Unilateral Tinnitus: When to Get an MRI?

Hi all,

• Issue: unilateral (left ear) tinnitus
• Duration: 2.5 months (began mid-January, 2021)
• Frequency: daily, but only intermittently & seems correlated with stress (occurs mostly when working on the computer during the day)
• Cause: unknown, but I assume stress/anxiety
• Severity: mild? somewhat controllable, doesn't affect sleep, etc., but causes me mental stress/anxiety
• Age: mid-30s, very fit/healthy, zero medical issues/medication

I met with an ENT doctor in February, who tested my hearing as "perfect" and found no issues. They told me I could get an MRI if I wanted, but that it was up to me and the doctor told me that her "gut feeling" was that I was "fine".

I have lingering concern there's a serious issue (acoustic neuroma?) due to my anxiety (I'm a worrier) and the fact the tinnitus is unilateral, which I know can be a red flag.

Question: despite the risk of radiation, would an MRI be worth it for me to if nothing else help curb my worrying which could perhaps then also reduce the tinnitus?

Thoughts? Thank you!

 

My take is that the combination “unilateral” and “no clear cause” means an MRI might be worthwhile.

If it were either bilateral, or clearly related to a severe acoustic trauma, then I would feel differently.

 

Acoustic neuromas are really, really rare, benign, and often only require yearly control of growth, and other issues can also cause unilateral tinnitus.

There is no exposure to radiation during an MRI, but the machine is loud, so if you decide to go through, use adequate hearing protection, double, if possible, and learn to insert it correctly.

 

When I was in your position, I did it, for peace of mind.

MRIs do not use ionizing radiation. They can be loud, however, so protecting the ears is probably a good idea.

 

There is no right or wrong answer here, but if you go for MRI make sure to wear ear protection. I wore headphones they gave me. MRIs are more or less for the piece of mind. Your tinnitus can still go away. It is still early for you. My tinnitus is only on the left side, from stress. Zero medical causes.

 

It would be unlikely that you have an acoustic neuroma given the statistics and the fact that you have "perfect" hearing. If there was evidence of unilateral hearing loss in the upper frequencies, then I would be very concerned.

Also, be aware that every acoustic neuroma patient presents symptoms differently, some with small tumors have substantial hearing loss while others with large tumors may have good hearing. Tumor size does not determine hearing loss/tinnitus/balance issues.

So, I would highly recommend getting an MRI with contrast to make absolutely certain and appease your anxiety over it.

Best case scenario is there is no tumor and no need for concern.

Worst case scenario is you have a tumor and need prompt treatment to arrest tumor growth, or do the "watch and wait" if small enough.

 

I have unilateral hearing loss with bilateral tinnitus that sometimes is unilateral because it changes frequently. Two ENTs posed an MRI as an option but neither one think I have an AN because I have no other symptoms so I was told it's only 1% likely. I opted NOT to have an MRI despite being a worrier, too.

My reasons: It's only a 1% chance!

MRI contrast fluid DOES expose you to radiation and may have dangerous side-effects or reactions:

Concerns Raised About MRI Contrast Dye

 

Original poster here. Thank you all for your thoughts/suggestions, it means a lot.

If I were to proceed with an MRI for the sake of peace of mind, I'm now mulling the consequences of the contrast dye used in the MRI, alluded to above, complicating things for me.

The thing with my unilateral tinnitus is that it seems to occur only when I'm under some type of stress (mental or physical), and is silent when not. E.g. it occurs with the most frequent regularity when I'm working on my computer during the day, but is silent when taking a walk, sitting on the couch, laying in bed, etc. If I had an acoustic neuroma, wouldn't the tinnitus be more unpredictable and pervasive? I can't imagine an acoustic neuroma would selectively behave to occur only or mostly when stressed.

Appreciate continued thoughts. Thank you again!

 

Off hand an acoustic neuroma seems unlikely if it disappears when not stressed. Do you clinch your jaw when stressed?

 

Thank you for your reply. I don't think I clench, but I guess I could be doing so without realizing, among other possible tension-added reactions. I will try and be more cognizant of this.

 

A bit more backstory on the origins of this:

In early January 2021, I had pressure in my right ear, and then my left, while also under significant work-related stress. My doctor removed wax from my right ear, which instantly alleviated the pressure, and my right ear has been perfect since. I left the doctor though wondering why my left ear felt pressurized given it contained no wax and looked healthy. Being prone to anxiety, it cause me a bit of concern.

One week to the day of the aforementioned doctor appointment, after a particularly long work-day, I developed the tinnitus in my left ear. To me, this was stress/anxiety induced and in ONLY my left ear given the unknown; as in my right ear was spared of the tinnitus as its pressurized feeling had a cause (wax). In hindsight, the left ear's pressure was likely anxiety/stress from the beginning, related to the right ear before I knew the right ear's cause.

And so here I am, months later with the tinnitus still in the left, but again, fortunately, very mild it seems.

 

They don't send people to MRI for acoustic neuroma only. They also look for something they call "vessel crossing" which is a condition when a blood vessel is touching the acoustic nerve from some reason. This can also cause tinnitus and maybe it is more prevalent than the neuroma.

 

And can anything be done about vessel crossing to make the tinnitus stop?

 

I think there is a surgery where the surgeon puts some isolation material between the nerve and the vessel. But it is dangerous though.