No Clue What's Going On: Could Clonazepam Have Contributed to My Tinnitus Getting Worse?

Hi everyone,

I was really hoping I'd never have to make a post here asking for advice but here I am...
This is going to be a bit of a novella, so buckle up if you're willing to read.

A little background: I'm 25 years old and my tinnitus started in December of 2016. I was driving to a doctor's appointment and went through some higher altitude areas, popped my ears by yawning as I normally would do. I didn't notice the noise until I was in the quiet of the exam room, but it hasn't left me since. I tried an ENT at the time who put me through the usual rigors; MRI came back negative for any tumors, hearing test was normal (at least in the ranges that they tested, I'm not sure of the specifics), ears looked physically OK. Basically the same story that's been repeated here a thousand times. I was told to habituate, and so I did. In my right ear, its a two-toned stuttering ring that "reacts", as it were, to sound. It stays the same volume but shifts an octave higher if I hear a noise. I can also shift it to the higher note by flexing my tensor tympani. The higher note is less bothersome, so I've used this to my advantage, flexing when necessary to get it to linger on that note. In the beginning it was very reactive, stuttering all the time, and has become less so in recent years to the point where it mostly rings the higher note and doesn't bounce around so much. It was a tough road but I made it to the point where 3 years later I hardly let it bother me.

Until it got worse.

In November of 2019 I started to notice my good ear (the left) seemed sensitive to sound. If I stood next to a running faucet, for instance, I'd come away with some ringing that would eventually fade in a quiet enough environment. I went to the ENT once more and once more they found no hearing loss, no abnormalities in my ear from a visual exam. They sent me away with an RX for methylprednisone which I did not take, having read about the risks and side effects and having had less than optimal experiences with steroids in the past (none related to my hearing). I decided I'd try to habituate to this ear too, and I was getting along pretty well with it until about early April.

I was sitting idly at my laptop, working from home due to COVID-19 and scratched a small itch on the outside of my left ear. Doing so caused an ungodly loud crunching noise, so loud and startling that I actually gasped. I touched my lobe, the tip of my cartilage, the tragus, all of those produced the same crunching noise. It sounded like bones scraping inside my ear, it was terrible. With a little more experimentation I realized that I didn't even have to touch my ear to make it happen - it would appear if I so much as rubbed my temple - it seemed as though any physical manipulation from the outside, anything that caused my ear to move at all, would cause it to crunch. I know what clearing the Eustachian tubes sounds like, I've heard it a thousand times - this wasn't it. I know what jaw popping sounds like, my jaw has clicked and popped regularly for as long as I can remember - this wasn't it. I decided to wait it out to see what happened, meanwhile trying decongestants and antihistamines, neither of which worked. In about a week, it went away. And in another week, it started in my right ear. The same symptoms to a tinnitus. I arranged a phone call with a doctor through my insurance - I couldn't physically go to one on account of the pandemic. She was baffled, said to try Flonase, which I did to no avail. In about another week, the crunching went away, seemingly on its own. But with that came new ringing in both ears.

My baseline sound in my right ear remains the same, slightly more reactive than usual, but underneath it a new fluttering, morse code-like beeping now exists. My left ear is now 10x louder and more reactive than it was when it began - the tonal ring still fades in a quiet environment and there's an additional morse code-like beeping underneath that persists, similar to the right ear but slightly different in pitch, louder. I feel more sensitive to sound than ever before; I find myself wincing at the sound of plates and cutlery. Its been like this steadily for a week now, and I'm starting to fear its going to stay.

The only thing I can think of that might have contributed to this is Clonazepam. I was prescribed it in November for anxiety and took it on an as-needed basis. This ended up being about twice a week (0.5mg each time) if that, with longer intervals, sometimes months, in between. It quieted my baseline ring and the ring that started in November, but I always attributed that to the anxiety-reduction. Now I'm beginning to wonder if it, in fact, caused the left ear to start up in the first place. My last dose was on the 13th of this month. I was determined not to use it anymore as I learned long term use leads to dependency, and I'd already been using it intermittently for 6 months. The new sounds appeared in that 12-day window from my last dose to now. I don't believe I'm dependent considering the amount I was taking was minimal, and spaced out days in between doses, sometimes weeks. I never suffered any symptoms of withdrawal the during the periods I wasn't taking it before. I'm anxious as all hell now but I'm more willing to attribute that to the newly emerged tinnitus sounds than the lack of Clonazepam. But I won't discount the possibility entirely.

If you've managed to read this far, I thank you with my whole heart, and will only make you suffer through these questions:

Based on my story above, does it make sense that the new sounds have emerged as a result of Clonazepam withdrawal? If so, how long can I expect this to last? I've read conflicting reports all over the internet that sound sensitivity and worsened tinnitus can appear during the withdrawal period, but this still does not explain the many times I had stopped taking it in the past and remained symptom free.

And the crunching. Has anyone out there experienced that sound before? What could possibly be the cause there?

And if these horrid new sounds can't be explained by the Clonazepam, then what can? Where do I even go from here? Is there any kind of home therapy I can do to alleviate the sound sensitivity? I am beginning to lose hope and am absolutely desperate for answers.

Thank you kindly,
Cass

 

Yes. Clonazepam withdrawal can cause tinnitus.
In your case it happened after subsequent withdrawal. Could go away within 3-12 months.
Hope that helps.

 

My new tinnitus is acting in a similar way. I would like to see what are the responses that you get.

 

The problem is that once the effect of the drug wear off, withdrawal starts. Over six months, even with little use - by start and stop - your teasing your brain. Don't get dehydrated, Some of your mentions appear like you are not drinking enough water.

 

Shocking!

This seems to be very likely. The alternative is that this is just happening at random, and I doubt that's the case.

That isn't surprising. This is similar to someone going to concerts for years and being ok afterwards, until one time not being ok.

All I can say is that you shouldn't assume that you will be stuck with with what you are hearing now. T often changes, albeit slowly. Hopefully in 3-6-12-24 months you will feel better...

 

You could try the methylprednisone in case there is inflammation in your jaw. I have a lot of clicking and crunchiness in my left jaw and found out I have a grade 5 internal derangement on that side according to my TMJ MRI report. My right side is normal. I'm trying steroid injections to my TMJ on 6-9.

I understand your frustration and hope you find relief! My noise is incredibly loud atm. I also take clonazepam, but am unsure if that is related to my noise.

 

Thanks for your insight! I've read that the prednisone is only effective if taken within a 2-3 day window after the symptoms were initially noticed. Being that this was months ago, would that still be advisable?

I've often wondered if my jaw was the culprit, although I have no pain. Do let me know how your injections go! Rooting for you.

 

Thanks, dan. Do you happen to have any resources on the matter of withdrawal (prior posts, articles, etc.)? I'm beginning to think that this has to be contributing, at least on some level, being that its the only variable that's changed recently. I know there isn't likely to be an exact road map to what the months ahead are going to look like for me but I feel it would be comforting to at least be aware of some others experiences.

 

Sarcasm? lol
I wasn't aware regular acclimatizing to slight altitude shifts was such a common cause of chronic tinnitus. My ENT at the time didn't think it would have been nearly significant enough to cause barotrauma. Is this a common cause here on the forums? Thanks for your reply.

 

Something similar happens to me, but it is more like a pop (and it is not the eustachian tube). It happens when I scratch my head. No idea about its origin, or the underlying cause, though.

 

I got a barotrauma from an airplane flight in 2008. First time ever that I got fluid in my left ear. Same side as my TMJ.

 

I suspect that my tinnitus was caused by lorazepam (a benzo similar to clonazepam). It is a common benzo withdrawal symptom that usually fades with time for most people. Unfortunately I am one of the unlucky ones and my tinnitus is still there after more than 2 years.

 

Hey Ken77, I'm really sorry to hear you're still dealing with some benzo fallout years after the fact. Did your T begin during withdrawal or was it worsened as a result? You say the T fades with time for most people - is yours as bad as it was the day it started, or have you gotten used to it any?

 

It's a very strange and unpleasant sensation. How long has this been going on for you, Juan?

 

My T began about a month after I took my last dose of lorazepam. I had never had tinnitus before that in my life. It hasn't really changed, but I guess I have gotten used to it a bit more (still hate having it though).

 

No, it wasn't sarcasm.

I've never heard of something like that happening to anyone else.

It is another innocent sounding activity that I will now have to think twice about.

It's not!

I don't think it is. I hope it isn't!!!

 

Several years. It is a symptom I get on and off, usually after noise exposure. I get pressure inside my ears and when I scratch my temples something pops inside my ears.

 

We use to see a few cases of Barotrauma mostly during the Summer and Fall. Many had been to Lake Tahoe high in the Sierra Nevada mountains about two hours from Sacramento. Patient's medical history and past blood work was checked. Several notations were often within records. History of colds, sinus infection with fluid and mucus (travel) Stage 1, not noted on X Rays or MRIs.

 

If you google implosive and explosive mechanisms of barotrauma you will understand it is not so uncommon. Not every barotrauma begins with scuba diving. That being said, I am not saying I understand what happened, I am just saying if someone's middle/innner ear is not OK, even high-speed elevators might possibly hurt them.

 

@Cass, have you tried taking Mucinex? I tried that in addition to taking a couple Advil and seem a lot better today. An ENT told me in the past that my left Eustachian tube was smaller or slightly abnormal compared to my right. I have had problems in the past like you from changing elevations, and especially airplane descents. Also an EarPopper might help possibly?

 

@Cass Benzos do weird things to tinnitus, but your usage seems pretty minimal. At one point I chased down like six people who had made posts on a different board about awful tinnitus following benzo withdrawal, and the five of them who replied to emails (years after their posts) all told me the tinnitus had either gone away entirely or become a non-problem. So it seems that even for heavy, daily users, any impact on tinnitus is usually temporary. (This is also my experience; I use clonazepam daily (and gabapentin) but I have withdrawn from benzos twice after years of use and in both cases any changes to my tinnitus were limited to the withdrawal period and some period of time afterwards).

It's definitely not, and in fact the only other barotrauma-induced tinnitus stories I've seen on here have either involved airplanes or SCUBA, and the barotrauma event itself described as significantly painful. That doesn't mean that a minor altitude shift wasn't the straw that broke the camel's back in your case, but if so, it's both highly unusual and would have happened at some point because pressure differentials are a part of life.

I have a friend with chronic tinnitus who finds it obnoxious enough that he takes gabapentin, who had it get SIGNIFICANTLY worse following a SCUBA incident where he repressurized incorrectly -- but after 2-3 weeks he said it was back to baseline. Of course there are no guarantees, but this was also a much much more traumatic injury.

Interestingly, my wife, who does not have chronic tinnitus but does get fleeting tinnitus is very prone to barotrauma (she has to use specific earplugs, pseudoephedrine and chew gum in planes; one time she had unilateral near deafness for 36hrs after a flight which would have made me insane with worry but she just shrugged off). She also has this "crunch"; once when we were about to get on my motorcycle, I pointed out that her earplug was not fully inserted, and when I tried to insert it normally the same way I do myself, there was a huge "CRRRRUNCH!" that surprised the hell out of her and was quite painful, and needless to say, I don't try to mess with her earplugs / ears anymore.

There's a lot of cartilage, connective tissue and then of course bone involved in the TMJ and area where the cranial nerves insert. It sounds like you might have some kind of physiological abnormality there; the kind of MRI you had was likely only looking for tumors. Visualizing soft tissue oddities can be very difficult, and then doing anything useful with that information, more so.

In general are you able to "clear" your ears easily? When I pinch my nose and blow with ~25% strength, both ears rapidly pressurize as my e-tubes open. My wife, in general, is unable to do this -- though her e-tubes work well enough to equalize fine on our drives from home (1600 feet above sea level) to town (5-800 feet).

 

@linearb Firstly, thanks for your thorough response - I really appreciate you taking the time.

I went into this quandary leaning more towards the notion that Klonopin was the culprit but now I'm not so sure. It seemed more likely due to it being the only recognizable variable that's changed in recent months but I'm beginning to think that perhaps time and a faulty jaw are to blame. I don't know how it never occurred to me until now, but I realize that the day my tinnitus first appeared I was doing quite a bit of yawning (and thus jaw stretching) in an attempt to equalize the pressure. I always thought that the equalizing itself was the issue but the jaw movements honestly make more sense being that I was driving in North Western New Jersey and not the Himalayas. Thinking on it now, my tinnitus (new and old) does sound louder late nights when I've been yawning a lot...

To answer your question, I've always been able to clear my ears easily. I took quite a few plane trips when I was a child/teenager and had no problems with it then. I don't change altitudes much now (enough to require a pop, at least) but I suspect that it wouldn't be too much of an issue.

It would probably behoove me at this point to finally get my jaw looked at (perfect timing what with the pandemic...). I've avoided doing so in the past because of the cost associated - American healthcare for you - but if it means I can prevent the T from worsening than I might just have to find a way to make it happen.

You seem pretty knowledgeable on the topic; if it turns out its my jaw and not the clonazepam, whaddya think the odds are of this being a permanent spike? lol I know its impossible to say, but I've read so many conflicting accounts of TMJ-related tinnitus I really have no idea what to make of them. Know of any stories with positive outcomes in that respect? I could sure use one at the moment.

 

It's so complicated; it can be a confluence of things. My tinnitus first appeared when I was 18 or 19, which followed, in the year prior: some of my first concerts, a car accident w/airbag deployment and whiplash, contracting HSV-I (oral herpes simplex virus, "cold sores", very common but this is a virus that lives forever in your cranial nerves and has theoretical connection to tinnitus), benzo, antidepressant and illicit drug exposure -- basically every risk factor I can think of. However, it was stable from 1999-2010 and the thing that made it substantially worse was a big noise trauma, no question there.

The noise gets significantly louder when I jut my jaw forward. This is true for a large percentage of people with tinnitus, but I do also definitely have TMJ problems (my jaw can actually dislocate, though this hasn't happened in a long time because I sleep with a bite splint that has repositioned my bite. I do notice that when I go a week or so without using it, things start to click and pop again and often my (constantly present) tinnitus gets worse.

I do think TMJ treatment, if that's part of your problem, can be useful but you very quickly get into, if not "alternative medicine", things which aren't that evidence based. There are several different styles of bite guard, and most TMJ clinics only offer the one or two they think are "the best", which varies clinic to clinic. Additionally, I paid $1700 (!!) for my current guard in 2016; I was assessed by a clinic up here that tried to sell me a "better" one for $5000. They also had all the hallmarks of being bullshit scammers, saying things like "oh, I think this will solve all your problems" and "did you know your tinnitus, carpal tunnel syndrome, lower back pain, cervical spine rotation, and visual problems could ALL be because your bite is off?"

No, I didn't know that, and I don't f'ing believe it, and I walked out of that place and never looked back.

This is a book I'd encourage reading the first chapers of and then at least skimming the rest before entering the dubious world of TMJ treatment: https://www.amazon.com/gp/product/1572241268

There are a bunch of self-treatment things you can do, and even if they don't end up being enough to keep you away from TMJ clinics, they should give you some idea if you have problems there and if they are impacting your ears.

Another thing that can help is direct myofascial release of the muscles of the jaw. This is usually done by a physiotherapist wearing gloves, inserting their fingers into your mouth and directly accessing various muscles. Once you've had it done professionally a few times, you can probably self treat pretty effectively, and they even make various tools to help: https://www.amazon.com/Pressure-Positive-Myofree-Solution-Burgandy/dp/B004O7B4XM

I don't own one of those, but I have long skinny fingers so it never seemed necessary. I have similar devices for various other muscle groups.

It's impossible to say or predict what will happen in any one case. I will say that in my case, treating my jaw has substantially helped my tinnitus, but not to the point that I want to deal with it unmedicated. On the other hand, it helps enough that when I stop doing it, after a week or so I really feel like I am paying a price. (Additionally, Clonazepam, being a muscle relaxant, has positive impact on my TMJ in terms of muscle tightness).

I've definitely read a lot of stories over the years of people reducing or eliminating their tinnitus through TMJ treatment. I'd say "reducing" is substantially more common than "eliminating", but, you don't really know until you get there.

Good luck!

 

o basically you can never take benzos? Not even once per month or per two months?

 

There is also for example tinnitus after an acoustic barotrauma. Many don't know what exactly happened to them. I don't know anything about TMJ. And I don't like when young people take benzos so I guess avoiding them, if possible, would be better anyway. So I am definetly not saying she should not consider other possible causes. I'm just posting what I read.

@Cass, why were you going to the doctor in the first place if you don't mind me asking?

 

As a small update, things have largely remained the same. Makes me a little nervous but I know any change to this (if a change happens at all) will take more time. Continuously bouncing back and forth on trying to figure out what could have caused all this, debating on whether or not I want to brave a doctor’s appointment. It would be difficult to hear for the fourth time that nothing can be done, but I remain hopeful.

@Backpacker, thanks for your input. To answer your question, it was an OBGYN appointment for an unrelated condition.

 

Clonazepam is not considered ototixc. If it contributed at all it should be temporary . Otherwise, there is some other reason. Tinnitus causes are very hard to figure out.

 

This is a grey/semantic area. It isn't considered ototoxic because it doesn't destroy your hair cells but the GABA/Glutamate imbalance that can occur with tolerance can cause neuroinflammation (with excess glutamate) and a host of other problems.

There are even GABA receptors on the OHC efferent neurons:

https://pubmed.ncbi.nlm.nih.gov/8260146/

Like @linearb said it is usually temporary but in some people this can be protracted (years).

 

Another update for those who are still here.
Things got really quiet for a time and then got massively worse. I have an entirely new sound in my left ear that's completely unmaskable. I have no idea why, I woke up about three days ago and there it was. It's Morse code-like, very reactive.

I was concerned before but now I'm starting to get really worried. That's five unique, unmaskable sounds total and three of them have come on in the past two months. What on earth is going on here? It's like every time begin to habituate, something new comes along and I have to start all over again. I don't know how many more habituations I can go through before pulling a Van Gogh. I worry there'll be a full orchestra in my head by the end of the year.

Can anyone point me to similar stories that ended in some modicum of success? That's really the only thing at this point I can do to maintain hope that somehow things will get better, not worse.

 

How do you do this?