Sudden Onset of Severe Nighttime Tinnitus with No Hearing Loss

[ex-engineer]

Hello everyone,

A bit about me… I'm an electrical engineer, and I don't work in a noisy environment. I work from home. I never go to concerts. I do use headphones when I work out, but they're pretty cheap and don't get very loud. I've never had tinnitus last for more than 10 seconds, and only every few months, my whole life. I'm now 56.

A few weeks ago (on July 15), while on a business trip, the ringing started in my right ear out of nowhere. It wasn't too loud at first, but it hasn't gone away. The worst of the sounds is a very high-pitched frequency that almost resembles a hissing noise. It's unbearably loud. It always gets worse when I lay my head down to sleep. It becomes so loud and overwhelming, like the sounds are inside my head. Does that make sense? It's like a squealing sound, similar to a dentist's high-speed drill.

Masking doesn't work. The tinnitus gets louder when I try different masking videos on YouTube. It feels as if the noise is irritating the auditory nerve even more, and the hissing grows even louder, like a mix of squealing and air being released from a tire. This only happens at night. Sometimes, it even seems like it's coming from my left ear too.

I have a wall-mounted AC unit and a fan to circulate air. That's the ambient noise, but it does nothing to mask or distract me from the tinnitus… especially that awful hissing.

The ENT says there are no signs of hearing loss in the past three years. I had two hearing tests in the last three weeks. They told me the testing goes up to 8 kHz. My right eardrum does have a small hole in it. My left ear is normal.

I'm now taking 20 mg of Prednisone for the next 15 days.

Are the masking videos making the tinnitus worse? Am I irritating my auditory nerve and making it louder? What should I do? I just want to sleep. I can deal with the ringing during the day, but the nights are unbearable. Whether I use masking or not, just lying down seems to make the noise explode. That awful hissing sound is enough to make me scream and bring tears to my eyes.

Please help. Any feedback or positive guidance would be deeply appreciated. It feels like some bizarre curse hit me out of nowhere.

By the way, sometimes that awful hissing just stops. Completely gone. Total quiet. That's when I try to fall asleep again.

 

[momus]

I'm a bit confused by your statement that your cheap headphones do not get very loud. In my experience, almost all headphones—whether cheap or expensive—can easily exceed safe hearing levels.

The way you described experiencing only brief, 10-second episodes of tinnitus that would stop afterward sounds like it may have been an early warning sign. I have not often heard of tinnitus that short in duration, but everyone is different to some extent.

You might have what people refer to as "normal" tinnitus now, meaning it is likely to be persistent. That said, there are certain triggers you should try to avoid, such as stress and sudden loud noises.

As an engineer, you probably have no trouble understanding the physiological basis of tinnitus. Once those tiny hair cells in the inner ear become bent or damaged, they usually do not return to their original state. When that happens, they send abnormal signals to the brain, which often results in tinnitus.

 

[ex-engineer]

I'm not sure I've ever met anyone who hasn't had the occasional experience of ear ringing that lasts a few seconds and then goes away. There are many reasons that can happen. I've had that happen once in a long while since I was ten. I'm now 56. I don't think it's an "early warning sign," unless you mean a warning that arrives 46 years in advance.

Yes, all headphones can be played too loud. My comment about them being cheap was simply to compare them to brands like Bose or Beats, which can blast your ears in a flash.

You may be right that this could be permanent, but I don't think you should make such glib comments when you have almost no context. The three ENTs I visited wouldn't even consider making a reckless statement like that. Yes, it can be permanent, and that's exactly what terrifies me, but your comment, well-intentioned or not, was out of line.

Anyway, I posted looking for encouragement, suggestions, ideas, or compassion... and all I got was you.

 

[Jammer]

Spicy retort to @momus. I see nothing out of line with the response and would have given the same advice. Hopefully, you'll habituate to your tinnitus in time.

 

[Badger55]

Three things are in your favor.

1. The exacerbation of your tinnitus does not appear to have a definite cause, such as a loud noise.
2. The exacerbation was recent (less than three months ago), which means it has a better chance of resolving than a long-standing spike.
3. You seem to have some periods of silence, which is not usually a characteristic of persistent tinnitus.

Try to stay in quiet environments for the next three months.

 

[virginiadoc]

I find it's hard for people with chronic tinnitus to be truly empathetic. I think tinnitus wears people down and leaves them rather cynical. This forum can be informative, but tough love is embedded here. All clinical sources mention psychotherapy or CBT as a reasonable component. Whatever it takes to become more self-aware and to practice more self-care is worth considering. Much luck, @ex-engineer.

 

[Sydnears]

Sleep is especially important in the early stages. If you are open to it, try melatonin and magnesium. If you need something stronger, benzodiazepines such as Xanax can be used for very short periods, ideally no more than a few weeks. You do not want to become dependent on them, as withdrawal can be extremely difficult.

 

[trevl]

I do use headphones when I work out, but they're pretty cheap and don't get very loud. I've never had tinnitus last for more than 10 seconds, and only every few months, my whole life. I'm now 56.

Hearing cell damage is cumulative over time with exposure to noise.

Each episode of tinnitus you have had is an indicator of excessive exposure to noise and hearing cell damage. Every recurrent episode of tinnitus indicates a further increase in hearing cell damage.

Tinnitus from excessive noise is a response by the brain, turning up the gain in an effort to receive adequate signals from damaged hearing cells in specific frequencies.

A secondary response by your auditory system (ears and brain) will be to recruit alternative hearing cells to tune into non-native frequencies and send signals to the brain for those frequencies lost due to hearing cell damage.

If successful, your tinnitus may decrease or resolve.

If hearing cell damage is too severe within and around the affected frequencies, recruitment will no longer be possible to restore input to the brain, and your tinnitus will remain.

Audiologist or ENT 6- or 8-point audiograms, from a possible 10,000 or 12,000 data points (Hz), are not adequate to determine whether your hearing is affected.

Audiograms that stop at 8 kHz do not go high enough in frequency to reveal high-frequency hearing loss.

Further, audiograms use the dB-HL algorithm, which down-weights the high and low frequency responses to try to present a straight line to the patient so the patient is not alarmed.

The dB-HL algorithm can actively hide hearing loss from the patient.

It's like a squealing sound, similar to a dentist's high-speed drill.

This suggests that you have high-frequency tinnitus.

This frequency cannot be masked with everyday sounds.

I would not even try.

Also, your tinnitus presents in one ear only.

So again, I would not even try.

There is a danger of damaging your relatively undamaged ear.

By the way, sometimes that awful hissing just stops. Completely gone. Total quiet. That's when I try to fall asleep again.

This suggests that your tinnitus is possibly not permanent at this point in time.

It also sounds like you are at the threshold where your tinnitus could become permanent.

I would re-think all the noise environments you are exposing yourself to from this point on.

Seventy dB and above is where hearing cell damage occurs.

Hearing cell damage is caused by both volume and duration, and it is cumulative.

There are frequency and volume measurement apps for your phone that you should use to get an idea of the parameters of the noise environments you are in.

Do not be complacent.

Actively take precautions.

Use safety earbuds, foam or silicone, and active noise-cancelling earbuds.

There is no such thing as "dodging a bullet."

You have damaged your hearing cells at this point.

You can easily do further damage, and it can get worse.