Can Multiple Sclerosis (MS) cause tinnitus (ringing in the ears) with a sensation of fullness?

Multiple Sclerosis and Ear Symptoms: Tinnitus and Fullness

Multiple sclerosis (MS) can cause tinnitus (ringing in the ears) and a sensation of ear fullness, though these are not among the most common presenting symptoms of MS. While audiovestibular symptoms are relatively rare in MS compared to other neurological manifestations, they can occur as early or presenting symptoms of the disease.

MS-Related Audiovestibular Symptoms

• The most common audiovestibular manifestation as an early symptom of MS is unilateral, moderate to profound, fluctuating, and sudden sensorineural hearing loss across all frequencies (250 Hz-8000 Hz) 1
• Other symptoms that can accompany MS include tinnitus, balance abnormalities, aural pain, and aural fullness 1
• These symptoms may occur independently or accompany sudden sensorineural hearing loss 1

Mechanism of MS-Related Ear Symptoms

• MS can impact the audiovestibular pathway at different stages of the disease through its immune-mediated, demyelinating processes 1
• Demyelinating lesions in the brainstem auditory pathways can cause tinnitus and other hearing abnormalities 2
• Evidence suggests that the immune-mediated mechanisms of MS may also affect peripheral structures of the inner ear, not just central pathways 1
• When MS lesions involve the pontine auditory pathway, auditory tests requiring precise neural timing are consistently abnormal 3

Differential Diagnosis

When evaluating tinnitus with ear fullness, it's important to distinguish MS from other conditions, particularly Ménière's disease:

Ménière's Disease vs. MS

• Ménière's disease is characterized by:

  • Episodes of vertigo lasting 20 minutes to 12 hours 4
  • Fluctuating low- to mid-frequency sensorineural hearing loss 4
  • Tinnitus and ear fullness 4
  • Believed to be caused by excess fluid in the inner ear 4

• MS with audiovestibular symptoms typically presents with:

  • Often progressive fluctuating hearing loss that may be steroid-responsive 4
  • May present with additional vision, skin, and joint problems 4
  • Tinnitus that may persist between episodes 1
  • Other neurological symptoms may be present 2

Diagnostic Approach for Tinnitus with Ear Fullness

• MRI of the brain with contrast is the gold standard for diagnosing MS and should be performed when MS is suspected 4
• Audiometric testing can help characterize the type and degree of hearing loss 4
• Evoked potentials measurements (ABR, VEMPs, MLR) can detect demyelinating lesions even when hearing returns to normal 1
• Video- or electronystagmogram may be used to evaluate vestibular function 4

Clinical Significance and Prognosis

• Tinnitus and hearing loss in MS may be transient and reversible in many cases 5
• In some patients, these symptoms can be the initial presentation of MS 5
• Deafness with tinnitus during acute MS episodes typically regresses after less than 3 months 6
• The occurrence of audiovestibular symptoms does not necessarily indicate a particular progression pattern of MS 6

Management Considerations

• Treatment should target the underlying MS with appropriate disease-modifying therapies 2
• Individualized treatment interventions can achieve remission of auditory symptoms in many cases 2
• Monitoring of both auditory symptoms and MRI findings is important for tracking disease progression 1
• Early diagnosis and intervention through appropriate referral when audiovestibular symptoms present can improve outcomes 1

Important Caveats

• Tinnitus and ear fullness are non-specific symptoms that can be caused by many conditions besides MS 4
• When these symptoms occur in isolation without other neurological signs, MS may not be the first diagnosis to consider 4
• Audiological symptoms in MS are relatively rare compared to other sensory disturbances like visual and proprioceptive changes 3
• Always consider other common causes of tinnitus and ear fullness before attributing symptoms to MS 4