Can Pulsatile Tinnitus Be Only Reactive in Nature?

I have had tinnitus (and Musical Ear Syndrome) for about 2 years now. I believe it was triggered by a medication I took briefly (Nortriptyline), but I can’t prove that.

My tinnitus is reactive in nature - it is only brought on after some sound exposure.
Sometimes when I wake up in the morning, I can barely hear it at all, especially if I had a quiet, deep sleep.

However, when my tinnitus kicks in, after even mild sound exposure, it is a pulsatile tinnitus primarily in my left ear. Once it does reappear, it almost always continues for the rest of the day and into the night. If I’m very lucky, it will have reset itself the next morning; if not, it will continue for the next day and indefinitely until I get a protracted bout of silence. Physical activity doesn’t really affect it too much.

Based on the above information, is my pulsatile tinnitus still likely to be vascular based, even though it appears to be able to almost (but not quite) go away?
I thought that if its origin is mechanical in nature, it would usually be at nearly the same volume all of the time. Am I wrong in that assumption?

 

Is there anyone who can comment on this? @Michael Leigh? @Greg Sacramento?

 

Hi @JayZee, last week I was wondering how you were doing. Then I reviewed our conversations from January 2021.

Both Zoloft and Nortriptyline can cause Musical Ear Syndrome (MES). Both medications contain hydrochloride. 20% of the time, MES is caused from hydrochloride. 70% from auditory deprivation that occurs with hearing loss. My MES was auditory.

Both medications can cause abdominal pain.

At my old age, my abdominal aortic (stenosis) is causing pulsatile tinnitus - upstroke, radiating to carotid arteries causing a murmur. Sometimes plague travels from the aortic vessel to the carotid arteries. Hypertension is one cause. This is my pulsatile tinnitus cause - I have a large abdominal aortic aneurysm. I also have sound reaction from both hearing loss and carotid arteries that sit next to my ears.

Need to know about your abdominal nerve pain. I know you had surgery.

 

Hi @Greg Sacramento. Thanks for your quick reply, much appreciated.

For starters, my blood pressure is normal; no hypertension. I recently had a hearing test and I believe I have mild hearing loss. The ENT said I was fine for my age but the audiologist tried to sell me some very expensive hearing aids. I tried them out for a while and realized I am definitely missing the higher frequencies but not enough to put up with the hassle just yet.

My abdominal pain long predates my hearing issues; I believe it first started at least 10 years ago. At that time I had random sudden pains in my abdomen every few months that I went to emergency for, but the pain always resolved itself ... until it didn't.

After going down many rabbit holes of incorrect diagnoses such as gastric issues, etc., after more than 5 years I was finally diagnosed as having ACNES - Anterior Cutaneous Nerve Entrapment Syndrome. (I've attached a PDF document if you're interested in reading about it).

Two years ago, I couldn't find any local surgeon who was experienced with ACNES (plus the virus was raging everywhere), so I found a plastic (hand nerve) surgeon who was willing to give it a try.

After the first surgery, the nerve pain was immediately gone, but then after a week or so I started getting worse again. After a few more weeks of taking Hydromorphone, I took the Nortriptyline for 5 days and all of my auditory issues started soon thereafter: reactive tinnitus, pulsatile tinnitus and musical ear syndrome.

A year later, I had a second surgery to go deeper in the same area (underneath the rectus abdominis) where I originally had the pain. I claim that surgery was technically successful, in that I no longer have any pain there at all. Unfortunately, the surgeon cut in exactly the same spot for both surgeries: about an inch above the original pain area. Now I have two new spots that are very painful on my abdominal wall, on both the left and right endpoints and slightly above the incision line. I suspect this is collateral damage from cutting me open twice. I think that if the surgeon had been more experienced or had better equipment, perhaps she would have cut directly above the area where I had the pain, to minimize this exact scenario (but I could be wrong about that). In any case, she's now leery of causing me even more damage, so she doesn't want to go back in there and try to fix things.

My pain specialist booked me in a few weeks to get an ultrasound done in the newly painful area to see if there are any detectable neuromas. I'm not sure if this is the right test to have, but no one is offering anything else.

 

@JayZee, Hydromorphone is not ototonic, but Nortriptyline hydrochloride can be; more so with abdominal issues.

Abdominal pain is found among people who take Nortriptyline hydrochloride, 60+ old, have been taking the drug for < 1 month.

Nortriptyline hydrochloride and Abdominal pain, a phase IV clinical study of FDA data - eHealthMe

View 'related studies' within report.

Treatments:

Imagination: Sleep helps. Think about good memories - often when waking up from sleep before getting out of bed. Use good relaxed posture after getting up from sleep. Most with MES have tight neck muscles. Tight neck and jaw muscles also contribute to reactive tinnitus.

I knew of one with ACNES (plus the virus). A hospital employee had an attack when working with me. ER doctor had no clue. He was also a mechanical biologist. First specialist had no clue. After being admitted, second specialist had a repeat ultrasound.

Yes ultrasound, but very doubtful neuromas will be found.

Please stay in touch.

 

I think we've gotten off topic discussing my abdominal pain.

My original question remains whether pulsatile tinnitus can be reactive in nature.

For example, this morning my tinnitus was very low. Then I watched a 3 minute video with sound and my tinnitus immediately reacted and increased in volume, but it was a pulsatile tinnitus. Hours after this 3 minute sound exposure, my pulsatile tinnitus remains.

Does this mean that my pulsatile tinnitus is not venous in nature? It appears that my brain is somehow almost instantly increasing my left ear sensitivity to the extent that I can hear my pulse. How do I treat something like that?

 

@JayZee, pulsatile tinnitus can become reactive at any time when amplified sound of blood circulating through arteries occurs. Association could be vascular - turbulent blood flow.

Reactive pulsatile tinnitus (pulse) can increase for hours from movement. Nerves within ear(s) can also pick up sound when laying down. Like with ringing/buzzing tinnitus - maybe being reactive - reactive pulsatile tinnitus - also includes nerves picking up on abnormal electrical signals moving from ears to brain. Even with a small amount of conductive hearing loss.

Possible, your pulsatile tinnitus was caused from abdominal association.

Increased blood pressure during operation from pressure of abdominal nerves to a heart or aortic valve sending (upstoke) cholesterol to neck arteries? Not sure on this for you.

A change in neck structure can cause MES and reactive tinnitus.

Also possible pulsatile tinnitus cause is hydrochloride - metabolically.

Probably no association with thyroid or anemia.

With being a non-smoker and with a good diet, you should remain stable.

Let me know results of ultrasound.

 

Sorry to hijack this thread.

How do I know if I have Musical Ear Syndrome? I have palinacousis and recently have developed new sounds that were not there before. Palinacousis is retention of sound after the stimuli is gone, for me it was loud bassy music that would trigger the mimicry, and it would sound vaguely similar to what i was listening to.

When I took Prednisone, the accuracy of sounds returned (lucky for me). I don't mind having random sounds but I'm making sure it's not Musical Ear Syndrome. My hearing is normal according to the ENT but I might still have hidden hearing loss.

I've had my palinacousis since June,I'm not entirely sure what could've triggered it, I just remember going to a show and wearing earplugs. I do take man's enhancement stuff for my partner and I know those can be ototoxic.

The sounds can be from low humming to low pulses, sometimes with rhythm pattern and sometimes not; they change often.

How loud is your Musical Ear Syndrome? My palinacousis would always go back to baseline after going to sleep.

Hope you feel better.