How Do You Distinguish Between Middle Ear and Inner Ear Tinnitus?

[SignalExec]

I have had tinnitus for about four weeks now. Mine started after working with some machinery. For a few days, my both ears were hissing. Then it stopped in the left. Now it's only the right.

Of course, my first thought was that I had damaged my hearing. However, the hearing test(s) came back ok and symmetrical. Now I am starting to wonder whether my tinnitus is caused by some inflammation in the middle ear. Or that my tinnitus is somatic. Maybe, the exposure to the sound caused some inflammation that cleared rapidly in the right ear but is still lingering in the left one?

Against this hypothesis is that mine started after some noise exposure.

In favor of this hypothesis are these:

• My tinnitus seems to get better over time.
• It seems to respond to oral steroids.
• I have no hearing loss and symmetric hearing (asymmetric tinnitus).
  
• I have no history of noise exposure - mine was pretty much a one of thing.
  
• I can manipulate the pitch of my tinnitus by maneuvers of the neck/jaw.
• I do have a history of neck problems (neck stiffens up, been treated)
  
• Not sure whether this is relevant: my left eustachian tube opens very difficulty - it's very hard to clear my left (tinnitus) ear.

I have been reading a number of recent scientific papers on the diagnosis of somatic tinnitus (see below). From these, I gather that mine might fit the profile. However, none of the papers were very clear on how this is diagnosed. They all referred to some examination by a dentist or another health provider and left it at that.

So, my question is whether anybody has ideas of ways a healthcare provider or I can distinguish middle ear problems from inner ear damage.

Fyi: These are the papers I read:

• Ralli, M., Greco, A., Cialente, F., DI Stadio, A., De Virgilio, A., Longo, L., … De Vincentiis, M. (2017). Somatic tinnitus. International Tinnitus Journal, 21(2), 112–121. https://doi.org/10.5935/0946-5448.20170022

• Sanchez, T. G., & Rocha, C. B. (2011). Diagnosis and management of somatosensory tinnitus: review article. Clinics, 66(6), 1089–1094. https://doi.org/10.1590/S1807-59322011000600028

 

[dayma]

It's not really one doctor to tell you and more a overall diagnosis from Audiologist, ENT, and Neurologist.

Audiologist should do an OAE test to measure cochlear status and more specifically hair cell function. Past that an ENT can look at MRIs and structures of the ear to make sure there are no issues. Once you get to the nerve part of things the Neurologist should examine your history and test how your T reacts to movements of the body etc...

...and, also add Dentist for TMJ...

Basically I am saying it takes an army to really get a overall picture of your T.

 

[dingaling]

There is no such thing as "middle ear tinnitus" as far as I know - I stand to be corrected of course

Tinnitus can be caused by middle ear problems through ineffective passage of sounds to the inner ear (such as ETD, TMD etc)

Standard hearing tests may not show up hearing loss beyond 8kHz. From your first paragragh, it is likely that your T has been caused by the machine noise. You will also now know to wear earplugs/muffs etc when operating on, or working around machinery

 

[glynis]

Inner ear damadge comes with other symptoms as well as tinnitus eg balance,vertigo,hearing loss.
Love glynis

 

[GregCA]

So, my question is whether anybody has ideas of ways a healthcare provider or I can distinguish middle ear problems from inner ear damage.

Pure Tone Audiometry (with bone conduction testing) shows conductive vs sensorineural losses, so it helps determine where hearing losses are, and therefore, where the problems are (middle ear vs inner ear).
Other tests include Rinne/Weber fork tests.

For specific issues that are suspected, imaging can help (for example, CT scan is often performed when otosclerosis is suspected, and MRIs when acoustic neuroma is suspected).

I have no hearing loss and symmetric hearing (asymmetric tinnitus).

You could have "hidden hearing loss", unfortunately.

I have no history of noise exposure - mine was pretty much a one of thing.

One acoustic trauma is enough to trigger synaptopathy (and "hidden hearing loss"), unfortunately.

The correlation between the episode with machinery and your tinnitus onset really points at hearing damage. It seems the simplest explanation.

 

[SignalExec]

The correlation between the episode with machinery and your tinnitus onset really points at hearing damage. It seems the simplest explanation.

I think that's a sensible assessment. However, I've been tested twice, also to 14khz.

I'll be seeing an audiologist as well. It is my understanding this will be a 90 minute visit. I hope to be able to get a more in depth assessment than from my ENT. If this results in any insight, I'll report back, maybe it is of help to anyone else.

 

[1MW]

Get the Peltor X5A earmuffs and wear them also avoid all noises/sounds (silent & loud)
Get some dexamethasone and your tinnitus will be cured in some time.
Your tinnitus is from noise... you must avoid noise at any cost for 1 year at least.
Many people from noise/sound trauma appear as somatic tinnitus afterwards but it is not somatic, it's from noise exposure

 

[SignalExec]

There is no such thing as "middle ear tinnitus" as far as I know - I stand to be corrected of course

The paper below (Zenner) explicitly lists different locations for the origion of tinnitus - the author describes Conductive tinnitus as tinnitus originating in the middle ear. He lists these as examples of middle ear problems leading to tinnitus: Disturbance of tubal ventilation, middle ear myoclonia, Hypermotility.

This is still something else than somatic tinnitus which is defined as 'preceded or strictly linked to a somatic disorder, and therefore related to problems of the musculoskeletal system rather than of the ear' (Ralli et al).

Zenner, H. P. (1998). A systematic classification of tinnitus generator mechanisms. International Tinnitus Journal, 4(2), 109–113.
Ralli, M., Greco, A., Cialente, F., DI Stadio, A., De Virgilio, A., Longo, L., … De Vincentiis, M. (2017). Somatic tinnitus. International Tinnitus Journal, 21(2), 112–121. https://doi.org/10.5935/0946-5448.20170022

 

[Proteo]

Don't implicitely trust the hearing tests unless they check the full spectrum of sound frequencies, tinnitus-causing hearing loss could very-well be multiple and localized, and missed by tests which only check several of the frequencies.

 

[GregCA]

The paper below (Zenner) explicitly lists different locations for the origion of tinnitus - the author describes Conductive tinnitus as tinnitus originating in the middle ear. He lists these as examples of middle ear problems leading to tinnitus: Disturbance of tubal ventilation, middle ear myoclonia, Hypermotility.

And of course, otosclerosis...