Why Ringing in One Ear Is Different
Tinnitus, the perception of sound without an external source, is extremely common. Most people experience it in both ears and it is usually benign. However, when tinnitus affects only one ear, it demands a different clinical approach. Unilateral tinnitus can be a sign of an underlying condition that requires urgent investigation, including acoustic neuroma, a benign tumour of the hearing nerve.
What Does Unilateral Tinnitus Sound Like?
Patients describe the sound in different ways: a constant ringing, a hissing, a buzzing, or a sensation similar to being on an aeroplane or the feeling after attending a loud concert. The key distinction is that the sound is heard in one ear only, or is significantly louder on one side. It may be accompanied by a feeling of pressure or fullness in the affected ear, and it is often more noticeable in quiet environments, particularly at night.
What Causes Ringing in One Ear?
The possible causes range from simple and easily treatable to more serious. Common causes include impacted ear wax, which can cause tinnitus and a sensation of fullness; otitis externa, an infection or inflammation of the ear canal; Eustachian tube dysfunction, where the tube connecting the middle ear to the throat does not equalise pressure properly; and noise induced hearing loss on one side, particularly in people exposed to occupational noise.
More serious causes that must be excluded include acoustic neuroma (vestibular schwannoma), a benign slow growing tumour on the vestibulocochlear nerve; Meniere’s disease, which causes episodes of vertigo, hearing loss, and tinnitus; sudden sensorineural hearing loss, which is a medical emergency; and, rarely, vascular abnormalities near the ear.
When to See a Doctor Urgently
You should seek medical attention promptly if you have tinnitus in one ear that has been constant for more than a few weeks, unilateral tinnitus with a sensation of aural fullness or pressure, any associated hearing loss, vertigo, or balance problems, or tinnitus accompanied by facial numbness or weakness.
Constant unilateral tinnitus lasting more than six months warrants urgent investigation to exclude an acoustic neuroma, even if you feel otherwise well.
How We Assess Unilateral Tinnitus
At Clinique Alpa, a tinnitus assessment includes a thorough clinical history, otoscopy (examination of the ear canals and tympanic membranes), assessment of the external ear for inflammation or infection, blood pressure and heart rate measurement, and cranial nerve examination. If otitis externa is found, we can treat it immediately with appropriate ear drops or antibiotics. If the clinical picture suggests a more serious cause, we arrange further investigations promptly.
Investigations You May Need
For persistent unilateral tinnitus, the most important investigation is an MRI scan of the brain with contrast, specifically looking at the cerebellopontine angle where acoustic neuromas develop. We can arrange this privately, often within two weeks, at a significantly lower cost than many patients expect.
We also recommend an ENT specialist consultation, which can be coordinated with the MRI to avoid duplicate appointments and fees. Alternatively, if you are registered with an NHS GP, we can write to them requesting an urgent two week wait referral to ENT, which is the appropriate NHS pathway for suspected acoustic neuroma.
Frequently Asked Questions
What is an acoustic neuroma?
An acoustic neuroma is a benign (non cancerous) tumour that grows on the nerve connecting the inner ear to the brain. It is slow growing and treatable, but early detection is important because it allows for more treatment options and better outcomes.
How much does a private MRI cost?
An MRI of the internal auditory meatus typically costs between £300 and £400 when arranged privately. We can provide a referral and help you find the most cost effective option in your area.
Can tinnitus go away on its own?
Tinnitus caused by ear wax, infection, or short term noise exposure often resolves with treatment or time. Persistent unilateral tinnitus that has lasted months is less likely to resolve spontaneously and should be investigated.
Book a Tinnitus Assessment
If you have been experiencing ringing, buzzing, or pressure in one ear, book an appointment at Clinique Alpa for a thorough assessment. Early investigation provides peace of mind and ensures that any treatable cause is identified promptly.
Written by Dr Mitesh Parmar, MBBS MRCGP, Principal GP at Clinique Alpa.