Can middle ear effusion cause tinnitus?

Middle Ear Effusion and Tinnitus

Yes, middle ear effusion can cause tinnitus by disrupting the normal impedance matching function of the middle ear and creating conductive hearing loss. 1

Pathophysiology of Tinnitus in Middle Ear Effusion

• Middle ear effusion (MEE) impairs tympanic membrane vibration, resulting in conductive hearing loss which can manifest as tinnitus 2, 1
• The presence of fluid in the middle ear serves as a barrier to sound conduction and decreases mobility of the tympanic membrane 2
• Fluid in the middle ear can cause up to 25-30 dB of conductive hearing loss, which may manifest as tinnitus 3
• The mechanisms of hearing loss (and associated tinnitus) from middle ear effusion include:
  • Reduction of the admittance of the middle-ear air space due to displacement of air with fluid (primary mechanism at low frequencies) 3
  • Increase in tympanic membrane mass by entrained fluid (primary mechanism at high frequencies) 3

Types of Middle Ear Effusion That Can Cause Tinnitus

• Otitis media with effusion (OME) - characterized by the presence of fluid in the middle ear without signs or symptoms of acute infection 2
• Acute otitis media (AOM) - characterized by middle ear effusion plus signs and symptoms of acute infection 2
• Chronic suppurative otitis media (CSOM) - persistent drainage from the middle ear through a perforated tympanic membrane 2

Clinical Presentation and Diagnosis

• Tinnitus associated with middle ear effusion is typically subjective (heard only by the patient) and non-pulsatile 2, 4
• When middle ear effusion causes tinnitus, it is often accompanied by other symptoms:
  • Sensation of aural fullness or pressure 5
  • Conductive hearing loss 2, 1
  • Occasionally balance problems 2
• Diagnostic approach should include:
  • Pneumatic otoscopy to visualize tympanic membrane mobility (reduced mobility suggests fluid) 1
  • Tympanometry to objectively measure middle ear function (flat tympanogram indicates fluid) 1, 6
  • Audiometric testing to document the degree of conductive hearing loss 4

Management Considerations

• Treatment of the underlying middle ear effusion will typically resolve the associated tinnitus 5
• For otitis media with effusion (OME):
  • Watchful waiting is recommended for 3 months from the date of effusion onset or diagnosis in children not at risk for developmental delays 2, 6
  • Tympanostomy tubes should be considered for chronic effusions with persistent symptoms including hearing loss 2, 6
• Medications that should NOT be used for OME:
  • Antihistamines and decongestants (ineffective) 2, 6
  • Systemic antibiotics (not effective for long-term management) 2, 6
  • Intranasal or systemic steroids (not recommended) 6

Special Considerations

• Persistent unilateral tinnitus with middle ear effusion warrants further investigation, as it may occasionally be caused by occult skull base lesions that compress the Eustachian tube 5
• In patients with persistent tinnitus despite resolution of middle ear effusion, other causes of tinnitus should be considered 4
• For patients with discomfort from persistent tinnitus with no remediable cause, auditory masking may provide relief 4

Pitfalls and Caveats

• Don't assume all tinnitus associated with middle ear effusion is benign; unilateral persistent tinnitus with effusion may require imaging to rule out occult masses 5
• Don't overlook the impact of hearing loss from middle ear effusion on language development and learning in children 1, 6
• Avoid unnecessary antibiotic use for OME, as they do not provide long-term efficacy 2, 6
• Remember that most cases of OME resolve spontaneously within 3 months, but about 30-40% of children have recurrent episodes 2