Dr. Roach: Double tinnitus is not an indication of brain damage

Dear Dr. Roach: Years ago, when I was in combat, there was a very close explosion. The blast hit my left side and I almost immediately noticed hearing a very mild ringing noise in my left ear. Within a short period of time, it became louder and constant. Through research, I deduced that I had tinnitus. My question is this: Sometimes I hear two separate ringing tones/pitches at the same time in that ear. Is that an indication of tinnitus in the left ear plus possible brain damage? Can two separate tones in the same ear at the same time be caused by tinnitus?

— M.W.

Dear M.W.: Thank you for your service and your sacrifice.

Tinnitus is a sensation of noise in one or both ears when no noise is present. The type of noise varies among those affected, but most frequently it is described as a ringing, hissing or buzzing. Most cases of tinnitus are due to hearing loss caused by damage to the cells responsible for hearing in the cochlea, the organ of hearing in the inner ear. Exposure to loud noise is a common cause of another kind of hearing loss, sensorineural. This kind is due to damage to the cochlea.

Tinnitus with two different frequencies (tones or pitches) has a name, double tinnitus, and it is uncommon. In a study from Poland, only seven out of 614 people with tinnitus had two different frequencies in the same ear. Three people had two different frequencies in BOTH ears. Almost all of them, like you, had sudden onset of hearing loss.

There does not need to be any brain damage to have double tinnitus, and there is no reason to suspect brain damage simply because of the presence of double tinnitus.

Dear Dr. Roach: I have shown elevated testosterone levels since I started monitoring. In 2016, my level was 1,254. It has gone up and down a bit, with my most recent level being 1,090 last January.

I am a healthy and physically active 69-year-old male, and the only medication I started taking in 2015 was finasteride for benign prostatic hyperplasia. I stopped taking finasteride beginning August 2021, and my 2022 level did not decline. Should I be concerned?

— A.F.

Dear A.F.: About 97.5% of healthy men over 19 will have a testosterone level below 950. When a man has a level above that, it would raise a concern that the man was taking excess hormone (that’s clearly not the case in you) or the presence of a testosterone-producing tumor. These usually are made in the adrenal gland and are often malignant (cancerous). So, they are a concern but are quite unusual.

Men who take testosterone supplements to get to your level are at risk of some alarming medical conditions, including dangerously high red blood cell counts, blood clots and possibly heart attack. However, your stable levels suggest that you are one of the 2.5% of men who have high-normal testosterone levels. This seems to be your normal level, and are not likely something to worry about.

Finasteride, by the way, does not lower normal testosterone; it blocks the formation of dihydrotestosterone, whose actions in the body seem to be to cause hair loss and make the prostate enlarged.

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