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Old 02-01-2004, 11:15 AM   #1
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Type of low-frequency Tinnitus with Meniere's?

I've had "regular" high-frequency tinnitus for about 10 years, then during the summer developed a VERY low "hum" tinnitus. Had a hearing test, which the ENT compared with a prior one, said no indication for MRI with only about 5% increase in loss over 3 years. No vertigo, no "fullness" - not sure what "fullness" means.

But here's the strange part, and I wondered if anyone has any ideas about this:

The low hum, which sounds like the deep notes of an organ, but not varying in loudness or pitch, began in the LEFT ear. Some days it would not appear.

Then, after about a month, it "migrated" to the RIGHT ear, louder, and is in that ear about 98% of the time now, all day, every day, all night, every night. Needless to say, it's been tough getting sleep!

Even weirder: Sometimes it will go back to the LEFT ear, but only after it begins to get fainter in the right ear, and this is usually accompanied by rapid clicking or tapping noises deep in my left ear region.

I understand Meniere's is usually in one ear only, at least initially. So I hope that's not what I have, even though one of the classic symptoms is low frequency tinnitus.

This tinnitus is so strange, however, not varying in pitch or volume (except when it's about to "jump" to the other ear), and so very low, that I wonder if anyone else has experienced anything like it?

Any ideas would be greatly appreciated!

Thanks,
Tom

 
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Old 02-01-2004, 12:34 PM   #2
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hbep HB Userhbep HB Userhbep HB User
Re: Type of low-frequency Tinnitus with Meniere's?

Hi Tom,

The clicking sounds like myoclonus - check out the cut and paste below which explains it. The new style tinnitus you're experiencing could also be muscular - I have also experienced high frequency tinnitus since I was a child. Since I've developed muscular problems in my neck and jaw I now intermittently get a new type of tinnitus - which I could describe variously as either a low rumbling - vibrating - hum. In my case I think this is very likely to be stapedial muscular spasm - also described below.

In terms of menieres, the reason why your doc referred to fullness is explained in the topic near the top of this page asking about menieres. Have a read of that. Fullness in the ears is one of the ways they diagnose menieres. From what you've described, menieres certainly doesn't sound likely.

Anyway, check out this bit of info - might shed a lot of light on what's going on...

TINNITUS
Current Evaluation and Management
Written By

D. Scott Fortune MD
David S. Haynes MD
Jay W. Hall III PhD


Neurologic Disorders
Neurologic disorders that cause objective tinnitus include palatomyoclonus and idiopathic stapedial muscle spasm. Palatomyoclonus is characterized by an irregular clicking sound within the ear. The myoclonus is rapid with a rate between 40 and 200 beats/min and occurs intermittently. The sound is generated by the mucous membranes of the eustachian tube snapping together as the palatal musculature undergoes myoclonic contractions. Patients may also complain of aural fullness, hearing loss, or sound distortion. Symptoms are worsened by stress. Frequently a history of muscle spasm with occipital headaches or temporomandibular joint pain can be obtained. The diagnosis can be made on physical examination by listening for the noise with a Toynbee tube or viewing myoclonic jerks in the palate. Tympanometry can occasionally record movement synchronous with the palatal contractions. Rarely, electromyography of the palate is indicated to confirm the clinical diagnosis. Treatment of palatomyoclonus is medical. Antispasmodic agents and muscle relaxants, such as clonazepam or diazepam, are the mainstay of treatment. Neurologic consultation is useful for long-term management of these patients.

Idiopathic stapedial muscle spasm creates a rough, crackling, rumbling noise in the ear. External sounds, such as music tones, water faucets, and voices, are known to accentuate the spasms. Physical examination reveals a normal tympanic membrane with rhythmic contractions synchronous with the noise. History and physical examination are sufficient for diagnosis. The disease is usually self-limited and remits with time; reassurance is often sufficient. Recalcitrant cases may be treated by middle ear exploration with division of the stapedius and tensor tympani muscles. Although the operation abolishes the symptoms, it is rarely necessary. [15]

Hope this helps,

hbep.
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Old 02-01-2004, 01:13 PM   #3
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thbrown421 HB User
Re: Type of low-frequency Tinnitus with Meniere's?

Thank you, hbep:
Looks like you're a mainstay on this board, and I really appreciate your input. In addition to the low hum I also have the "rough, crackling" noise which I was wondering about -- it does indeed appear to be simultaneous with certain external sounds. And I also do have sound distortion - which I have learned is called "diplacusis" or "double-hearing." This is limited mostly to TV, sound systems, and noises from other rooms. Interesting phenomenon, but very disconcerting!

Question: If this terrible loud low hum is indeed muscular in origin, what kind of specialist should I see for that diagnosis? A neuro-otologist?

My regular physician, my ENT and even my tinnitus audiologist haven't mentioned myoclonus or stapedial dysfunction as a possibility, but it certainly makes sense in light of your exerpt on tinnitus. It's so frustrating that all these docs seem to be so inept in the area of ear disorders!

Thanks again for being there, and for the "right-on-the-money" citation!

Tom

Last edited by thbrown421; 02-01-2004 at 01:14 PM.

 
Old 02-03-2004, 07:29 AM   #4
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hbep HB Userhbep HB Userhbep HB User
Re: Type of low-frequency Tinnitus with Meniere's?

Hello there,

I just noticed your post on dizziness when looking up. As you are also experiencing dizziness, then yes, your best bet is definitely a neuro otologist. As far as I remember neuro oto's specialise in dizziness, but prior to doing this have to do regular ENT training. Seems a neuro otologist will be the quickest way of getting all your queries answered. A good one should know full well about myoclonus - although I stress, as with any of these specialists, it needs to be a good one. Seems that when it comes to specialists it's a matter of luck how good they are, and unfortunately, unless you can get a recommendation, you only find out when you go.

If it does turn out to be all muscular then the treatment tends to be benzos, or anti spasmodic drugs like neurontin. I managed to get my ear vibration under control with very careful (it's addictive) and sporadic use of valium at a very low dose - 2mg. As mine is linked to tempero mandibular joint disorder - connected to clenching my teeth, I also wear a splint - (mouthguard) at night, to suppress clenching. If you want to look in to whether tmjd is a problem for you the correct person to see is a dentist who specialises in this area. Although again, a good neuro oto should be aware of the connection btwn tmjd and muscular based ear problems.

Hope this helps,

best,

hbep.
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