What could be causing a 2-week persistent whirling sound, likely tinnitus, in my left ear without any other symptoms?

Whirling Sound in Left Ear for 2 Weeks

You need an audiogram within the next few days and should be evaluated for sudden sensorineural hearing loss (SSNHL), which can present with tinnitus as the primary symptom and requires urgent treatment within 2 weeks of onset for optimal outcomes. 1

Immediate Clinical Priorities

Your "whirling sound" represents tinnitus that is unilateral (left ear only) and has persisted for 2 weeks. This presentation requires prompt action because:

• Sudden sensorineural hearing loss affects 5-20 per 100,000 people and can present with tinnitus as the primary symptom, even when you don't notice hearing loss yourself. 1 The American Academy of Otolaryngology defines sudden hearing loss as occurring over a 72-hour period, but the key point is that up to 32-65% of cases may recover spontaneously—but only if identified and treated promptly. 1

• The primary presenting symptom of sudden hearing loss is often just a "full or blocked ear" sensation, not obvious deafness, which is why both patients and physicians frequently delay evaluation. 1 This delay can be catastrophic for hearing recovery and quality of life. 1

• You are still within the critical 2-week window where corticosteroid therapy may be offered, which has the strongest evidence for improving hearing recovery. 1 After 2 weeks, treatment options become limited to "salvage therapy" with lower success rates. 1

Required Diagnostic Workup

Get a comprehensive audiologic examination (pure tone audiometry, speech audiometry, and acoustic reflex testing) within the next few days—do not wait. 2 The American Academy of Otolaryngology makes a strong recommendation for prompt audiologic testing in patients with unilateral tinnitus, regardless of whether you perceive hearing difficulties. 2

What the audiogram will determine:

• If you have documented hearing loss (even mild), this confirms SSNHL and you should receive corticosteroids immediately. 1 Treatment is most effective when started within 2 weeks of symptom onset. 1

• If hearing is normal bilaterally, imaging is NOT indicated because you have no pulsatile quality, no neurologic symptoms, and no asymmetric hearing loss. 2 The American Academy of Otolaryngology makes a strong recommendation AGAINST imaging for non-pulsatile, unilateral tinnitus when hearing is symmetric. 2

Critical Distinction: Is This Pulsatile?

Confirm whether your "whirling sound" is truly pulsatile (synchronized with your heartbeat) versus continuous. 3, 4 This distinction fundamentally changes the diagnostic approach:

• If the sound pulses with your heartbeat, you need urgent imaging (CT angiography or high-resolution CT temporal bone) because pulsatile tinnitus has an identifiable vascular or structural cause in over 70% of cases. 4, 5 Life-threatening causes like dural arteriovenous fistula or arterial dissection must be ruled out. 4

• If the sound is continuous (non-pulsatile), which is more likely given your description of "whirling," then the workup focuses on audiometry first, not imaging. 2

What Happens Next

If audiometry shows hearing loss:

• Oral corticosteroids should be offered as initial therapy within 2 weeks of onset. 1 This is the only treatment with systematic review evidence showing benefit for hearing recovery. 1
• If you have contraindications to oral steroids (diabetes, severe hypertension, psychiatric disease), intratympanic steroid injections through the eardrum can be offered instead. 1
• Follow-up audiometry should be obtained within 6 months to document recovery or persistent deficits. 1

If audiometry is normal:

• You have primary tinnitus, which affects 10-15% of adults and is often idiopathic. 2 The nearly universal accompanying tinnitus in SSNHL frequently contributes to anxiety and depression, so psychological support is important. 1
• Education about tinnitus mechanisms and natural history should be provided. 2 Most patients adapt to the phantom sound over time, though approximately 20% require clinical intervention. 3
• Sound therapy (white noise, hearing aids if any hearing loss is present) and cognitive behavioral therapy are the evidence-based treatments that improve quality of life. 2, 6 CBT is the only treatment shown to improve quality of life in patients with persistent, bothersome tinnitus. 7

Common Pitfalls to Avoid

• Do not dismiss this as "just tinnitus" without getting an audiogram. 1 New onset of ear blockage or fullness can be a symptom of potentially serious conditions and warrants prompt evaluation. 1

• Do not wait to see if it resolves on its own. 1 While spontaneous recovery occurs in up to 65% of SSNHL cases, prognosis for recovery depends heavily on time between onset and treatment. 1 You are already at 2 weeks—this is the outer limit of the treatment window. 1

• Do not get an MRI or CT scan before getting an audiogram. 2 Imaging is not indicated for non-pulsatile, unilateral tinnitus without documented asymmetric hearing loss or neurologic abnormalities. 2 This represents inappropriate resource utilization with no benefit. 2

• If you have severe anxiety or depression related to this symptom, mention this to your clinician immediately. 1, 3 Patients with tinnitus accompanied by severe anxiety or depression require prompt identification and intervention due to increased suicide risk. 3