly, you need to have that tooth removed for other reasons, reasons that are completely unrelated to your tinnitus. So have the procedure done for those other reasons - and if your tinnitus happens to improve as a result, consider it to be a welcome bonus! That's how I see it, anyway.

Hope this helps.

Stephen M. Nagler, M.D.