Tinnitus can emerge in any of the four sections of the hearing mechanism: the outer, middle and the inner ear, and the brain. Some tinnitus or head noise is normal for all individuals, so if one is placed in a sound proof booth, or is wearing very effective earplugs, he or she will become aware of these sounds. Tinnitus of course works on a different level of volume, which is the reason why it is so particularly bothersome. It is nearly impossible to drown out and/or ignore and it gets even louder when things quiet down.
The outer ear is not often the culprit in emergent tinnitus but some conditions are associated with this section of the ear and the buzzing symptoms. The two most common causes of the tinnitus symptoms due to outer ear problems are:
1) A build-up of earwax, or cerumen, in the ear canal which may irritate the hearing mechanisms
2) A narrowing or poorly shaped ear canal, which may affect the perception of sound
There are methods to deal with both of these types of causes making outer-ear tinnitus one of the most physically treatable. The middle ear, however, can harbor the roots of a much more complex tinnitus symptomatology, some of which may require the attention of your health care provider and possibly even further steps in terms of treatment, surgery not being entirely out of question. In most cases all of these causes may be resolved with adequate medical attention.
The Middle Ear Tinnitus Causes
1. Serous otitis media with fluid in the middle ear:
Otitis media is inflammation of the middle ear, or middle ear infection , it occurs in the area between the ear drum and the inner ear, including a duct known as the Eustachian tube. Otitis media is very common in childhood, with the average toddler having two to three episodes a year, almost always accompanied by the common cold. The rhinoviruses (nose viruses) that cause the common cold infect the Eustachian tube that goes from the back of the nose to the middle ear, causing swelling and compromise of pressure equalization, which is one of the normal function of the tube. The other main function is the lateral drainage of fluids from tissues on either side of the skull
2. Perforation of the ear drum
Perforated eardrum is a rip or perforation (hole) in the eardrum. It can occur due to an infection, trauma (by trying to clean the ear with sharp instruments), explosion, loud noise or an accidental surgical mistake. Flying with a severe cold can also cause perforation due to changes in air pressure and blocked Eustachian tubes. The perforation may heal in a few weeks, or up to a few months. Some perforations require intervention - this may be a simple procedure which uses a paper patch to promote healing, or surgery. In some cases the damage is unable to heal naturally and may require surgical attention.
3. Fixation or dissociation of the ossicular chain (the bones in the middle ear)
Ossicular chain dislocation may happen due to a fracture, tympanic membrane perforation, or trauma. The most common presentation of ossicular discontinuity is separation of several joints. Ossicular fixation may occur several months after the temporal bone fracture if exuberant growth of new bone at the fracture line fuses the ossicular chain. Treatment in any case is middle ear exploration and ossicular chain reconstruction.
4. Cholesteatoma (a pocket of the eardrum growing in the middle ear as a result of chronic ear infections)
Cholesteatoma is a destructive and expanding keratinizing squamous epithelium in the middle ear and there are two types: congenital and acquired. Acquired cholesteatomas is the more common and can be caused by a tear or retraction of the ear drum. Sometimes the disease may be congenital, when it grows from birth behind the eardrum.
5. Glomus tumor (a vascular tumor arising in the middle ear space)
A glomus tumor is a rare benign neoplasm, is a specialized arteriovenous anastomosis usually found in the skin of the extremities, arising from the glomus body. Research has indicated that there are at least four genetic mutations that lead to a glomus tumor. If there is no underlying inherited condition, then the tumor is considered “sporadic” or random. They are usually solitary and small, and can be found under the fingernail, but they can also be found on the tympanic membrane, which in turn causes middle ear damage and tinnitus. These lumps are often painful and tend to have a bluish discoloration, although sometimes they can present as white.
