Ear Pain Triggered by Sound, Need Help!

Hi folks

I get pain, a sense of fullness, and what seems like blocking and unblocking sounds in my left ear, which is only triggered by loudness and further aggravated by sharp frequencies.

Gotta wait some months for my ENT, but just trying to get my head around what this could be.

I only get this when I jam music. I try and protect my ears with plugs, but sometimes it doesn't take much to aggravate my left ear, and when that happens, everyday sounds can further aggravate it, until the pain subsides, and my ear goes back to normal. I have mild to moderate tinnitus in both ears, and some but not significant hearing loss.

Could this be a form of hyperacusis? Or Tensor Tympani syndrome? Something else?

Look forward to any feedback given

 

I have both T&H, when I first described my inner ear cramps and my unpleasant physical ear reactions to two different ENTs none of them knew anything. After I read up on it I concluded with TTTS. I saved the best definition of this and I have shared it here on the forum several times. I lost the source but here it is:

"In the middle ear, the tensor tympani muscle and the stapedial muscle contract to tighten the middle ear bones (the ossicles) as a reaction to loud, potentially damaging sound. This provides protection to the inner ear from these loud sounds. In many people with hyperacusis, an increased activity develops in the tensor tympani muscle in the middle ear as part of the startle response to some sounds. This lowered reflex threshold for tensor tympani contraction is activated by the perception/anticipation of loud sound, and is called tonic tensor tympani syndrome (TTTS). In some people with hyperacusis, the tensor tympani muscle can contract just by thinking about a loud sound. Following exposure to intolerable sounds, this contraction of the tensor tympani muscle tightens the ear drum, which can lead to the symptoms of ear pain/a fluttering sensation/a sensation of fullness in the ear (in the absence of any middle or inner ear pathology). It does not harm the ear to experience TTTS, and even though the TTTS symptoms can seem as if the ear is being damaged by some sounds, this is not the case. Moderate, everyday sounds are quite safe and do not harm the ear or cause a hearing loss. "

Don't know if this corresponds with your experiences but it seems like you could be having TTTS. In my case it's mostly cramps inside the ear, like something is contracting. In addition I feel crunching sounds and I can create this just by touching my earlobe. Check out former posts and discussions on this.

Ps: Sharp frequencies is normally what triggers H.

 

@Per, I never feel pain, just discomfort from sounds when the surroundings are quiet. I can actually feel it; it's my ear muscles that feel super tense. And they tighten. The discomfort, I can feel it down my spine, I think it's anxiety triggered by sounds in general, when the surroundings are quiet.

When I touch my ears or hear certain sounds in a quiet room, my ear also rumbles, like a deep "woom".

On chat-hyperacusis they told me this doesn't sound like hyperacusis, as I have no problems with loud sounds really, it's more the startle reflex. I am very anxious and tense in my whole body.

Does this sound like something that could resove/be worked with and improve?

 

These contractions seems to be a common factor to many grades of hypersensitivity, in your case you don't have severe H but you do have T, so perhaps the physical inner ear sensations your experiencing is in fact a type of TTTS - "this contraction of the tensor tympani muscle tightens the ear drum." Not everyone have severe H like me, some could have milder type but it still is a hypersensitivity / H. I remember years before I got T&H that I felt vibrations inside my ear and also some crackling sounds and cramps. At the time I didn't put much focus on it cause I didn't have T and never heard about H. However, when I was struck by severe T the H came as well - and it came hard.

As discussed before H is to a degree manageable trough long term treatment, I'm wearing white noise generators as you probably know. So I have my hopes up for it to be less of a troublemaker some day in the future. I'm having threshold tests done each month now, as a matter of fact I'm having one next week again. That will be the third DLT, I'm hoping my audiogram will give signs of improvement, but it's a slow and tedious process. My last test showed a tiny improvement on the discomfort threshold, so I'll grab onto that as something positive at least.

Perhaps we use the same clinics and sometimes speak to the same docs. Who knows when the knowledge is mostly self taught - seems like the docks dont wanna deal with T.

 

@Per, wow, it does seem like you've nailed it for me, or at least I'm really on the right track with getting the correct diagnosis.

Yes! A fluttering sensation - thats the description I've been looking for! and I definitely get the fullness feeling and of course pain.

That's a relief! It certainly feels like my ear is being harmed at times! Eek! I hope my ENT is gonna help with this in a few months.

 

Hope so too, but be ware of the chance that they have no clue on either T, H or TTTS. Some are slightly more into the T aspect but it stops there. You need to read material and talk to others, thats the best strategy. In terms of H you could contact an audiologist.

 

I to feel a tensioning of the eardrum sometime ... and now i`m writing this a actually feel it all the time but sometimes it just contracts a little. Mainly with loud treble sounds. Ear is also prone to pain and infections.

 

It seems incredulous to me that an ENT, through careful examination of my symptoms, may not be able to properly diagnose me?! Haha, I mean what am I paying these guys an arm and a leg for?

I had another ENT tell me my ear problems both T and the ear pain was caused by EBV or Eptsein Barr Virus! This has been dismissed and basically ridiculed by every other specialist I've encountered.

But yes, empowering ourselves through networking with like-minded folks does seem to be the best strategy. I've learned more in two days from being on this forum that two years from seeing specialists!

 

Any known therapies and treatments for TTTS?

 

TTTS can be a side effect of hyperacusis or misophonia or phonophobia. Once you alleviate the aforementioned conditions then the TTTS will go away.

Liked I stated elsewhere, call up an audiologist and ask them about their experience with hyperacusis and about a loudness discomfort test.

 

@NeoM, yes I am totally on the case with that, just gotta find an audiologist. Cheers!

 

I've been wondering about this myself but to me it seems like its a mechanism more than an illness or a treatable condition. I guess being less bothered by H would mean less tensor tympani muscle issues/responses, but I don't know that cause I'm still battling H. Looks like TTTS is just one of the bodies many response mechanisms, like squeezing lemon juice on to your tongue makes your mouth water. This is my perception of it anyways. I bet they could produce a drug to suppress TTTS responses if they wanted to.

As NeoM mentioned TTTS occurs with conditions like misophonia or phonophobia also, perhaps some people with hearing loss and not T&H also have it?

 

Yeah, good analogy. A drug would be good, but it does seem that changing ones attitude, particularly anxiety around their ear issues is the way to go in dealing with TTTS. Maybe I need to take up meditation, and learn to chill more!

I definitely don't have misophonia, or phonophobia, not sure about hyperacusis, perhaps in a mild form, but I do have some hearing loss and T.

It's only jamming that brings these symptoms on. The last time I had this problem was a year ago when I started jamming again after abstaining for a while. I stopped for a year, had no problem with my ear (besides T) and now, due to jamming, it's kicked in again.

 

I would recommend to stop jamming before it is too late. There does appear to be a point of no return where it becomes increasingly difficult or impossible to recover.

 

Are you talking specifically about TTTS?

 

I'm talking about all of these symptoms, "TTTS" included.

 

I guess, part of the reason why many of us use these forums, is that we want to strike a balance between managing our ear problems while continuing with the things we love.

I don't want to give up playing music, but I recognise that I need to protect my ears, and (these days) I do this by jamming at safe levels, or by wearing musicians ear plugs. This protects my ears from my T and my hearing loss becoming worse. I also use plugs at gigs, and any other noisy environment.

But TTTS is a different matter. The more I learn about it, the more I'm becoming aware of the psychological aspect of this condition and how I might manage this. I get TTTS even when I use my ear plugs, while jamming, or at a gig or doing the dishes. It's not as simple as protecting my ears or avoiding situations that may make it worse.

My goal is to keep playing music, while protecting my ears, and somehow managing my TTTS symptoms. I think it's reasonable to think that I can at least try and achieve this, and I'm certainly not going to quit without a fight

 

How you proceed is entirely your call. I can only speak from my own personal experience.

When the fluttering spasm and pain started in my left ear, I had no idea it had anything to do with noise. For months I was convinced it was a TMJ problem. It only ever seemed to happen when I spoke or chewed food, so I figured it must have been triggered by my jaw movement. To me this demonstrates that my 'beliefs about sound' had literally nothing to do with the problem.

As it worsened (following exposure to noises, nonetheless,) I started noticing that noises would trigger the spasms as well. Since then I have worsened even more significantly, not just from very loud sounds, but from sounds that I didn't even expect would be even near a high enough volume to cause issues. There have been instances where I felt fine listening to a sound, only to have symptoms increase hours later, or even the next day.

I'm not convinced that anyone has this condition figured out, or at least not to such a degree that it would be productive to try and convince anyone that there are any consistent answers.

But like I said, it is your call. I hope you find the help you are looking for, and I wish you all the best.

 

@Ears4Funk,

I think I've lost my fight for music. At least the headset use and the many hours of digging into my record collection. It all stopped the day I woke up with T. I think it's great to see that you wanna pursuit and keep music important in your life, doesn't your T get aggravated after music exposure? I read that your T is moderate, but still.

Miss those Steely Dan tunes dancing around in my head. Now it's far distance, easy listening. Caught myself pausing outside a record store, just listening to music they had playing in there. I guess that's how it is from now on.

 

Ears4Funk,

If you can jam, it is very unlikely that you have hyperacusis.

The fluttering sensation you describe can sometimes be a symptom of middle ear myoclonus, which is considered a type of tinnitus. In this case, the fluttering could be due to the contraction of either the tensor tympani or stapedius muscles.

Some doctors and researchers believe the persistent contraction of the tensor tympani muscle can produce a wide range of auditory symptoms, including ear pain, ear fullness, a burning sensation, dizziness, numbness, and distorted hearing. It is important to keep in mind that, so far at least, there is very little scientific proof that the tensor tympani syndrome exists.

Ear pain triggered by loud sound may be a warning sign, but there is no way to tell over the Internet. Earlier, you wrote that you feel your ear is being harmed at times. Please do yourself a favor and make an appointment this week for a comprehensive audiological evaluation. That is the best way for you to keep playing music and to continue to do the things you love. I would hold off on jamming for now until your doctor can provide a diagnosis and treatment plan for your ear pain.

You might also talk to an audiologist about being fitted for custom musician's earplugs. They are more expensive than the kind you can buy over the counter, but they will last for years and would be custom made for your ears.

here2help

 

@Per how are you doing?

 

I've been reading online, Jasterbroff TRT seems to be a commonly suggested treatment for TTTS (and all that that encompasses) I've also seen people recommending Botox injections to attenuate the reactions of the TT and also surgery to cut the TT although some state that that can have negative implications in some facial nerve (I think it's quite clear I know little about the subject) Anyway, I plan on beginning a TRT treatment for my H and T and hope that my TTTS will be treated as a result. If not, then I guess I will pursue the Botox and if not, then surgery. Who is capable of doing those things, I suppose I'll have a year or so to investigate.

 

Can we get an update? Hows the T/H doing? And the TTTS? Do you still feel that reverberation or fluttering when you speak? I plan on doing the same thing with a doctor here in LA.

 

My tts ALWAYS lessens when my t and h do...I wasn't aware that botox has been successfully used as a treatment for tts yet, as the muscle is so small..do you have any references?

 

A fluttering sensation in the ear may be a symptom of middle ear myoclonus. The fluttering could be due to the contraction of either the tensor tympani or stapedius muscles.

The tensor tympani muscle and stapedius muscle reflexes serve to protect the ear from exposure to sound. The more sensitive of the two, the stapedius reflex is considered to be the dominant sound-generated reflex in people. Typically, the sound is loud; however, if we believe the sound is dangerous even if it isn't loud, it is possible for this reflex to engage. The persistent contraction of the tensor tympani muscle can produce a wide range of auditory symptoms, including ear pain, ear fullness, a burning sensation, dizziness, numbness, and distorted hearing. It is impossible to try to determine over the Internet whether any of these symptoms are due to either stapedius or tensor tympani myoclonus. The best way to learn more is to be examined to a good ENT.

@Street Spirit The reference is to a case report from Liu, Fan, Lin, and Zhao from 2011 called Botox transient treatment of tinnitus due to stapedius myoclonus. Here is what they did: They placed a piece of gelfoam containing botulinum toxin type A into the middle ear space through a perforation in the tympanic membrane. The patient was symptom-free for three months. The symptoms returned at four months and disappeared after a follow-up treatment.

@shenandoah, to correctly administer the injection, it is essential for the doctor to understand the anatomy of the tensor tympani.

here2help

 

@here2help that is great news! hopefully more docs get on board with this method of treatment. Thanks for sharing

 

@shenandoah, to correctly administer the injection, it is essential for the doctor to understand the anatomy of the tensor tympani.

here2help[/QUOTE]

I think that goes without saying, but how do I find that doctor who understands the anatomy of the tensor tympani? Looking around on the internet, it doesn't seem like a very common procedure and before anyone sticks a needle in my ear I wanna be damn sure they've got experience.

 

Finally got to an Audiologist. I've been diagnosed with TTTS. I have no hyperacusis to everyday sounds, but I do have some fears around jamming, I don't suffer from misophonia or phonophobia, just mild T, and some (not significant) hearing loss.

My Audiologist has given me a management plan of conditioning myself to jamming (obviously at safe volume levels) and challenging my fears of threatening sounds by basically starting at low volumes and working up to more moderate volume levels of sound making. I've just started doing this and have been getting mild symptoms of TTTS. I dont get TTTS in any other situation. The sound I've been making isn't really much louder than everyday sounds, so its of a safe volume, and I believe my mind, is anticipating sound that could be threatening, thus causing my TTTS symptoms.

My plan is to persevere with jamming at safe volume levels, and challenge my conscious and perhaps even subconscious fears around threatening sounds. I use musicians ear plugs when ever I need to, at gigs and what not, and my T hasn't worsened since it's onset in 2009, so my only issue now is TTTS symptoms.

Anyway, I'm gonna try and get some management around my symptoms, if not then bye bye sound making forever. I'll keep this thread updated.

 

Sorry to sound stupid , but what is TTTS , I have tinnitus , about 10 weeks now, my ears does hurt when sounds are above normal..Thanks Take care!

 

Hi, you're not being stupid at all. TTTS, or Tonic Tensor Tympani Syndrome, is summed up pretty well by here2help member who says: "The tensor tympani muscle and stapedius muscle reflexes serve to protect the ear from exposure to sound. The more sensitive of the two, the stapedius reflex is considered to be the dominant sound-generated reflex in people. Typically, the sound is loud; however, if we believe the sound is dangerous even if it isn't loud, it is possible for this reflex to engage. The persistent contraction of the tensor tympani muscle can produce a wide range of auditory symptoms, including ear pain, ear fullness, a burning sensation, dizziness, numbness, and distorted hearing". There is not a lot of information on TTTS, and most GP's and even ENT's have never heard of it. I got my information from my own research on the internet, and then I got properly assessed by a (reputable) audiologist. Good luck to you too!