Ringing and Hearing Loss in One Ear Only: When to Worry (Including Acoustic Neuroma)

The direct answer

Ringing (tinnitus) or hearing loss in only one ear is not something to wait out. Most causes are harmless or treatable, but the pattern of one-sided symptoms is the one doctors take seriously, because it can occasionally signal a problem with the hearing nerve or inner ear that a scan can identify. See an ENT and have a hearing test, and go the same day if the hearing drop was sudden.

Common causes of one-sided symptoms

• Earwax: a plug on one side muffles hearing and can cause ringing. See ear wax removal.
• Fluid or infection behind the eardrum, often after a cold.
• Eardrum perforation after infection or injury.
• Noise injury to one ear, for example from a loud blast on one side.
• Eustachian tube problems. See airplane ear.
• Meniere's disease, with episodes of vertigo, fullness and fluctuating hearing.
• Sudden sensorineural hearing loss, a medical emergency. See sudden hearing loss and its treatment.
• Age-related or asymmetric loss that is worse on one side.

What is an acoustic neuroma?

An acoustic neuroma, also called a vestibular schwannoma, is a slow-growing, benign tumour on the nerve that connects the inner ear to the brain. It is rare. It is not cancer and does not spread, but as it grows it can press on the hearing and balance nerves.

• Gradual hearing loss or ringing in one ear.
• Trouble understanding speech in that ear, out of proportion to the loss.
• Unsteadiness or dizziness.
• Occasionally numbness or weakness in the face as it grows larger.

These symptoms have many other, far more common causes, and having them does not mean you have a tumour. That is exactly why a proper check is important: it settles the question.

What a proper check involves

• Ear examination by an ENT to look at the canal and eardrum.
• Audiogram and speech test by an audiologist to measure the difference between the ears. See understanding your audiogram.
• Middle-ear test (tympanometry) to look for fluid.
• Objective tests such as auditory brainstem response, where indicated.
• MRI scan when the results are asymmetric, unexplained or suspicious.

Most one-sided problems end with a simple diagnosis and treatment. Where a scan is needed, early detection gives more options.

What to do now

• Book an ENT visit and a hearing test rather than waiting to see if it settles.
• Go the same day for a sudden drop in hearing, or if there is dizziness, facial weakness or severe headache.
• Do not put drops or anything else in the ear before it has been examined.

If the loss is confirmed and permanent in one ear, options exist. See single-sided deafness and CROS/BiCROS aids and tinnitus treatment options. Book a free hearing test to start, and we will refer you to an ENT if anything needs medical attention. This article is general information and does not replace medical advice.