Objective tinnitus

woman suffering a migraine
Objective tinnitus is the perception of sound in the ear without an external source of the noise, and this noise can, however, be heard by the doctor using a stethoscope.

It is the opposite of subjective tinnitus; while the symptoms may be the same, subjective tinnitus noise is only heard by the tinnitus patient. Even when a stethoscope is placed over the tinnitus patient’s ear, the doctor will not listen to the noise, but with objective tinnitus, the noise will be heard.

Objective tinnitus is a rare kind of tinnitus, but it has an identifiable cause that is usually treatable. This is different from subjective tinnitus, which is often idiopathic and incurable.

An observer can hear objective tinnitus noise because there is actual sound being generated in the body. This sound being generated reaches the ear, and it is what causes the noise in the ear. So while there is no external noise source, there is usually an internal noise that results in tinnitus.

Objective tinnitus is also referred to as rhythmic tinnitus, while non-rhythmic tinnitus refers to subjective tinnitus. Certain types of tinnitus, like muscular tinnitus and pulsatile tinnitus, also known as pulse-synchronous tinnitus, are rhythmic; hence they are categorized as objective tinnitus.

Pulsatile Tinnitus

Pulsatile tinnitus is the perception of a rhythmical noise that is in sync with your heart rate. Pulsatile tinnitus noise can be likened to a whooshing or thumping noise. Since the noise in sync with your heartbeat, when your heartbeat increases, the noise in your ear will increase, and when your heartbeat reduces, the noise in your ear reduces.

Pulsatile tinnitus may be benign and simply annoy the tinnitus patient, but it can be severe and debilitating that regular activities like sleeping and concentrating are affected in other cases.

Just like other types of objective tinnitus, pulsatile tinnitus often has an identifiable cause. It is caused by the awareness of a change in blood flow in blood vessels close to the ear. These veins and arteries may be those found at the base of the skull or in the ear.

Pulsatile tinnitus noise may come and go, or it may be constant. It can also disappear on its own without any treatment. It is, however, important to visit a doctor when you notice this type of ringing because it may be a symptom of a dangerous health condition that can cause serious damage, including death if left untreated.

Muscular Tinnitus

Muscular Tinnitus is a type of objective tinnitus that happens when the myoclonus affects muscles in or around the ear. Myoclonus refers to the involuntary jerking or spasm of a muscle or muscles. Abnormal contractions and relaxations of muscles usually cause this.

The major causes of muscular tinnitus are degenerative diseases of the ear and neck, such as multiple sclerosis. Muscular tinnitus sound is often heard as a clicking sound.

Symptoms of Objective Tinnitus

Woman with headache

 

Tinnitus is not considered a medical condition; rather, it is regarded as a symptom. Just like every other symptom, it always has a root cause. This means that the presence of tinnitus is a sign that something is wrong.

This, however, does not mean that the tinnitus noise is the only thing you will feel if you have tinnitus. Other symptoms often accompany it. These symptoms are often referred to as tinnitus symptoms. The symptoms may result from the tinnitus, but others may have the same underlying cause as the tinnitus.

The symptoms of objective tinnitus are alike to those of subjective tinnitus. The most common symptom of objective tinnitus is the perception of sound or noise in the ear. Depending on the tinnitus cause, the sound may be perceived as a clicking, thumping, throbbing, roaring, whistling, or whirring noise. The noise in the ear can come and go, or it may be present always.

The volume or pitch of the tinnitus noise can fluctuate or vary from person to person. In some cases, the tinnitus noise gets louder during the night because of the lack of background noise. In other cases, the volume of the noise remains the same.

Also, the severity of the tinnitus noise and its effects on the tinnitus patient’s life varies from patient to patient. No two cases of tinnitus are ever considered to be the same.

This is because while the degree of the tinnitus noise may be considered the same, the tinnitus’s impact on the life of the tinnitus patient and its severity is based on how the individual perceives it.

Two tinnitus patients may have similar degrees of noise. Still, while one can go about his normal daily activities without much interference, the other may suffer serious setbacks and may not be able to concentrate or sleep because of the noise.

Aside from the noise in the ear, other objective tinnitus symptoms include difficulty understanding speech, difficulty concentrating, insomnia or difficulty sleeping, headache, anxiety, vertigo, and depression.

Objective Tinnitus Causes

Doctor Examining Patient Ear

 

Objective tinnitus is often caused by diseases, abnormalities, or disorders that affect the vascular system (blood vessels) and the muscular system (muscles) near or in the ear.

When blood vessels are affected or abnormal, the flow of blood through them changes, resulting in the turbulence of blood flow that can be heard in the ear.

Let's examine the causes of objective tinnitus in detail.

1. Atherosclerosis

Atherosclerosis, also known as atherosclerotic cardiovascular disease, is the hardening or narrowing of arteries caused by damage to the endothelium.

The endothelium is the thin membrane that lines the interior of blood vessels and the heart; it performs vital functions like controlling blood pressure, prevents blood clotting, and filters out anything that shouldn't be in the blood, and triggers immune responses.

The endothelium also controls the release of water and electrolytes into the blood, and it is responsible for the growth and repair of blood vessels.

When the endothelium gets damaged, it can no longer perform all these functions, thereby making the blood vessels vulnerable to diseases such as atherosclerosis.

Atherosclerosis can be caused by cardiovascular disease, high cholesterol, strokes, arthritis, lupus, smoking, diabetes, high blood pressure, and obesity. While these may not directly cause blood vessels’ hardening, the damage they cause to the endothelium creates room for plaque to build up in the artery wall.

Without the endothelium filtering what gets into the blood vessels, bad cholesterol can enter the arteries’ walls. The cholesterol is digested by the white blood cells, and over time, the digested cholesterol and the cells form plaques on the wall of arteries.

The plaques create bumps on the artery walls. The bumps continue to grow until a blockage is formed in the artery. This blockage makes it difficult for blood to flow through the arteries. It is important to note that it is not only one artery affected by Atherosclerosis, but all the arteries in the body are also affected, which is why the ears are affected.

With the blockage of the arteries, blood flow becomes more forceful and turbulent. This turbulent blood flow is heard as objective tinnitus, which is why it is in sync with your pulse.

Symptoms of atherosclerosis are often felt when a heart attack is imminent. Asides from turbulent blood flow, other symptoms are pain in the upper body, including the neck, difficulty speaking, difficulty understanding speech, severe headache, unusual heartbeat, paralysis, high blood pressure, and kidney failure.

2. Susac Syndrome

Susac syndrome is a rare autoimmune disease that makes your immune system attack the smallest blood vessels in your inner ear, brain, and retina. Susac syndrome is also known as Small Infractions of the Cochlear, Retinal, and Encephalic Tissue SICRET.

Even though the exact reason why the immune system begins to attack the tiny blood vessels, the major victims of this attack are the endothelium’s endothelial cells.

As you already know, these cells play a vital part in ensuring the growth, repair, and cleaning up of blood vessels. When the endothelial cells are attacked, they swell up. This swelling can completely or partially stop blood flow through the affected vessel.

This blockage of blood flow prevents oxygen and the required nutrients from getting to the part of the body being serviced by the blood vessel.

The symptoms of Susac syndrome often correspond with the area of the body affected. This means that the symptoms vary based on the part of the body affected. These symptoms, however, are not felt at the same time. The most common first symptoms are brain symptoms.

If the eye is affected, symptoms include loss of side vision, visual disturbance, and dark areas in parts of the visual field.

Brain symptoms include short-term memory loss, walking difficulties, slurred speech, confusion, severe headache accompanied with vomiting, depression, aggression, withdrawal, and anxiety.

Inner ear symptoms of susac syndrome include tinnitus, hearing loss, and dizziness or vertigo.

Susac syndrome can be treated with medications that suppress the immune system. It is, however, important that treatment is commenced immediately as soon as it is diagnosed. Delay of treatment may worsen the damage.

3. Acoustic Neuroma

Acoustic neuroma, also known as vestibular schwannoma, is a slow-growing tumor that grows on the main nerve connecting the inner ear to the brain.

The vestibular nerve branches play an active part in hearing and balance.

The origin of acoustic neuroma in the body can be traced to a gene malfunctioning on chromosome 22. The cause of the malformation is unknown, but the gene affected is responsible for the production of tumor suppressor protein.

The tumor suppressor protein controls the growth of Schwann cells that cover nerves. The Schwann cells are important for the development, maintenance, regeneration, and function of peripheral nerves.

When acoustic neuroma starts, it begins from the Schwann cells and covers the nerve. The tumor may not grow at all after this, or it may begin to grow slowly.

If an acoustic neuroma is quickly diagnosed, the tumor may be prevented from growing bigger. If, however, it is not quickly diagnosed, it can progress slowly until the tumor begins to put pressure on nearby blood vessels, brain structures, and adjacent nerves that control sensation and facial muscles.

In extreme cases, the tumor can grow so large that it will begin to press in the brainstem. This pressure prevents the normal flow of cerebrospinal fluid from the brain to the spinal cord. This will cause the fluid to build up in the head, thereby increasing the pressure inside the skull.

Acoustic neuroma usually affects one ear. The symptoms are only felt in the affected ear. Common symptoms of acoustic neuroma are sudden or gradual hearing loss, vertigo, tinnitus, facial weakness, and muscle weakness.

4. Glomus Tumors

Glomus tumors, which are also known as paragangliomas, are benign but locally invasive in the blood vessels in the head and neck.
Glomus tumors arise from glomus cells, and they can grow in the major blood vessels in the neck (carotid arteries), the jugular bulb (the area below the middle ear), and the middle ear.

Even though glomus tumors are benign, they can increase in size and damage surrounding tissues if they are left to grow.

The fact that glomus tumors are benign does not mean that it doesn't cause any symptoms. These symptoms, however, vary and are dependent on the location of the tumor.

If the tumor is located in the middle ear, it is referred to as a glomus tympanum tumor. Common symptoms of this type of glomus tumor include pulsatile ringing in the ear, bleeding from one ear, and hearing loss.

A tumor in the carotid arteries is known as a carotid body tumor. Common symptoms include difficulty swallowing, a mass in the neck, and harness.

Glomus tumors located in the jugular bulb is known as glomus jugulare tumor, and it can cause ear pain, shoulder drop, bleeding in one ear, hearing loss and difficulty swallowing.

If the tumor affects stress hormone levels, it can cause high blood pressure, anxiety, and headaches.

The best treatment for glomus tumors is surgical excision.

5. Fibromuscular Dysplasia

Fibromuscular dysplasia is a rare cause of objective tinnitus. It is a medical condition that causes the stenosis (narrowing) and aneurysms (enlargement) of medium-sized arteries in the body.

The arteries that are commonly affected are arteries leading to the brain and kidney. When the arteries are narrowed, blood flow through them is reduced, and the reduced blood flow can affect the body’s function. Asides from the arteries leading to the brain and kidney, fibromuscular dysplasia also affects arteries leading to the heart, legs, and abdomen.

When the carotid artery, which is the artery leading to the brain, is affected, it can cause temporary loss of vision, headache, neck pain, facial weakness, difficulty speaking, dizziness, pulsating ringing in the ear, neck pain, and Numbness in the limbs.

Even though the cause of fibromuscular dysplasia is unknown, factors such as genetics and hormones have been linked to it.
Abnormal formation of arteries due to the use of certain medications and lack of oxygen has also been identified as a possible cause of fibromuscular dysplasia.

There is no known cure for fibromuscular dysplasia yet. The available treatments are aimed at managing the symptoms and reducing the complications associated with them.

6. Sinus Wall Abnormalities

The most common type of sinus wall abnormality that can cause objective tinnitus are sigmoid sinus diverticulum and dehiscence. The sigmoid sinus is located on the side of the brain, and it is a channel that receives blood from veins in the brain.

The sigmoid sinus diverticulum occurs when small pouches that protrude through the sigmoid sinus wall located behind the ear in the mastoid bone are formed. These pouches interfere with the normal flow of blood within the affected area.

Dehiscence, on the other hand, is the absence of a part of the bone that surrounds the sigmoid sinus in the mastoid behind the ear.

Both sigmoid sinus diverticulum and dehiscence cause a change in the pressure, noise, and blood flow in the sigmoid sinus. In some cases, the blood vessel leading to the sigmoid sinus can also be damaged. This change in the pressure and flow of blood causes the flow to become noisy. This noise is what is perceived as objective tinnitus.

7. Other Causes

Other causes of objective tinnitus include the following:

  • Superior Semicircular Canal Dehiscence Syndrome
    This condition is where the temporal bone that overlies the superior semicircular canal is too thin or absent. The superior semicircular canal is found in the vestibular apparatus in the inner ear, which is responsible for hearing and balance. The absence of this thin bone can cause objective tinnitus and balance problems.
  • Abnormal Capillaries
    The abnormal formation of capillaries can affect the flow of blood and cause objective tinnitus.
  • Idiopathic Intracranial Hypertension
    The buildup of cerebrospinal fluid in the head can increase the head’s pressure and cause symptoms like double vision, headaches, and tinnitus.
  • High-Blood Pressure
    High blood pressure can either cause or aggravate objective tinnitus. When your blood pressure is high, the flow of blood through the carotid artery becomes turbulent and louder than normal. This can cause tinnitus.
  • Patulous Eustachian Tubes
    This is a condition where the eustachian tubes, which are normally closed, are abnormally open. This opening causes vibrations to be sent directly to the eardrum when chewing, talking, or swallowing. This can result in objective tinnitus.

Objective Tinnitus Treatment

Ear examining

 

There is no cure for tinnitus yet. But objective tinnitus can be cured or improved by identifying and treating the primary underlying cause.

For instance, if the cause of objective tinnitus is glomus tumors, the removal of the tumors through a surgical procedure will automatically handle the tinnitus. In the same manner, if the objective tinnitus is caused by sigmoid sinus diverticulum and dehiscence, undergoing a sinus wall reconstruction surgery can cure the tinnitus.

If, however, after a thorough examination, the source of the tinnitus is not identified, you may have to undergo Tinnitus Retraining Therapy or make use of masking devices.

This is rarely the case because the cause of objective tinnitus is often known, and there are appropriate treatments available to either cure or manage the underlying cause.

Conclusion

If you notice ringing in your ears, don't hesitate to inform your doctor. Even though the causes of objective tinnitus can be identified and handled, if it is not given prompt medical attention, the damages may be permanent.

In most cases, such damages do not just affect your hearing; they can spill over to other aspects of your health. And in cases where severe damage was done due to delay of medical care, death may occur.

Have you experienced objective tinnitus? What was the underlying cause? How was it treated? We would love to read your feedback in the comment section.

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