kpons at BYELECTRIC.COM ("Kevin Pons") wrote:
>I've noticed over the years that some patients will complain of tinnitus =
>after a cold, "sinus infection", hospital stay for illness, or after a =
>middle ear effusion. Prior to the incident no significant hearing loss =
>was apparent and there had been no other otologic complaint. They =
>subsequently schedule an appointment for tinnitus evaluation which =
>typically shows some slight to moderate high frequency HL but no other =
>abnormal signs and otologic evaluation is noncontributory. My =
>assessment has been that the HL preceded the URI etc. and therefore =
>predisposed the ear to generate tinnitus which is then precipitated by =
>the other minor incident. Has anyone else noticed this or know of any =
>literature related to this phenomenon. I would be interested in your =
>thoughts.
.................................................................
A few thoughts, if I may - -
Individuals who develop tinnitus for whatever reason will frequently
(and quite naturally) try to associate it with some kind of
precipitating event, even if - in actuality - the onset of tinnitus
and that "event" aer coincidentally rather than causally related.
Certainly viral infections and the taking of ototoxic medications can
result in tinnitus, possibly even the psychological effects of
hospitalization can do the same, but the mere temporal relationship is
no clear indication of a causal relationship. (Many of us have had a
recent illness, an effusion, a cold, or a sinus infection. How many
of us have developed intrusive tinnitus as a result - even including
those with prior documented high frequency hearing loss?)
With respect to the association between high frequency hearing loss
and tinnitus, I believe that much of the current thinking in the
professional tinnitus community is that while the same insult can
cause both high frequency hearing loss and tinnitus, high frequency
hearing loss does not itself cause tinnitus (although hearing loss CAN
make tinnitus appear more prominent), and tinnitus does not in and of
itself lead to hearing loss. About 95% of hearing at the hair cell
level is a function of inner hair cell integrity, whereas cochlear
tinnitus is largely an outer hair cell issue. This phenomenon
provides a clear explanation of why one can be totally deaf yet not
experience tinnitus, and one can have raging tinnitus in the presence
of a totally normal audiogram. Most of the time, however, the noxious
event(s) damaging inner hair cells also damage outer hair cells, so
the hearing loss and tinnitus coexist.
I hope this information is helpful.
smn
Stephen M. Nagler, MD, FACS
Director
Southeastern Comprehensive Tinnitus Clinic
Atlanta, Georgia
http://www.tinn.com
(404) 531-3979
