Tinnitus - the sensation of sound/noise in the ear or head is an age old symptom that continues to perplex sufferers and researchers alike. The interest in tinnitus stems not only from the fact that it is an annoyance to sufferers, but that there are as many types of tinnitus as there are theories about its origin.
Tinnitus could be subjective (audible only to the sufferer) or objective (can be heard by the clinician as well as the sufferer), high or low pitch, regular or irregular noise, persistent or pulsatile and could result from organic and non-organic causes. Interestingly the noise could result from diseases affecting the external ear (ear wax, foreign body, growth, etc), the middle ear (plethora of these) as well as the inner ear (Meniere's disease, Vestibular schwanoma, etc) as well as diseases of the Eustachian tube, central nervous system and systemic diseases.
Theories put forward to explain tinnitus focused on peripheral mechanisms (discordant damage to outer and inner hair cells, imbalance of afferent and efferent hair cells of the auditory pathway, etc), brain stem anomalies (inferior colliculus and dorsal cochlear nucleus hyperactivity / disinhibition, etc), and the cerebral cortex(auditory cortex / amygdala hyperactivities, etc) and other non-auditory mechanisms for generation of tinnitus.
To tinnitus sufferer, the simple worry is 'Am I going crazy or is something terribly wrong with me or my head'?
To the clinician, the worry is 'Is this tinnitus of organic or non-organic source'? 'Is it of central or peripheral origins'? 'Is it associated with hearing loss'?
Now the interesting aspect is, with this plethora of possible etiologies, patients with tinnitus and middle ear diseases (like cholesteatoma and chronic suppurative otitis media) coming for ear surgeries (Tympanomastoidectomy, tympanoplasty) often ask the most interesting question: 'Will this noise disappear after my ear surgery'?
After a decade of middle ear surgery, I finally found the most interesting analogy as response to that scary question. It goes like this:
Imagine there are 3 of us living in a house - you (patient), myself (the clinician) and a cat. Now imagine the 2 of us were seated in the living room and a noise was headed continuously from the bedroom, with the cat nowhere in site!
The interesting initial assumption is "it is that stupid cat'.
Now there is only the one way to verify that assumption: Go into the bedroom and look for the cat. Now, this is where it gets so interesting, finding a cat in the room does not CONFIRM it is the source of the sound/noise. What the modern scientific medicine taught is that we remove the cat from the room, close the door and go back to the living room to listen again. It is the absence of the noise/sound after that, that CONFIRMS 'It is the cat'. Persistence of the sound after that means we need to look for other source(s) of the sound.
This "Cat Roommate" analogy has assisted me in putting succinctly the reality regarding expectations from middle ear surgery in patients with background tinnitus. Perhaps you may find it useful for your cases too.
Further Reading
1. Theories of generation and management of tinnitus. https://www.mayo.edu/mayo-edu-docs/mayo-clinic-audiology-conference-documents/handouts-new-theories-on-the-generation-and-management-of-tinnitus.pdf
2. Tinnitus- Current neuroscience research and theories. http://www.hearingloss.org/sites/default/files/docs/LeaverAM_.pdf
