Is Tinnitus from Head Trauma Permanent?

Hi Dr. Ancill,

We are so happy to have you on board. I read you have a great deal of knowledge on Head Trauma related Tinnitus. I have T in both ears and it started 50 days after head trauma, but its louder in my left ear.
My T is either from Head Trauma, High Intracranial Pressure and/or Ear infection. I also had PTSD so perhaps that contributed as well?

I was walking home alone at night and I was assaulted from behind all over my head and jaw by 2 guys and I was hit especially on both ears thus causing some kind of ear Infection. My ENT doc gave me Ciprodex for ear drainage/infection because my T had not started on week 3. I also started getting mild head pain in week 2 which I later found out was due to high intracranial pressure from the assault.

However on Day 50 (week 8) since the Head Trauma I developed T. Why did it take 50 days since the assault for T to develop? I'm sure my T is indirectly related to the assault or perhaps directly or the ear infection caused T? I had no broken bones, luckily.
Anyways, my ENT doc ordered a Brain and Ear MRI and they found HIGH INTRACRANIAL PRESSURE because 1 guy was on top of me bashing my head. I'm lucky to be alive today due to bystanders stopping the assault. So I had to get a Lumbar Puncture on Nov 26th to bring the CSF fluid pressure down from 33 to 13.5. See details below.
My T has lowered since getting the Lumbar Puncture and my head feels so much better as the pressure is gone. However my Tinnitus is still there.

My Tinnitus is around 50-55 dB so day to day sounds mask my T which helps, however in a quite room I can hear my Tinnitus and of course every night when I go to sleep. In your opinion does Head Trauma related T resolve on its own over time? Maybe in a few years? Should I take any specific meds?

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BRAIN:
There is bilateral distention of the optic nerve sheaths, with
flattening of the posterior globes and bulging of the optic nerve
heads, suggestive of papilledema and elevated intracranial pressure.
There is also an expanded, partially empty sella. Meckel's caves
appear slightly prominent.
Brain parenchyma appears normal. No mass lesion, abnormal
enhancement, infarction or hemorrhage is identified.
Ventricles are normal in size.
Paranasal sinuses and mastoid air cells appear clear.
IACs:
Posterior Fossa:
Brainstem and cerebellum appear unremarkable. No cerebello-pontine
angle cistern mass.
A vascular loop of the right anterior inferior cerebellar artery
slightly enters the right porous acusticus.
A vascular loop of the left superior cerebellar artery abuts the
medial cisternal segment of the left trigeminal nerve near the root
entry zone.
Temporal Bones:
Seventh and eighth nerve complexes appear unremarkable, without
evidence of mass. Otic capsule structures appear normal in signal.
Mastoid signal within normal limits. No other temporal bone signal
abnormality is identified.
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Lumbar Puncture:
Opening pressure was 33 cm H2O. 19 ml of clear colorless cerebrospinal fluid was removed and sent to the laboratory for analysis. Closing pressure was 13.5 cm H2O.
The needle was then removed and a bandage applied to the site.
The patient tolerated the procedure well without any immediate complications.

 

I was sorry to hear about the assault and I hope you are recovering. Recovery from a significant brain injury may take up to 2 years.

MRI results are often unhelpful as an MRI is basically a very expensive camera. Damage that is diffuse and microscopic will not be seen. Tinnitus after head trauma is like any other form of tinnitus - sometimes is goes away, occasionally it gets worse but mainly it stays the same.

I make sure my patients with tinnitus get to sleep and you should discuss this with your doctor. A common combination for sleep is melatonin (5-10mg) + diphenhydramine (Benadryl, 25-50mg) but again, check with your doctor to make sure there are no reasons to avoid this.