Initial Help — What Should I Do First?

Sorry for the long info but I wanted to be thorough, I trust the people on this board because I understand that when you are researching for yourself, you have probably done more research than many of the physicians in the field.

Was on Paxil for 8 years, quit in 2010 - had all kinds of withdrawal including tinnitus. It went away for the most part except for a tiny lingering which was on and off, pretty low and not bothersome. Then, I started Celexa in 2013 I quit Celexa after being on it for 3 years (I did notice that being on the Celexa made my tinnitus slightly worse especially after I used the hair dryer) but overall, it was still very manageable. I quit Celexa in February of this year. The first 8 months of withdrawal were totally fine. I did notice a sensitivity to sound but I thought it was just me being irritable (the sounds felt more annoying than they did painful). A couple times, but not frequently, I would also notice my hearing would shut off slightly in on of my ears for a day or so then go back to normal (however, this hasn't happened in a while). Then after a stressful event which went on for 2 months, my tinnitus was getting a bit louder at times, especially at night while watching TV (at this time I was doing some clenching and grinding of my front teeth - this was something new for me because I was stressed). The tinnitus also felt more solid and was a totally different sound. My normal sound was a broken high pitched ringing sound mainly in my right ear. This new occasional sound was in both ears and was more of a solid hissing. At that time, it wasn't super loud but I did notice it. That happened on and off a couple nights without too much frequency but I didn't think about it too much as my tinnitus has always fluctuated in the past and I was somewhat okay with it.

After the stressful 2 months, I decided I wanted to go back on the Celexa. Upon restarting, I had a severe reaction. My body had built a tolerance to it and rejected it on the 3rd dose. I got Akathisia which is an oversensitization of the CNS (it's a really bad thing) caused by medications like SSRIs or Anti-Nausea. At that point, I didn't notice any changes with the tinnitus and I'm not sure if I even got the fluctuation at night which I was previously having.

During the Akathisia fits (adrenaline filled, glutamate, dopamine and norepinephrine related fits which could be anywhere from a couple hours to the entire night) I noticed I would clench my jaw very tightly. This went on for about 2 months. It was severe torture. However, I still didn't notice any fluctuations with my tinnitus. What I did notice, is that I have occasional pains in my ears and my hypercusis was extremely apparent (Akathisia also causes a sensitivity to sound so I connected it to that). Then I started doing better for a couple weeks, when it relapsed again really hard. This time, after the first few days of the relapse, I developed severe hypercusis and very loud tinnitis - I haven't measured it but it is literally unbearable and much too loud be muffled by other sounds. It was the shrill hissing tinnitus in both ears. I could barely hear my old tinnitus, it was covered but the other sound.

The intense tinnitus has stayed its course over 2 days solid, along with severe hypercusis, then on the 3rd day, everything seemed to let up a bit. The tinnitus lowered by about 80%. I spent most of the day like this and was totally relieved. By the evening, I noticed it started getting a little louder. I woke at 4am and it was full blown again. Later in the day it seemed to increase in volume EVEN MORE which I didn't even think was possible, however the hypercusis seemed to be a little less but was replaced by ear pain/fullness in both ears. My hearing does not seem to be effected. I do notice increased pain when driving and going up and down hills but I don't feel any "popping".

Today, to my surprise, it seems to have lessened again by around 50%.

I saw an ENT yesterday and she said I had three things that could be causing this.
1. She saw some irritation in my nasal passages and said my equestrian tubes could be irritated (she gave me 2 types of sprays), I did notice I was recently getting some bad sinus headaches over the past month. 2. She said it could be from the clenching. 3. From the drug reaction

Question 1:
Since this seems to be in the phase where it's going up and down and in the hypercusis/ear pain phase, the precursor to tinnitus, is there anything I can do this phase for prevention on permanent onset? (i.e. take NAC, gabapentin, steroids, etc.) Currently, I'm on 2.5 mg of Propranolol (it's a baby dose, starting dose is 10mg, I know this is an Ototoxic drug but I need to be on it for the Akathisia - Note: the loud tinnitus started before I started taking this). I can not take an SSRI as I have become sensitive to them. I have prescription for Lamictal which I'm scared to take because it can cause tinnitus. I'm also a little scared of Mirtazapine because it has weird side effects but could potentially help me if my condition is serotonin related.

Question 2:
Best guess as to what's going on. Not sure if this is ototoxic because I was sort of already getting it slightly during late onset withdrawal, now it just seems to be amped up. Can this just be an exasperated withdrawal/reaction? Is there a chance it might go back to normal? I saw that usually most SSRI withdrawal cases get mostly better with time.

Thanks again, your input is appreciated.

 

I would read up on TMJ and get your dentist x-ray your jaw.
Temeromandibular joint problems can cause tinnitus as the joint is by your middle ear when your jaw gets inflamed from gritting and grinding teeth at night.
A mouth guard will help reduce your tinnitus if It's TMJ over time....lots of love glynis

 

It's back up again today in full force and possibly even louder.

Thanks Glynis, I know I've already been sensitive since my Paxil withdrawal. I will get my jaw checked out but I feel like the most likely culprit is the withdrawal/reaction/anxiety.

I hope it gets lower again but it seems as though as though it wanted to build up to this state. In more serious cases withdrawal or drug induced cases, does it just appear full force, or does it wax and wane like this first?

Please let me know if you think I should get a prednisone shot or be taking any supplements. I just want to stop the pain so that it stops getting worse. Thanks again for your help.

 

This is long but I never provided a proper introduction...

I had a some leftover mind tinnitus from a Paxil withdrawal in 2010. It masks well in normal environments so it doesn't bother me (it's in one ear and is an on and off ringing). Recently, I had an adverse reaction upon reinstating Celexa which I had quit in Feb 2016. I've been messed up for a couple months now and had slight H for a while but didn't really realize it until now. Now I have a loud static/refrigerator sound evenly in both ears with an overlay of high pitched ringing. Sounds more like it's in the middle of my head.

The Audiologist said I have very mild mid level hearing loss more so in my right ear.

I did notice that about a month or so before the reaction, while I wasn't on any medication, I was getting a mind form of this on and off but didn't think too much of it. I had been VERY stressed out (that's why I had decided to get back on the medication).

I think even though this appears to be withdrawal/reaction (or ototoxic) I believe it to be oxidative stress induced. Throughout this whole ordeal, I have been grinding my teeth while awake and - I don't think I'm doing anything in my sleep. I also have some severe tension in my neck.

Can the sound of the T help determine the cause?
I'm wondering a couple things here. I remember when I had my Paxil withdrawal, the T was more of a ringing sound and when it dissipated for the most part, I was left with that one little ring. This sound, is more like when I would use the hairdryer and get some static sounding T for a few hours.

I'd like to hear your opinions or "best guess"...

1. Does this mean that this T might be sounds induced because of the H? Perhaps my ears were just really sensitive and I wasn't protecting them (I use the blender a lot in the morning and maybe something like that caused it).
2. It's my jaw and neck muscles from the clenching
3. Or it is from the drug
​

Is the refrigerator tinnitus sound more closely linked with a specific cause?

Thanks for your help.

 

Withdrawals and anxiety can spike tinnitus and you need time for your brain adjust after stopping medication.
Steroids would only be a quick fix and can cause other problems.
Keep an eye on your anxiety as it will spike it and Christmas can be stressful for some
..lots of love glynis

 

Could be TMJ from grinding teeth or stress.
Antidepressants can spike tinnitus when first start them as your brain adjusts to the medication
..lots of love glynis

 

Don't think it is, mine is refrigerator, hiss type and have no hearing loss. T is a mystery, if the ENTs actually kept some info, took a questionnaire re sounds versus possible cause we may have some better data, as far as I know such info does not exist.

With ADs it's generally withdrawal or the first few days upon starting taking them.

TMJ - get it checked, doing the same...have had TMJ for 20 years but can't alter t pitch with movement so skeptical in my case...still wort investigating but don't get me started on that...referral got lost twice...aargh.

Anyhow, I digress...take care.

 

How are you making it these days? Did you find any answers? Curious as to what your dentist said? My tinnitus has gotten very severe 4 months ago from a gabapentin withdrawal to where i was clenching very hard at night, enough to wake me up from biting to hard, even heard my jaw pop, but i assumed it was a drug withdrawal that started my extreme T... now I am wondering if it might be nerve damage from the clenching,,,,could be both....let us know how your doing,,,,I hope you are getting along better

 

@Florida John I'm still the same except that my H has worsened. I'm wondering if my worsening was actually gabapentin interdose tolerance. I starting taking it right at onset, I felt like things were calming down slightly only to get ramped up again mid-February. I was only taking 100mg of gabapentin - I know this is nothing but for me, it's a lot since I'm sensitive. I was dosing 1x per day and realized later on the that the half life is only 8 hours, which is why perhaps it was making me worse if that was in fact the cause (mini-withdrawals between doses?). I figured it's probably not a good drug for me so I just started tapering it by 10% (made a liquid formula). My body doesn't really feel that nervous from the taper.

I'm skeptical that my T is related to hearing loss (even though I have some mild hereditary mid-level) except for the concept of hearing loss + stress reaction = T. But everything came on way to aggressive initially so I'm skeptical.

I think a good way to find out if it's jaw related is to get some kind of nerve block injections around the jaw. If things calm down, that might be the cause. I have TMJ as well but I there are a lot of people that do, so any TMJ doctor will convince you that's probably your cause (and sometimes they can be right). I may try some injections first before going the splint route even though I've already been fitted for one. I'm uncomfortable enough without having to wear a weird thing in my mouth.

The clenching nerve damage sounds plausible in my case as well. I can not modulate my tinnitus by moving my jaw, it has no effect but that doesn't mean there're a nerve that got severely crushed/irritated. This also sounds interesting as it is an anti-inflammatory which can be injected into the jaw. http://www.regenexx.com/what-is-regenokine/

 

if for some reason you stay on gabapentin take it every 8 hours, that way its in your system 24 out of 24 hours per day,,,it is given to people for nerve damage, I had a many dr try to prescribe it to me for tinnitus,,,,but it was a fast withdrawal from gabapentin that started my current nightmare,,,,seams that withdrawal from alot of meds create problems with tinnitus,,,,we are stuck in a viscous cycle,,,,because we need meds for help, I had and sometimes still have suicidal thoughts, from what this has done to me, so i turned to a benzo to stay alive and try to figure a way out, this might be hard for some to understand until it gets that bad, anyways back to the point of using medicine, most need it for the anxiety, depression, and sleep problems this monster has created for us, I dealt with mild tinnitus for over 20 years, never realized how bad it can get and what it can do to the mind, I have appointment to see my psychiatrist today, who wants me on a antidepressant, to which I have been fighting for months, think he said lexapro or celexa, but here I am back in the viscous cycle, we do not have alot of choices and none of the med choices are good,but some how we have to keep our minds from being a nervous wreck, I do wear a mouth guard at night, the one thing it does is puts more pressure on the front teeth and distributes it better, and not on back teeth where more pressure is put on where jaw hinges near the ear,,,although it is a pain in the ass getting use too, I take a muscle relaxer before bed, and that helps sleep and relaxed muscles,,,,are you currently on a antidepressant of any kind?

 

@Florida John Celexa caused my initial reaction which is how all of this started. Your psychiatrist probably mentioned those two medications because they are more mild with less side effects but Celexa is notorious for causing T and I'm iffy about Lexapro. In regards to SSRIs some people tend to do better with Sertraline or the older tricyclics (if you don't have H).

Currently I had to start taking Klonopin. Been on it for 3 months, I did not notice a decrease in volume but it calmed me down. I feel that at this point I would like to take an AD but I'm worried about restarting the reaction, I know for sure I can't take an SSRI even though I did fine with them for years.