Ringing in the ears, also known as tinnitus, can be caused by a variety of factors. However, in some cases, tinnitus may be a symptom of an underlying tumor. Tumors that develop in the head and neck region can sometimes cause tinnitus by putting pressure on structures in the ear or disrupting nerve connections.
Some types of tumors that may lead to tinnitus include:
Acoustic neuroma
An acoustic neuroma is a noncancerous tumor that develops on the main nerve leading from the inner ear to the brain. This nerve is called the vestibulocochlear nerve and is responsible for sending sound and balance information from the inner ear to the brain. As an acoustic neuroma grows, it presses against the inner ear and interferes with normal nerve function, resulting in hearing loss, tinnitus, vertigo, and disturbances in balance.
Acoustic neuromas usually develop slowly over many years. In the early stages, people with an acoustic neuroma may experience unilateral (one-sided) tinnitus. As the tumor grows larger, hearing loss or deafness, dizziness, and facial numbness or tingling may occur.
Acoustic neuromas are benign tumors but can still be serious if left untreated. Treatment options include surgical removal and radiation therapy. Most people with this condition are between 30-60 years old, and it affects women more often than men.
Vestibular schwannoma
A vestibular schwannoma is essentially the same condition as an acoustic neuroma. It is a noncancerous tumor that arises from the Schwann cells that surround the vestibulocochlear nerve. As it grows in size, it compresses the cochlear nerve that carries sound and balance information to the brain.
Early symptoms of a vestibular schwannoma are typically tinnitus and hearing loss in one ear. Larger tumors can cause complete deafness, dizziness, facial weakness or numbness, and difficulty swallowing or speaking. Surgery and radiation therapy are the main treatment options.
Vestibular schwannomas account for about 8 out of 10 tumors found in the region around the cerebellum. They are generally slow-growing and are more common in people between 30-60 years old.
Cholesteatoma
A cholesteatoma is an abnormal skin growth that occurs within the middle ear behind the eardrum. It usually develops as a cyst or pouch from a defective eardrum caused by chronic middle ear infections. Over time, skin cells can multiply and fill the middle ear.
As the cholesteatoma grows, it can destroy the surrounding delicate bones of the middle ear. Hearing loss, tinnitus, and vertigo are common symptoms. There may also be ear pain, drainage from the ear, and facial muscle weakness on the affected side.
Cholesteatomas most often occur in children and young adults who have a history of repetitive middle ear infections. The only treatment is surgical removal of the growth. Delays in treatment can result in serious complications like meningitis, brain abscess, or permanent hearing loss.
Glomus tumor
Glomus tumors arise from the glomus bodies, which are specialized structures in the inner ear responsible for sensing balance and position. Glomus tumors are typically benign small vascular growths that develop near the jugular vein.
As a glomus tumor grows bigger, it presses against the inner ear and triggers pulsatile tinnitus (like a rhythmic throbbing or whooshing sound in the ear). Other symptoms include hearing loss, dizziness, and pain. Glomus tumors are usually treated surgically or with radiation therapy.
These tumors are rare overall but account for about 1-6% of tumors found in the head and neck region. They occur more often in women between 30-50 years old.
Meningioma
A meningioma is a common benign tumor that arises from the meninges—the membranous layers surrounding the brain and spinal cord. Although a meningioma can occur anywhere in the meninges, certain locations are more likely to cause tinnitus.
If a meningioma develops along the nerves that control hearing and balance near the inner ear, it can press on those nerves. This leads to unilateral hearing loss and tinnitus on the same side as the tumor. With continued growth, deafness may result.
Surgery is typically done to remove accessible meningiomas. Radiation or chemotherapy may be options if the tumor cannot be completely removed. Meningiomas occur more often in women than men and are usually diagnosed between ages 40-70.
What causes these tumors?
The exact causes that lead cells to abnormally grow into benign tumors in the head and neck region are not fully understood. Possible contributing factors include:
- Genetic mutations – Certain genetic changes can cause cells to divide and multiply excessively. Acoustic neuromas often involve a genetic condition called neurofibromatosis type II.
- Radiation exposure – Prior radiation treatment to the head or neck area appears to increase the long-term risk of tumors like acoustic neuromas and meningiomas.
- Hormonal influences – Hormonal factors may help explain the higher incidence of certain tumors in women versus men.
- Chronic inflammation/infection – Repeated infections and inflammation in the middle ear cavity can set the stage for cholesteatoma growth.
- Head injury – Some research links prior head or ear trauma to an increased risk of tumors like meningioma and neuroma later in life.
- Cochlear hydrops – Cochlear hydrops describes a chronic buildup of fluid in the inner ear that can destroy surrounding bone and nerves over time, leading to tumor growth.
However, in many cases there are no clear predisposing risk factors. The tendency of cells to proliferate abnormally and circumvent normal growth controls can occur sporadically.
Diagnosing ear tumors
If tinnitus occurs in only one ear, especially when accompanied by gradual hearing loss on the same side, it raises the possibility of a tumor as the underlying cause. However, tinnitus alone does not definitively indicate a tumor is present. A careful medical evaluation is needed to identify the cause.
To check for tumors, the doctor will perform a complete examination of the ears, nose, throat, head, and neck. They will also review your full medical history and possible risk factors. The following tests may be recommended:
Hearing test (audiometry)
This determines whether hearing loss is present and identifies the frequencies that are affected. Tumors often cause hearing loss affecting mainly the low- and mid-range sound frequencies.
Balance testing
Balance tests assess the function of the inner ear vestibular system. Disorders of balance or gait can signify a tumor disturbing normal inner ear function.
Imaging scans
CT or MRI scans of the head can pinpoint tumors in the delicate structures of the ear and adjacent areas. These provide detailed images that help determine the exact size and location of any growths.
Other tests
If a tumor is found, other tests like a biopsy, blood tests, or spinal tap (lumbar puncture) may be done. These help determine whether the tumor is malignant or benign.
Treating ear tumors
Treatment options for tumors causing tinnitus depend on the type, location, and size of the growth. Since many inner ear tumors are noncancerous, they may not require intervention right away. Small tumors that aren’t enlarging or causing major symptoms can sometimes just be monitored over time.
If the tumor is benign but growing steadily and affecting hearing or balance, the main treatment approaches include:
- Surgery – Surgery aims to remove the tumor through the ear canal or with an incision behind the ear. This can preserve or restore hearing in some cases. But large tumors often cannot be fully removed without damaging the nerves that control hearing and balance.
- Radiation – Focused radiation beams are directed at the tumor in daily treatment sessions over several weeks. This causes the tumor to shrink and stops further growth. Radiation can often preserve useful hearing if the tumor is small.
- Stereotactic radiosurgery – This type of radiation therapy delivers a high dose of radiation all at once to the tumor. It provides results similar to traditional radiation but over a much shorter timeframe.
If the tumor is found to be cancerous (malignant), treatment will be more aggressive and usually involves some combination of surgery, radiation, and chemotherapy to try to destroy the cancer cells.
Coping with ear tumors
Being diagnosed with a tumor can be frightening. Many fears and concerns arise when facing treatment, potential loss of hearing, and uncertainty about the future.
It is important for patients to build a strong support system. Doctors, family members, and support organizations can provide information, counseling, and coping strategies.
Some tips for coping include:
- Learn about your specific tumor type and treatment options
- Communicate openly with your treatment team
- Explore different approaches to manage tinnitus symptoms
- Join a support group to share experiences with other patients
- Seek counseling if you are experiencing anxiety, depression, or stress
- Do activities that help you relax and stay positive
With an early diagnosis, careful monitoring, and proactive treatment, many inner ear tumors can be managed effectively. Working closely with your medical providers and getting needed social support can help you adjust and cope with a tumor diagnosis.
Conclusion
Tinnitus affecting only one ear can sometimes be a sign of a tumor occurring in the delicate structures of the ear and skull base. Common culprits include acoustic neuromas, meningiomas, glomus tumors, and cholesteatomas. These growths put pressure on the hearing and balance nerves, causing tinnitus, hearing loss, vertigo, and other problems.
A medical evaluation is needed to identify the presence of a tumor. This typically involves hearing tests, balance assessments, brain imaging scans, and other studies. Treatment depends on the tumor type, location, and size. Options include careful monitoring, surgery, radiation therapy, and chemotherapy drugs. Coping strategies and support are key to managing the diagnosis and process of treatment.
While tinnitus has many potential causes, it is important to see a doctor when unilateral tinnitus arises to check for a possible underlying tumor. Catching and treating tumors early provides the best chance of preserving hearing and preventing serious complications.