If Fluoxetine Resolves My Tinnitus, Is Tensor Tympani the Cause?

Hi,

For the last 4 months I have been suffering from a low hum/ morse code/ fluctuating tinnitus that seems to react to sound, combined with vertigo/ balance problems.

My GP has mostly dismissed as anxiety or 'a minor problem with labyrinth'. I had a private hearing test, which reported a 10-15 decibel loss in the ear with the tinnitus.

After a couple of months of trying to soldier on, the persistent sound - and the anxiety surrounding it - made me admit defeat and take the medication. And the sound and dizziness have resolved. However, I now feel a new kind of awful with the side effects of the medication, and I personally would rather not take them long term. I have tested whether it is the medication that resolves the problem by stopping for a few days and the sounds returned.

My question is, if an SSRI resolves the tinnitus, what is the most likely cause? Could it be tensor tympani syndrome? I saw a locum GP last week who looked at me like I was a mad woman when I mentioned it because he had never heard of it.

Thanks for all advice,

Francesca

 

Hi Francesca and welcome to the forum

Do you have any fullness in the ear or distortion of hearing?

 

Your T resolved completelly with fluoxetine ? even in silent room with closed ears ?

Tinnitus with balance problems mean problem to labyrinth.
How many days after you got fluoxetine problem solved ?
There are high spontaneous recovery rate without medication for these problems.

 

Hi,

Not that I've really noticed apart from the reported loss on the hearing test

Francesca

 

Hi,

I was just going to reply to say, yes, completely resolved. But when I place my hand firmly over the affected ear I can hear a slightly different noise which sounds like a combination of a rattling/ vibration/ beeping. But unless I do that, I hear complete silence. I am on day 2 of complete resolution. But I did have 5 previous days of resolution before I tried stopping the medication and having to restart because the sound came back?

Francesca

 

Sorry, I didn't answer question properly.

It took about 14 days from starting medication for it to stop - with the odd day of silence. And another roughly two weeks again after stopping and restarting the medication.

 

Fluoxetine to start work needs 2 to 4 weeks so maybe has to do with it.

Your symptoms refer to labyrinth problem and yes anxiety can cause labyrinth problems.

Also fluoxetine and antidepressants in general can mask a problem or improve anxiety and don't
bother your problem.

Tinnitus is so mysterious that none can answer you with sure what happens.

Fluoxetine common side effects are loss of libido/changes in appetite/flattened feelings (these I had when I got it).

Fluoxetine is an SSRI antidepressant and I heard one friend of mine to say to me that paroxetine
another SSRI antidepressant improved his tinnitus.

Have any of you got history of benzodiazepines use or another psychiatric drug?

 

I don't know. But, I do know that there is a doctor's corner where you can ask the psychiatrist (@Dr. Ancill) your questions. He won't look at you as if you are mad. Promise.

To my knowledge, there is no antidepressant medication which has been proven to reduce the loudness of tinnitus. There are two medications of the "benzo class" which have shown potential efficacy in this regard (one of them is Clonazepam). But benzo medication can lead to a rebound effect upon cessation.

There is a 2016 webinar by the ATA which looks into the management of tinnitus through the prism of pharmacology. There is also a section on future treatments geared specifically at treating (not managing) tinnitus. But of course, given the video is two years old, that is already outdated information... There is such a thing as typewriter tinnitus and here I think Tegretol is known to be efficacious (niche knowledge).

There was a recent review of all the existing literature of antidepressants which was so massive/significant that it made the headlines in the main media. The review was published in The Lancet. The bottom line of that review is that antidepressants do work for the treatment of depression. But it is also noted as critiques of that review that long-term follow-up studies are lacking (and hence some undesirable side-effects might be missed – and one possible side-effect is actually tinnitus). The review looked into the use of antidepressants from both the point-of-view of "efficacy" and "acceptability".

Hope that helps...

 

Yes, I had used diazepam shortly before the tinnitus started. And took Mirtazapine for 18 months about two years before that.

 

Thank you for compiling such a detailed response. I will check out the Doctor's Corner. I didn't know about that. Thank You

 

Diazepam can induce tinnitus from withdrawal and mirtazapine is ototoxic and can cause hearing loss & tinnitus.

What doses of diazepam you took and for how long time?

 

There is most definitely cases where Fluoxetine can reduce Tinnitus in individuals. The Cleveland Clinic has done studies on Fluoxetine and Gabapentin used together or separately. In general Fluoxetine is used for other nerverous system issues also.

 

I'm mostly trying to work out what mechanism/ pathway that the fluoxetine is working on? So I can perhaps find a more natural alternative? And also wondering whether that by taking the meds I could potentially be masking something that requires further investigation. It's all so confusing...

 

I have a feeling that my problems have something to do with these two meds. I have suffered with depression before, but never anxiety/ panic disorder until after I had withdrawn from the mirtazapine. 6 months after quitting I started having panic attacks and, and at that time, I could feel an internal vibration in my throat/ neck. I've only just made the connection that this and the vibrating/ tinnitus in my ear could be connected.

 

I have taken in the past mirtazapine 7.5mg & 15mg for sleep.
My side effects was rapid weight gain, swollen legs, intense nightmares and possibly increased/worsened tinnitus.
The withdrawal was easy I had no problems.

6 months after withdrawal I don't think that mirtazapine but diazepam can do protracted withdrawal syndrome that lasts years.

How many times and what doses you took diazepam?