A few weeks ago, I saw a patient that came to see me for evaluation of testosterone replacement. He had been told by another provider that his fatigue was likely due to low testosterone even though his levels were in range and he denied low libido (sexual drive) per se. Upon asking questions, it turns out that the fatigue was likely due to his lack of sleep which in turn he attributed to a buzzing in his ear. He reported that this was driving him insane. He had seen an Ear, Nose, and Throat doctor who had ordered the appropriate workup: audiogram to see if he had some hearing deficit, examination of his sinuses, infection, and he even got an MRI of the brain ( to rule out any tumors) and even vascular studies of his neck.
I felt really bad because no easy treatment was offered- there is none really. Though it can be managed by sound generators, hearing aids (if hearing loss in present), and psychoeducation or counseling. Stress-reducing guided exercises (Mind fullness-based tinnitus reduction courses available online) are also encouraged so that patients can learn to let go of the preoccupation with the sound in their ears and make it less bothersome. In some cases, anxiolytics and antidepressants are recommended.
I was listening to NPR this AM and there was a report on how there has been a rise in the prevalence of tinnitus. As you may know, and some of you may have experienced, tinnitus or ringing in the ear is really a perception of sound when no external sound is present. The sound may appear to sometimes come from one ear, in some cases from both. It can be described in different ways: clicking, buzzing, thumping, pulsing, hiss, roaring, etc. Tinnitus can be initiated or worsened by stress. Even if there is an underlying physical reason for the tinnitus, certainly stress can heighten the intensity of it and make it more bothersome. This tends to occur more in individuals that have a neurological predisposition to be more sensitive to any stimulus, in other words, individuals that have a hyperactive nervous system. Certainly, during the night, when there are fewer distractions, the sound becomes more prominent. Even though tinnitus per se is benign, it can be dangerous if it disrupts sleep and the health consequences that come with that. In addition, it may signal that the stress response of the individual is excessive and thus it is time for stress to be released and/ or deal with the root of the stress.