One-sided tinnitus paired with hearing loss in one ear warrants prompt medical evaluation because it can signal rare but serious conditions, including acoustic neuroma, that require specialist assessment. While tinnitus affects millions of people, the pattern of symptoms matters significantly. A case study of a 43-year-old woman presenting with four to six months of unilateral hearing loss and intermittent buzzing in her right ear illustrates why healthcare providers must take a systematic approach to diagnosis.

What Causes Tinnitus, and Why Does It Matter?

Tinnitus, which literally means "to ring" or "ringing," is defined as an unwanted auditory perception of internal origin. Most people experience subjective tinnitus, meaning only they can hear the sound. However, objective tinnitus, which can be detected through a stethoscope placed near the ear, is rarer and associated with vascular causes that require immediate referral.

The challenge with tinnitus is that it can stem from numerous underlying conditions. Most cases of tinnitus result from the same conditions that cause hearing loss, although the exact mechanism remains poorly understood. Understanding the pattern of symptoms helps narrow down the cause.

Which Conditions Trigger Tinnitus and Hearing Loss?

Healthcare providers evaluate tinnitus by considering a wide range of potential causes. Some are benign and self-limiting, while others demand urgent attention. The list of possible culprits is extensive:

• Ear-Related Causes: Ear wax buildup, Eustachian tube dysfunction, ear infections (otitis media with effusion), otosclerosis, cholesteatoma, and perilymphatic fistula
• Systemic Conditions: Anemia, diabetes, lupus, multiple sclerosis, thyroid disorders, and temporomandibular disorders (TMD)
• Medication Side Effects: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen have been reported, though rarely, to cause both tinnitus and hearing loss
• Serious Neurological Conditions: Acoustic neuroma, a benign tumor of the nerve connecting the ear to the brain, which may present with unilateral tinnitus and hearing loss
• Other Triggers: Head and neck injury, exposure to loud noise, foreign objects in the ear, and vascular abnormalities

In the case of Mrs. Salwan, her medical history included vitamin B12 deficiency managed with regular injections and recently diagnosed rheumatoid arthritis treated with ibuprofen. The timing of her arthritis diagnosis and the onset of tinnitus raised the possibility of NSAID-related adverse effects, though other causes needed to be systematically ruled out.

Why One-Sided Tinnitus Raises Red Flags?

The location and pattern of tinnitus provide critical diagnostic clues. Unilateral tinnitus, meaning it occurs in only one ear, can be associated with more serious pathology compared to bilateral tinnitus affecting both ears. This distinction is important because it influences the urgency and type of evaluation needed.

When Mrs. Salwan confirmed that her buzzing sound occurred only in her right ear and lacked a pulsatile quality (ruling out vascular causes), her healthcare provider recognized that common causes had been largely eliminated. This made rare but critical conditions like acoustic neuroma impossible to exclude based on symptoms alone, since symptoms other than hearing loss or tinnitus can take months to become apparent.

How Should Healthcare Providers Evaluate Tinnitus?

A systematic approach to tinnitus assessment involves several key steps. First, a detailed medication history is essential because many medicines can cause tinnitus. Second, physical examination of the ear helps rule out obvious causes like ear wax or foreign objects. Third, understanding the nature, duration, severity, and frequency of the tinnitus narrows the differential diagnosis.

For Mrs. Salwan, an ear inspection revealed no abnormal findings, which helped rule out ear wax and cholesteatoma. However, because she presented with unilateral tinnitus without other obvious causes, further assessment was necessary. Her healthcare provider recommended that she see her general practitioner for additional evaluation, which might include audiological assessment and potentially an MRI scan to rule out serious neurological conditions.

"Establishing the cause is necessary prior to any intervention. An audiological assessment is often required and because Mrs. Salwan has unilateral tinnitus with no other symptoms, an MRI scan might be considered by her GP," noted the clinical assessment in the case study.

Pharmacy Magazine Clinical Case Study, 2026

Can Medications Help Manage Tinnitus Symptoms?

While medication is generally ineffective for treating tinnitus itself, corticosteroids like prednisone may play a role in certain ear-related conditions. Prednisone is a corticosteroid that suppresses immune system responses to relieve inflammation. When ear infections cause swelling and fluid buildup in the middle ear, reducing that inflammation can help alleviate associated symptoms.

However, prednisone is not typically a first-line treatment for ear infections. Instead, it may be considered for individuals with moderate to severe symptoms, especially when inflammation is a significant component. When used for ear infections, prednisone usually works alongside antibiotics rather than as a standalone solution.

"While it's not typically the first-line treatment for ear infections, it may be considered for individuals with moderate to severe symptoms, especially when inflammation is a significant component of the condition," explained Hannah Cohan, a board-certified Nurse Practitioner with the Medical Offices of Manhattan.

Hannah Cohan, Board-Certified Nurse Practitioner, Medical Offices of Manhattan

Prednisone typically begins working within one to two hours, so it might start relieving ear infection symptoms quickly. Studies have shown that steroid treatment paired with an antibiotic can help resolve infections faster in the short term, though it has minimal effect on long-term symptoms like hearing loss. For sudden hearing loss specifically, high-dose prednisone therapy may be initiated promptly under the supervision of audiologists or ear, nose, and throat (ENT) specialists.

What Are the Practical Steps for Managing Tinnitus?

While waiting for a formal diagnosis, several strategies can help reduce tinnitus symptoms in the short term:

• Sound Management: Avoid silence, which can make tinnitus more noticeable. Instead, spend time in places with background noise that can act as a distraction from the ringing sound
• Hearing Protection: Use ear protection to limit exposure to loud noises, which can worsen tinnitus or cause additional hearing damage
• Medical Evaluation: Seek assessment from a general practitioner or ENT specialist, particularly if tinnitus is unilateral, to rule out serious underlying conditions

The key takeaway from Mrs. Salwan's case is that tinnitus should never be dismissed as a minor annoyance. When it appears suddenly, affects only one ear, or accompanies hearing loss, it demands professional evaluation. While many causes of tinnitus are benign and manageable, some require urgent intervention to prevent complications or identify serious underlying conditions early.

Healthcare providers, including pharmacists, play an important role in recognizing red flags and ensuring patients receive appropriate referrals. Taking a thorough medication history, performing a physical examination, and asking detailed questions about symptom characteristics can help distinguish between benign and serious causes of tinnitus, ultimately guiding patients toward the right level of care.