From the Guidelines
Yes, it is plausible to experience tinnitus unilaterally, meaning in only one ear. Unilateral tinnitus is relatively common and can have different causes than bilateral tinnitus. When tinnitus occurs in only one ear, it warrants prompt medical evaluation as it may indicate specific underlying conditions such as Meniere's disease, acoustic neuroma (a benign tumor on the vestibular nerve), or damage to the auditory system on one side from noise exposure, ear infections, or earwax blockage.
Key Considerations
- Unilateral tinnitus, especially when accompanied by sudden hearing loss, vertigo, or facial weakness, should be considered more concerning than bilateral tinnitus.
- The brain processes auditory information from each ear somewhat independently through separate neural pathways, which explains why damage or dysfunction can affect one ear without necessarily involving the other.
- If you experience unilateral tinnitus, particularly if it's sudden in onset or associated with other symptoms, you should consult a healthcare provider, preferably an otolaryngologist (ENT specialist), for proper evaluation and treatment, as recommended by recent guidelines 1.
Evaluation and Management
- A thorough history, physical examination, and audiometry are helpful for elucidating a cause of unilateral tinnitus 1.
- Imaging should be considered to exclude a retrocochlear lesion in cases of unilateral tinnitus, especially if accompanied by other symptoms such as hearing loss, vertigo, or neurological deficits 1.
- The management of unilateral tinnitus may require addressing the need for hearing aids or hearing assistive technology systems, as well as other supportive measures to improve quality of life 1.
From the Research
Unilateral Tinnitus
- Unilateral tinnitus refers to the perception of sound in only one ear, in the absence of any external source [(2,3,4)].
- It is a common symptom encountered in primary care, and its underlying cause must be determined to best help patients [(2,4)].
- Unilateral hearing loss plus tinnitus should increase suspicion for acoustic neuroma, a type of tumor that grows on the cranial nerve running from the brain to the inner ear 3.
Diagnosis and Evaluation
- A comprehensive audiologic evaluation should be performed for patients who experience unilateral tinnitus 2.
- Neuroimaging is not part of the standard workup unless the tinnitus is asymmetric or unilateral, pulsatile, associated with focal neurologic abnormalities, or associated with asymmetric hearing loss 2.
- Initial evaluation of tinnitus should include a thorough history, head and neck examination, and audiometric testing to identify an underlying etiology [(3,4)].
Prevalence and Impact
- Tinnitus is a common disorder with many possible causes, and its incidence in Germany and the western world is about 10% 5.
- About 1-2% of the population are severely disturbed by tinnitus, and it may disrupt everyday activities and sleep 5.
- Unilateral tinnitus can be a lifelong disorder and will bring about annoyance, anxiety, depression, insomnia, hyperacusis, concentration difficulty, and, in some extreme cases, suicide 6.