Hidden Hearing Loss, Ear Fullness/Pressure, Hyperacusis, and Tinnitus After Second Acoustic Trauma

[jennyb123]

In December 2024, I had an audio accident in a rental car where I was blasted with around 105 dB of audio for about six seconds. Within a couple of days, I developed the following symptoms:

• Distorted hearing, with muffled sound and a loss of stereo immersion
• Ear pressure and fullness
• Music sounding unclear, requiring me to turn up the volume
• My voice sounding distorted and too loud
• Soft seashell-like reverberation tinnitus
• Sensitivity to loud sounds
• Difficulty understanding people in noisy public environments
• Pain radiating below the ear, especially noticeable when lying down

I could not get into the ENT office for a few weeks because of the holiday. The audiogram revealed mild sensorineural hearing loss in the left ear, an increase of 10 dB from my baseline. I was given 60 mg of Prednisone for one week, followed by a one-week taper, prescribed by a physician's assistant. I saw an ENT from another institution a week later, and a second audiogram revealed mild conductive hearing loss at the lower frequencies. I was still on steroids at the time. When I mentioned that I was not hearing in stereo, he ordered an ABR, which came back normal.

After five months, my symptoms had reduced, and I was starting to feel like I had reached a new version of normal. The ear fullness had gone away, the seashell reverberation was unnoticeable, and I could again clearly understand speech in noisy environments. The most consistent issue was a lopsided hearing experience, as there was mild loss in the left ear. I still had a slightly deadened feeling in that ear, but by five months it felt like it was opening up and evening out. The hyperacusis had largely improved, and I only reacted negatively if my phone alarm was too close to my head in the morning.

After the accident, I stopped listening to music because it sounded unclear and lacked detail. The loss of stereo immersion made it completely joyless. At about four months, I began listening to music again, and by the five-month mark I felt like I had regained a pseudo-stereo sound. Just as this improvement occurred, I listened to audio at 85 dB (fluctuating between 82 and 87), which did not cause immediate pain or discomfort but sent my ears into a complete spiral of symptoms.

After this episode, I developed the following:

• Both ears became plugged and full, with intense pressure
• My own voice sounded muffled and dialed down, as did general sounds
• Audio became shallow and overly treble, almost canned, with a noticeable lack of clarity, like an old radio
• My chewing sounded louder
• My ear began crackling and popping when speaking
• I developed ringing tinnitus, first in the left ear and then in both
• After a month of unrelenting fullness, I began experiencing disorientation and dizziness

When the pressure and fullness became overwhelming after a week, I went to immediate care and was prescribed 40 mg of Prednisone for seven days, but it did not help. I then saw another ENT, who ordered an audiogram that came back as "normal" hearing. He did not suggest intratympanic steroids or offer any explanation for my symptoms.

It has now been three months since this re-injury. Although the intense pressure has stabilized and the dizziness is no longer constant or severe, all the other symptoms have remained stable and persistent. There has been no improvement in clarity or in the distortion of sound into that shallow, old-radio quality. Sounds are still muffled and reduced. The tinnitus is constant, with occasional temporary spikes in volume. The hyperacusis is still present, as I now react to volumes that did not bother me after the first injury.

Because there has been no improvement in hearing for three months, I am beginning to feel deeply sad that I may never again hear music anywhere close to how I once knew it. I have a classical musician's mind, where detail and immersion are central to my enjoyment, and that is now gone. I honestly cannot listen to opera without my eyes filling with tears because it sounds so unpleasant. This is probably the most difficult health-related issue I have ever faced, because I have lost such a huge part of my mind and identity. Had I been born with the hearing I have now, I doubt I would have ever enjoyed music or played an instrument. Where sound used to be a source of great pleasure, it is now almost the opposite.

From my research, three possible explanations seem most probable:

1. Cochlear synaptopathy
2. Endolymphatic hydrops
3. Tonic tensor tympani syndrome

Research by John Oghalai and others shows that after acoustic trauma, two common outcomes are endolymphatic hydrops (a buildup of fluid in the cochlear sacs) and cochlear synaptopathy (loss of connections between hair cells and auditory nerve fibers). One is not thought to cause the other, but both are observed as sequelae of trauma.

Although it is less widely accepted and some ENTs do not consider it a valid diagnosis, tonic tensor tympani syndrome is believed to cause muffled hearing, hyperacusis, and ear fullness. The audiologist I am seeing for hyperacusis and tinnitus therapy supports this possibility.

An OAE test showed some hair cell loss at one frequency in both ears, though the audiologist said this was still within normal range. I will be doing a VNG test and possibly an ECOG, although I have read accounts of tinnitus worsening after ECOG. Because I have developed disorientation, I am concerned that I might end up with some form of Ménière's disease.

At this point, I feel hopeless about regaining unblocked ears and relatively normal stereo sound, as three months have passed without improvement.

If anyone has opinions on whether recovery is still possible from these symptoms, or advice on what I could do, I would greatly appreciate the feedback.

 

[DimLeb]

This is very unfortunate for you, and I truly sympathize, being a musician myself. I fear every day about this condition. I get periodic episodes of pressure, tinnitus, and changes in hearing, which may or may not be linked to hydrops or migraine. Thankfully, they are temporary, but always terrifying.

Have you tried taking Betahistine, vasodilators, or anything recommended in Meniere's forums, such as the John of Ohio regimen or lysine? No one can say for sure if it is hydrops in your case, but it does not hurt to try. Since it began with an acoustic trauma, it might just need time to heal. From what I have read here, people with acoustic trauma are more likely to recover over time, which can take anywhere from six months to two years, as long as they avoid major setbacks.

Hydrops usually causes hearing loss in the lower range, but since your audiograms show only mild hearing loss (please correct me if I am mistaken), the problem might be elsewhere, such as with the Eustachian tubes. It may be worth looking into that as well. In my experience, one ear problem often leads to another. I went from just tinnitus, to ear spasms, to ear fullness, to ETD, and so on.

As for TTTS, it is usually a spasm reaction to sudden or short sounds. It is very annoying, but I do not think it can cause that type of hearing problem.

 

[jennyb123]

This is very unfortunate for you, and I truly sympathize, being a musician myself. I fear every day about this condition. I get periodic episodes of pressure, tinnitus, and changes in hearing, which may or may not be linked to hydrops or migraine. Thankfully, they are temporary, but always terrifying.

Have you tried taking Betahistine, vasodilators, or anything recommended in Meniere's forums, such as the John of Ohio regimen or lysine? No one can say for sure if it is hydrops in your case, but it does not hurt to try. Since it began with an acoustic trauma, it might just need time to heal. From what I have read here, people with acoustic trauma are more likely to recover over time, which can take anywhere from six months to two years, as long as they avoid major setbacks.

Hydrops usually causes hearing loss in the lower range, but since your audiograms show only mild hearing loss (please correct me if I am mistaken), the problem might be elsewhere, such as with the Eustachian tubes. It may be worth looking into that as well. In my experience, one ear problem often leads to another. I went from just tinnitus, to ear spasms, to ear fullness, to ETD, and so on.

As for TTTS, it is usually a spasm reaction to sudden or short sounds. It is very annoying, but I do not think it can cause that type of hearing problem.

@DimLeb, thanks for the compassionate remark, I really appreciate it. I'm sorry you're dealing with struggles in your ear function. It's such a crappy and scary feeling, and what's worse is that ENTs are mostly useless when it comes to diagnosing or treating these issues.

I haven't tried Betahistine because I'm still waiting to get in with another neurotologist. They're very booked in my area since there really aren't many. This is one of the things I plan on bringing up, to see if it could help me in any way. I didn't know that vasodilators were sometimes used for these problems, so that's another topic I'll raise—thanks for pointing that out. I've also been wondering if trying diuretics might show whether the fullness would change, which could indicate whether hydrops is contributing to my symptoms.

I had a temporary conductive drop in hearing, meaning a threshold increase in the lower frequencies, when I went on high-dose steroids a few weeks after the initial accident. Fortunately, that resolved. Since then, my thresholds shifted back to a "normal" audiogram, meaning above 25 dB, whereas I had initially dropped to 30 dB (sensorineural) at 2 kHz. However, compared to my baseline audiogram from a couple of years before the accident, I've had a lasting 10 dB threshold increase, or hearing loss, at 2 kHz and 8 kHz. That left me with a 10 dB gap between ears, where before my biggest gap had been 5 dB. So the hearing ended up lopsided after the initial trauma from that 2 kHz hit, but that lopsidedness was starting to improve right before the second setback.

Now both ears feel equally muffled and full. Instead of an altered, less clear, and more immersed stereo sound, I don't have stereo sound at all.

I've been testing my hearing fairly regularly with the Mimi app, and my thresholds remain consistent. I read somewhere that secondary (non-idiopathic) hydrops doesn't necessarily cause fluctuations in hearing, but I don't know how valid that is or what ENTs actually see in clinical practice. The audiologist I went to said that what she consistently hears from hydrops and Ménière's patients is rumbling tinnitus, not the standard static ringing tinnitus that she often sees in her hyperacusis patients, which she attributes to her belief in the TTTS construct.

What type of tinnitus do you get?

Also, when you say that you've read about people making recoveries over several months or even years, do they recover from muffled or distorted hearing back to normal, do their threshold shifts on audiograms resolve, or do you mean improvements in secondary symptoms like fullness, pressure, or ETD symptoms?

I'm adding my audiograms for the sake of discussion:

1. Baseline audiogram from 2020, before the December 2024 accident
2. Three weeks after the first trauma
3. About a month after the trauma while on oral Prednisone
4. About a week after the second injury
5. About two months after the second injury

 

[DimLeb]

@DimLeb, thanks for the compassionate remark, I really appreciate it. I'm sorry you're dealing with struggles in your ear function. It's such a crappy and scary feeling, and what's worse is that ENTs are mostly useless when it comes to diagnosing or treating these issues.

I haven't tried Betahistine because I'm still waiting to get in with another neurotologist. They're very booked in my area since there really aren't many. This is one of the things I plan on bringing up, to see if it could help me in any way. I didn't know that vasodilators were sometimes used for these problems, so that's another topic I'll raise—thanks for pointing that out. I've also been wondering if trying diuretics might show whether the fullness would change, which could indicate whether hydrops is contributing to my symptoms.

I had a temporary conductive drop in hearing, meaning a threshold increase in the lower frequencies, when I went on high-dose steroids a few weeks after the initial accident. Fortunately, that resolved. Since then, my thresholds shifted back to a "normal" audiogram, meaning above 25 dB, whereas I had initially dropped to 30 dB (sensorineural) at 2 kHz. However, compared to my baseline audiogram from a couple of years before the accident, I've had a lasting 10 dB threshold increase, or hearing loss, at 2 kHz and 8 kHz. That left me with a 10 dB gap between ears, where before my biggest gap had been 5 dB. So the hearing ended up lopsided after the initial trauma from that 2 kHz hit, but that lopsidedness was starting to improve right before the second setback.

Now both ears feel equally muffled and full. Instead of an altered, less clear, and more immersed stereo sound, I don't have stereo sound at all.

I've been testing my hearing fairly regularly with the Mimi app, and my thresholds remain consistent. I read somewhere that secondary (non-idiopathic) hydrops doesn't necessarily cause fluctuations in hearing, but I don't know how valid that is or what ENTs actually see in clinical practice. The audiologist I went to said that what she consistently hears from hydrops and Ménière's patients is rumbling tinnitus, not the standard static ringing tinnitus that she often sees in her hyperacusis patients, which she attributes to her belief in the TTTS construct.

What type of tinnitus do you get?

Also, when you say that you've read about people making recoveries over several months or even years, do they recover from muffled or distorted hearing back to normal, do their threshold shifts on audiograms resolve, or do you mean improvements in secondary symptoms like fullness, pressure, or ETD symptoms?

I'm adding my audiograms for the sake of discussion:

1. Baseline audiogram from 2020, before the December 2024 accident
2. Three weeks after the first trauma
3. About a month after the trauma while on oral Prednisone
4. About a week after the second injury
5. About two months after the second injury

About Betahistine and Lysine, they are low-risk options that you can try without a doctor's advice, honestly. I do see the drop at low frequencies, which is suspicious. I don't think I can help much though, since audiograms can be inconsistent and don't show the bigger picture. It does sound strange how your stereo perception is ruined, but then again, I've also experienced odd changes in my hearing during some of the episodes I mentioned, which I can't explain.

Some cochlear dysfunction can probably make sounds seem displaced, as if they're coming from an odd location, or maybe it affects how the brain interprets sounds. That's probably similar to how diplacusis happens. This is why audiograms, and ENT doctors for that matter, are useless with that type of problem.

My tinnitus is actually multi-tonal, though mild most of the time. I usually have one or two mid-range rings, exhaust or white noise, and intermittent mid or high rings that appear randomly. Sometimes I get a high-pitched shimmering sound, around 10 kHz or above. It's generally very fluctuating, but I wouldn't describe it as rumbling or low-pitched. I do sometimes get SBUTTs, usually daily or even multiple times per day, that are lower in the 500–1000 Hz range. I'm not sure if they're connected to my usual tinnitus.

During the severe episodes I mentioned, when I get intense pressure or fullness, my tinnitus usually goes wild and produces all sorts of sounds. The last time, I had a severe metallic tone that reacted to almost every noise I heard and made my usual tinnitus five times louder. Other times, I just get an extra ringing, which may or may not be reactive. I still don't have any definitive answers about these episodes. My audiograms only show a 20 dB drop at 2 kHz and fluctuations around 10 dB, which is still within normal.

I'm honestly so tired of trying to make sense of all this.