Ear Problems

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Many fibromyalgia patients experience ringing in the ears (tinnitus), hearing loss, dizziness, and vertigo (a sensation of spinning and subsequent loss of balance); however, although exceptions exist (Rosenhall et al., 1996), ear-related symptoms are rarely confirmed by standard clinical and laboratory assessments, such as hearing tests (also known as audiometry), when administered to fibromyalgia patients. Alternatively, fibromyalgia patients who do not report ear-related symptoms have been found in some research studies to actually have detectable impairments, such as hearing loss (Bayazit et al., 2002; Yilmaz et al., 2005).

The reasons why fibromyalgia patients experience ear-related symptoms are not well-understood. Some researchers believe that underlying neurological problems may be to blame (Gunduz et al., 2008), while others have suggested that ear problems may simply be an extension of underlying temporomandibular joint disorder (TMJ) (Bayazit et al., 2002). Other researchers have suggested that fibromyalgia patients have a dysfunctional ability to adjust to perceived disturbing stimuli (Dohrenbusch et al., 1997). One study conducted in 12 children with fibromyalgia found no clinical or laboratory evidence to support the children’s complains of chronic dizziness; as a result, those authors suggest that the persistent musculoskeletal problems inherent in fibromyalgia may affect an individual’s sense of balance and orientation (Rusy et al., 1999).

A study by Bayazit and colleagues (2002) was designed to assess ear symptoms and issues in individuals with fibromyalgia. The researchers evaluated 24 female patients who all were diagnosed with fibromyalgia in accordance with the American College of Rheumatology (ACR) diagnostic criteria. In addition to administering standard fibromyalgia assessment questionnaires, the researchers performed detailed physical examinations and asked each participants specific questions related to their personal history of hearing loss, ringing in the ears, balance problems, and dizziness. Each participant also underwent a series of tests designed to evaluate their hearing ability. After analysis, the researchers found that dizziness was the most common symptom, with nine of the 24 patients experiencing it. Four patients had ringing in the ears, three had hearing loss, and two experienced balance problems. In their discussion, the authors note that fibromyalgia patients frequently suffer from subjective ear-related symptoms that are rarely detected or confirmed using standard and objective diagnostic procedures. They supported this generalization with the results of their study, which also failed to confirm the presence of self-reported ear problems in a number of these patients. However, the authors also noted that the reverse was true, and described how some fibromyalgia patients have clinically significant ear problems without having any noticeable symptoms.

Yilmaz et al. (2005) involved performed a series of hearing tests on 16 female fibromyalgia patients and 15 healthy female controls. Tests were administered to evaluate hearing ability, hearing loss, speech discrimination, and other parameters. Overall, the study found no significant differences between the hearing test results of the fibromyalgia patients and the control subjects. In addition, there were no significant differences found with regard to the hearing ability of those who did and did not report having ear-related symptoms. Similar to Bayazit et al., these authors note that fibromyalgia patients frequently experience ear-related symptoms that are rarely able to be confirmed using standard clinical or laboratory tests (Yilmaz et al., 2005).

An earlier study by Rosenhall and colleagues reported somewhat conflicting findings. These authors evaluated the hearing and ear-related neurological findings of 168 fibromyalgia patients, 141 of whom were women. They found that 72% of the patients reported a history of dizziness and balance issues, and hearing tests confirmed the presence of sensory-related hearing loss in 15%. Furthermore, additional hearing deficits were confirmed in 30% to 58% percent of the patients, depending on the particular assessment (Rosenhall et al., 1996).

Medication Side Effects

It is important to note that tinnitus can be a side effect of treatment with antidepressant medications, as well as a side effect of major depression. In light of the fact that many fibromyalgia patients suffer from comorbid depression and as a result, receive treatment with antidepressant medications, it can be difficult to determine the cause of tinnitus when it presents in a depressed fibromyalgia patient. Adding to the confusion is the fact that dizziness is also a common side effect of many prescription medications, in particular antidepressants.

As a result, it is very important for fibromyalgia patients who suffer from tinnitus and/or dizziness to closely monitor and track their treatments. Diligent tracking of symptoms such as these alongside tracking of medications and other treatment efforts can help to narrow down and pinpoint the cause of new or worsening symptoms. This can expedite treatment modifications that may bring quicker symptomatic relief to the patient.

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References

1.        Bayazit YA, Gürsoy S, Ozer E, Karakurum G, Madenci E. Neurotologic manifestations of the fibromyalgia syndrome. J Neurol Sci. 2002;196(1-2):77-80.

2.        Yilmaz M, Baysal E, Gunduz B, Aksu A, Ensari N, Meray J, Bayazit YA. Assessment of the ear and otoacoustic emission findings in fibromyalgia syndrome. Clin Exp Rheumatol. 2005;23(5):701-703.

3.        Rosenhall U, Johansson G, Orndahl G. Otoneurologic and audiologic findings in fibromyalgia. Scand J Rehabil Med. 1996;28(4):225-232.

4.        Gunduz B, Bayazit YA, Celenk F, Saridoğan C, Guclu AG, Orcan E, Meray J. Absence of contralateral suppression of transiently evoked otoacoustic emissions in fibromyalgia syndrome. J Laryngol Otol. 2008;122(10):1047-1051.

5.        Rusy LM, Harvey SA, Beste DJ. Pediatric fibromyalgia and dizziness: evaluation of vestibular function. J Dev Behav Pediatr. 1999;20(4):211-215.

6.        Dohrenbusch R, Sodhi H, Lamprecht J, Genth E. Fibromyalgia as a disorder of perceptual organization? An analysis of acoustic stimulus processing in patients with widespread pain.

Z Rheumatol. 1997;56(6):334-341.

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