Can Ringing in the Ears Be a Symptom of Polycythemia Vera?
Yes, tinnitus (ringing in the ears) is a recognized microvascular symptom of polycythemia vera, occurring as part of the spectrum of transient inflammation-based occlusive phenomena caused by clonal platelet-endothelial interactions. 1
Pathophysiology and Clinical Context
Tinnitus in polycythemia vera represents a microvascular disturbance rather than a primary auditory disorder. 1 The mechanism involves:
- Platelet-endothelial interactions in arterioles causing transient occlusive phenomena 1
- Hyperviscosity from elevated hematocrit contributing to reduced blood flow 2
- Part of a broader constellation of microvascular symptoms that affect 50-80% of polycythemia vera patients neurologically 2
Associated Microvascular Symptoms
When tinnitus occurs in polycythemia vera, it typically presents alongside other microvascular manifestations: 1
- Headache and light-headedness
- Transient neurologic or ocular disturbances
- Atypical chest discomfort
- Paresthesias
- Erythromelalgia (painful burning of extremities with erythema and warmth)
Clinical Significance and Management
These microvascular symptoms are classified as non-life-threatening complications, distinguishing them from the major thrombotic events (myocardial infarction, stroke) that represent the primary mortality risk in polycythemia vera. 1, 3
Treatment Approach
Low-dose aspirin (81 mg daily) provides prompt relief for microvascular symptoms including tinnitus, typically within hours, by inhibiting thromboxane-mediated platelet activation. 1 However:
- Hematocrit control below 45% through phlebotomy is essential as the foundation of therapy 4, 5
- Cytoreductive therapy (hydroxyurea or interferon) may be necessary if symptoms persist despite aspirin 1
- Caution with aspirin in extreme thrombocytosis (>1000 × 10⁹/L) due to acquired von Willebrand disease bleeding risk 3
Important Diagnostic Caveat
While tinnitus can be a symptom of polycythemia vera, the ACR Appropriateness Criteria strongly recommend against imaging for subjective, nonpulsatile tinnitus that does not localize to one ear and lacks focal neurologic abnormalities or asymmetric hearing loss. 1 This guideline applies to general tinnitus evaluation, but in the context of known or suspected polycythemia vera, the focus should be on: