Somatic Tinnitus, Pulsatile (Partially) Tinnitus, and Distortions — I Cannot Deal with This

This will be a long read but I feel the need to describe my tinnitus and the time leading up to it as fully as possible.

I am 20 years old and have a history (for my whole life) of easily clogged and uncomfortable sinuses. My mother mentioned the other day how when I developed a cold as a baby, I would become so miserable that she would sometimes wonder if I had a more serious health issue. All my life, a blocked nose has caused me to feel much more miserable than most people. I also sometimes get recurring blocked nose in the morning when I wake up in the weeks following a cold. Flights and other (relatively) significant or rapid pressure changes have always caused me more disc0mfort than most (although luckily temporarily).

Looking back, I probably have had periods/moments of noticeable tinnitus for a lot of my life, but I just always saw them as something normal. As is the case with a large proportion of the population, yawning or opening my mouth unusually wide has often caused loud buzzing tinnitus in both ears that resolves instantly once I close my mouth again. The first time I noticed a sound in my ears other than this was in 2021 when I ate some edibles and blasted music through my headphones to vibe. I noticed a buzzing, almost chirruping sensation in my ears after the music turned off, and attributed this to a side effect of being high over time - it would only ever be noticable when I was in this state, and even then only when I focused in on it. The other thing I have experienced for a long time is clicking in the ear when I swallow. It has sometimes become an area of hyperfocus for me, with me swallowing several times until both ears click.

Towards the end of 2021, I began to experience what I eventually learnt was earwax blockage and occlusion in my left ear. I have very narrow ear canals, particularly in my right side (although as I said the problem was on the left). This runs in my family, and seems to come from both of my parents! It would only ever flare up when water got into it, namely after either a swim or a bath. At first, the blocked feeling and hearing loss would only ever last a few hours, but eventually the blockage became permanent, which led me to get treatment in June 2022 via microsuction, which instantly resolved the problem.

All of this may seem irrelevant, but during this period, I would have moments of what I now know is pulsatile tinnitus in my left ear whenever I would bend my head down, to the side or in other unusual positions that you do not keep your head in. It would also flare up while I was straining for a bowel movement. I noticed this, but it did not give me any additional worry as at the time I had no knowledge of tinnitus at all and assumed it was some kind of side effect to the ear blockage. After the microsuction, the pulsatile tinnitus stopped even when my head was in unusual positions.

In August 2022, I flew for a family holiday. The flight back left me with a fairly mild but noticeable blockage in my left ear - it would no longer click when I swallowed, and my hearing from it felt reduced (although nowhere near what it was when I had the earwax blockage). During this period, which lasted a few days, I would once again have the pulsatile tinnitus, which again was only when my head was in the same unusual positions as before. After a few days, both the pulsatile tinnitus and general blockage resolved.

This brings us much closer to the present day. It has been a very bad winter in the UK for colds and other respiritory viruses, with a large amount of people here getting numerous and/or severe infections. Despite my volatile sinuses, I am not prone (compared to most people) to getting ill. I did not have any noticeable illness (outside of the periodic slightly blocked sinuses) between October 2020 and late summer 2022. The cold I had then was minor, resolved quickly, and did not have any lasting effects on my ears. But in December 2022, I was caught out (like the vast majority of the British population) with a cold which started in my chest, giving me a fairly persistent and annoying productive cough, and then promptly moved up to my sinuses. The blocked nose I experienced was nowhere near as bad as previous colds I've had, but I did notice my ears were not clicking like they usually do when I swallowing (the same way my left ear did after the flight). And what would turn out, ultimately, to be the killer, was that my left-ear positional pulsatile tinnitus was back.

After this first cold went away, my ears began clicking normally again, but the positional pulsatile tinnitus remained. Due to me only hearing it momentarily, it was never debilitating, but I did notice it being there and could tell that my left ear was not quite the way that it was before the cold. And I would occasionally hear a new, non pulsatile sound in my right ear, which looking back, was the start of the tinnitus which now is debilitating me. It was never loud or caused problems, but it was there, and represented a change from before the first cold. Unfortunately I can not pinpoint when this sound first appeared, due to how minor it initially was.

And then around the middle of January came the second cold, which has introduced me to the hell that I now live in today. It presented in a virtually identical way to the first cold, with it starting in my chest and causing an annoying yet bearable productive cough. This time though, the cough was more severe, and my chest generally felt worse. After a few days, as before, it moved up to my sinuses, and this was when the damage occured. At first, it felt like a fairly unremarkable blocked nose combined with a fever - I was in bed for around two days. But then, a day or two after this began to subside, I noticed the pulsatile tinnitus was more prevalent. It would now occur when I first lay down, not just when I moved my head in unusual positions. I was mildly alarmed by this, but dismissed it at the time as a side effect of the congestion. And then, on January 26th, I noticed the pulsatile element when lying down was gone, but there was a new, constant ringing on my left ear, which would be especially prevalent when I pressed that ear. In addition to this, the existing very quiet sound on the right side was much more noticeable, and there were also general buzzing tones which came and went, sometimes replacing the ringing on either side.

Since then, despite my cold resolving, things have gone from bad to worse. I now have somatic tones which change and fluctuate when I walk or move my neck, the initial ringing on either side is still there, and new tones on my right side have gradually appeared. I've noticed that I can never hear more than 3 or 4 of these tones at a time. My right ear also feels full in an on-and-off manner (some days I will barely notice it, other days it will be rather annoying) but never has any pain. Pain has never been a part of this. But by far the most insufferable element of this is the somatic aspect. When I move my head, neck and body in general, I will often hear infuriating TV static tones that will normally instantly resolve once my position changes, but is very noticeable. And when I lie down to try and sleep, the sound will gradually get louder and louder, and new static tones will appear. Every night I will wake up after a few hours to a deafening sound mainly in my left ear, that gradually goes down to the 'normal' daytime level over a couple of hours. But the 'daytime' level varies from day to day, as do the sounds I can hear. All of this makes this incredibly difficult to habituate to, as no two days are the same with these hellish sounds. In addition, I have existing health anxiety, so have convinced myself at various points that I have a number of different conditions, most of which my rational brain will tell me I do not have, but to little avail. I spend the vast majority of each day either thinking about or hearing the sounds, which obviously is only making them worse to me.

I have had a hearing test which came out virtually normal (I never believed any of this was due to hearing loss), and have also visited an osteopath who said that my neck is very tense and the CSF is not behaving normally. This, combined with the somatic aspect makes me think that at least part of this is caused by my bones and/or muscles, with my prone-to-congestion sinuses also definitely having an impact. I have spoken to two different doctors from my local practice on the phone, and now have a referral to an ENT specialist (although I have no idea when this will happen).

I know it may seem a little soon for me to be posting any of this, given it has been acute for less than a month, but the constantly changing aspect of it makes this incredibly difficult for me to live with. I cannot carry on in this headspace. It will destroy me.

 

Welcome to the forum.

Sorry that you are hurting from your tinnitus.

One thing about somatic tinnitus is that if the ENT or other specialists can fix the source of the problem, your tinnitus will fade or decrease in intensity. New tinnitus tends to be unstable and can morph into multiple tones, thus causing much anxiety.

I will pray that you will find the fix to the somatic tinnitus. In the meantime, try masking and perhaps get some nerve calming supplements such as Lemon balm, Valerian, Kava, Chamomile etc. Try Melatonin if you have trouble sleeping.

Take good care. God bless.

 

At night try sleeping on right side only, if that is your quieter ear.

Is this affecting your work?

Avoid biting nails. Eat softer foods that don't require as much biting or chewing.

Also, try to relax your jaw all the time, let the muscles relax. You don't need to tense your jaw muscles to keep your mouth closed.

 

So sorry to hear of your travails. I hope the ENT visit can be scheduled quickly so that you can get some answers soon.

Did your osteopath or dentist ever say anything about your jaws? Some people unknowingly grind their teeth while they sleep, or else clench their teeth from stress while awake, and this has been known to exacerbate tinnitus. It may not apply to you at all, but I bring it up only because it is an avenue that might be worth exploring.

In the meantime, aside from reducing stress and improving sleep, it may be helpful to seek out foods and supplements that lower inflammation. Ginger, garlic, and curcumin (also known as turmeric) are just a few of the things that people on this message board have recommended.

I hope you can get some relief soon. The ever-changing noises are indeed very hard to habituate to.

 

Hi @Isaac Ramsay.

I'm sorry you're struggling. Yes, lots of people are ill in the UK, I can attest to that.

To keep it simple, it seems that some damage to the inner ear has occurred. It often doesn't show up on an audiogram as it only needs a bit to trigger tinnitus.

As for somatic or tinnitus modulated by movement, it is often not the muscles of joints involved that cause the tinnitus. When the inner ear receives damage and the stimulation from the auditory nerve is damaged, other nerves up regulate their activity. Nerves such as the trigeminal nerves and dorsal column nerves, together with the auditory nerve all feed into the dorsal cochlear nucleus. So movement of the head or jaw can be interpreted as sound.

Read any recent (post 2000) literature by Shore, Martel et al.

In the past this would lead people to rush off to a physio, chiropractor, dentist etc, but to no avail.

So first of all don't assume it's due to a muscle, spine or dental issue and run off lining their pockets. Medications like Baclofen or Cyclobenzaprine can help somatic tinnitus. Cyclobenzaprine has the best evidence and it does act on the brain stem. Unfortunately it's not available in the UK, but could be bought with a private prescription from say a Canadian Pharmacy relatively cheaply.

 

Hey @Isaac Ramsay. I am sorry to hear that. Tinnitus is an intriguing symptom, with many causes. It is very important to understand your medical history and the days prior to your tinnitus onset, and also your symptoms.

My recommendation would be that you visit a very well trained Otologist or ENT. Did you do a speech-in-noise test? It is a good test and, if done correctly, you can rule out hidden hearing loss. Also ask for a high-frequency audiogram.

Anyway, I think your case may be due to Eustachian Tube Dysfunction and inflammation, which can increase pressure in the middle ear and increase the tinnitus volume temporarily of an already existing tinnitus (basically you hear it louder, but there is no damage to the inner ear).

You have a long history of barotraumas, congestion and colds. Check for allergies, maybe a CT scan and I would recommend a very well trained doctor to explore your ears, to see if you have retracted ear drums, redness, inflammation, fluid, etc.

Eustachian Tube inflammation takes very long to heal. The fact that lying down makes your tinnitus louder, can be due to inflammation and Eustachian Tube Dysfunction. Antihistamines could help.

As @billie48 has suggested, if it is somatic and there is a cause, it can be resolved or reduced very much, to your prior baseline.

Remember, MRIs can be dangerous for your ears (use earplugs), be cautious with ototoxic medications (review if you took some for the colds and sinuses).

All the best, you will be fine! I am very sure about it.

 

I have an ENT referral from my GP, but this being the NHS, I'm not sure exactly when I will see them. My GP very briefly looked inside my ears and said my right ear canal was slightly swollen. This made sense at the time, last week my right ear felt tight at times. This has since gone away.

Nothing has really changed for me since my posting of this, except for the fact my positional pulsatile tinnitus is now much quieter, randomly.