Tympanoplasty on Patients with Tinnitus

[marqualler]

Hi Dr. Nagler,

I have a question regarding tympanoplasty. To make a long story short, I started noticing tinnitus in my left ear about 6 weeks ago in the midst of a bad sinus infection. It has not gone away although it has reduced in intensity from the first couple weeks to today--both in terms of loudness and my own habituation. In looking into the problem initially, doctors prescribed antibiotics for a double ear infection, which apparently at least cleared the infection up. However, the left ear, after a CT scan and an unsuccessful attempt to suction fluid out, showed that it was still inflammed in the canal and on the ear drum, and the ENT I saw who did the CT referred me to a different ENT who is a surgeon. Most recently last week, he looked at my left eardrum and said it is still inflammed a little bit, in addition to the hole that was there from the suctioning, and he is recommending tympanoplasty. In essence, a spot of myringitis on my eardrum would be removed, necessitating the need to replace that part with new skin. He said that I could wait and do nothing but that the myringitis is unlikely to heal on its own at this point.

My question is, how would this effect my tinnitus? I'm not excited to do anything that would make it worse, which it seems from my reading that it is a likely side effect to the surgery regardless of whether someone has had it or not. But I am also confused by some reports that I have read that seem to indicate that tympanoplasty for patients with existing tinnitus offers good control and in some cases elimination of tinnitus, although my ENT said that is not likely. Here is the main source that I have seen regarding that thought:

http://www.ncbi.nlm.nih.gov/pubmed/17684660

and another source here (around page 5 that discusses how patients with existing perforations or damage to the ear drum may have tinnitus and how the surgery can help reduce it)

http://online.x-plain.com/modules_v3/otolaryn/ol300102/ol309102.pdf

Any assistance you can send would be greatly appreciated. Thanks much for your expertise!

Mark

 

[Dr. Nagler]

Hi @marqualler -

Tough to predict the effect of tympanoplasty in any given case.

The theory is that a perforated eardrum results in a conductive hearing loss. Repairing the eardrum results in return (or near return) to pre-perforation hearing - and any tinnitus resulting from the sudden change in hearing thresholds from the perforation should hopefully resolve. That's the theory, anyway.

The problem is that there are so many variables, that it's largely a crap shoot. Your tinnitus could improve, stay the same, or possibly even get worse.

I guess my first question to the ENT would be what clinical benefit does he hope to achieve by removing the small amount of inflammation and repairing the perforation. Once you have a clear idea of the exact reason he is recommending the procedure, you might be in a better position to decide whether or not to go through with it. I mean, you've only had tinnitus for six weeks - and it seems to be improving. So at this early stage I'm not so sure I'd undergo the procedure because of tinnitus alone. On the other hand, there may be compelling reasons to move ahead that have nothing to do with your tinnitus. That's why you should seek some further clarification in the matter.

Hope this helps.

Dr. Stephen Nagler