The Trifecta: Aural Fullness, Hyperacusis, and Tinnitus

Hello everyone,

I've been lurking these forums for a couple weeks and thought I would make a post.

Some basic info:
Age: 33 years old
From: Canada
Current location: Southeast Asia - the event that caused the ear issues occurred while traveling. I haven't traveled back home because flying may cause further complications... and if it does go wrong, taking a 20+ hour flight with multiple transfers is not going to be a fun time.

The Event:
A little over 5-weeks ago (October 15th, 2022), I went out with a friend to a bar/club. It was to celebrate the end of a trip. The music was ridiculously loud - even when yelling at the person next to you, you could barely hear them. Drinking didn't help the situation as it then sort of "masked" the damage being done and any logical thinking that I should leave early. I was there for 3 to 4 hours.

I don't have a history of going to concerts or clubs with loud music. I am more of a quiet, stay-in kind of person. I've gone to 2 concerts in my entire life and was never big into the nightlife seen with only the random occasion.

Symptoms after the event:
On the way home I noticed I had a ringing in my ears. But didn't think to much of it as it was a long night, I was drunk, and then just showered and went to bed when I got to my room. I woke up in the morning and could barely hear. Loud constant ringing. And had pressure in my ears. The right ear was noticeably worse than the left ear. The speakers were to my right side most of the night. After a few days, I started to notice some hyperacusis, which seemed to occur more as the muffled hearing disappeared.

1st ENT Appointment:
I got an appointment and saw an ENT and audiologist at the hospital 3 or 4 days after the event. The symptoms were still very bad with constant ringing, ear fullness, and muffled hearing, and some hyperacusis. The hearing test showed my hearing was normal in all ranges that they tested. The doctor said give it a few days, things usually go back to normal within a week. She gave me Serc, b-vitamins, methylcobal, and sodium bicarbonate ear drops to clean out any ear wax.

Walk-in Clinic
Using the eardrops caused pain. The next morning my ears hurt even more so I quickly went to the walk-in clinic. The doctor said he saw pus and it looks like I have an infection. He gave me Ofloxacin eardrops and Amoxicillin to take. Within a couple of days the stabbing ear pain started to disappear (the type of pain from an ear infection).

2nd ENT Appointment:
About 10 days after the event, I saw a different ENT at the hospital. He did another hearing test, which showed normal hearing. He also did a Tympanometry test (checking ear-pressure) and my ears passed showing they are equalizing the pressure and that there is no fluid in the middle-ear. He said these things take time to heal, usually, it can take a few weeks. He gave me Arcoxia (NSAIDs) to take. I don't believe this did anything to help. He said to come back in a week if there is no improvement.

3rd ENT Appointment:
This time he told me it can take a few months to heal. I need to be patient. He said he believes that my inner ear is inflamed, and this is causing pressure on the auditory nerve, which is causing my ear fullness, tinnitus, and hyperacusis. He gave me Prednisolone 30 mg a day for 5 days. He said if there isn't improvement come to see him again in 3 weeks. He doesn't think this will be permanent. Everything will go back to normal. It will just take time. He also gave me more Serc and B-vitamins to take

He said that theoretically, I should be able to fly since I passed the Tympanometry test. If something goes wrong on the flight, I won't die (that was very comforting /sarcasm), just that it may be a very painful flight.

Phone appointment with my family doctor in Canada:
I explained everything to my family doctor via the phone. His opinion is there is nothing left to try or do at this point, other than just let time take it's course. He doesn't think there is any medication or treatment that will help. He doesn't think it will be permanent "If we were to talk again in 5-years, I'm sure it won't be bothering you by then. It may take a few years though" (again, very comforting /sarcasm)

He also said he's unsure if I can fly. It may be painful and it may cause further complications.

Current Situation
Which one of the 3 (tinnitus, hyperacusis, aural fullness) annoys me the most depends on the time and on the day. They all suck.

Tinnitus: The first week was the worst, then it started to lower in volume. Right now during the day when I go outside for walks, or anywhere with some background noise like the gym, I don't hear it. If I'm in my hotel room, I hear it fairly steadily. If I'm in bed with everything quiet and just the fan on I can hear it. If i cover my ears I can definitely hear it. My right ear is significantly louder than my left.

Tinnitus has been about the same level for the last 3 weeks

Hyperacusis: Around weeks 2 to 3 was probably the worst. I couldn't go outside without earplugs. Normal conversations were painful. Cars outside were painful. It then improved a bit (around the same time as the Prednisone). I can now go for walks outside without earplugs, or sit in the hotel lounge where they play quiet music and there is some talking (about 60 dB as per my phone app) without much issue. Sometimes things like the shower, clanking plates, honking etc. still causes issues. But I"m not trying to be overprotective and trying to minimize the ear plug usage - but anytime there is loud noise or i know there will be I use them. I have not used headphones since the event. My right ear is worse than my left, when noise gets to loud, I tested using an earplug in only my right ear and it resolved the issue. At a certain point I do need it for my left though.

Hyperacusis has been about the same level for the last 2 weeks

Aural Fullness: All 3 stress me out, but if you ask me this second, this one is probably the most on my mind today. Although other days is can be hyperacusis, or tinnitus. I have had trouble finding much written about this, and if it actually improves for anyone.

The worst of the Aural Fullness was the first week when it was all blocked up. Currently the right ear is worse than the left, but it is present in both ears. The constant pressure in the ear, the discomfort, and pain associated with it is really aggravating. It feels like it has been the same for the last 3 weeks. I thought it improved slightly a few days ago, but it lasted only maybe a day or two and it's back to being its regular level.

Other
Right now this is very tough physically to deal with, but mentally as well. Not knowing if this will ever get better makes it tough to keep going on. It's also tough not being back home (Canada) and being "stuck" in Southeast Asia waiting for it to eventually get better "hopefully", so that I can fly home.

Currently, I am taking serc and b-vitamins, and I'm also taking a multi-vitamin. Going for 2-hour walks each day, plus going to the gym regularly. Trying to eat as much fruit and vegetables as possible, and sleeping as much as my body can. Basically, I'm trying to do everything as healthy as I can to give my body a fighting chance.

Any tips anyone has would be greatly appreciated (about any of tinnitus, hyperacusis and aural fullness). I think there is a lot to read on this site about tinnitus and hyperacusis, but I haven't found as much on the aural fullness.. has anyone had any success with that disappearing? Do you guys think this will improve or am I likely stuck with this trifecta? Which one usually heals first if they do?

Wishing you all the best.

Cheers.

 

Hi @Playdohh, I am sorry to hear about your experience, it must suck being so far from home and not knowing how long this will take.

I had all the symptoms you mention after my visit to a club 2.5 months ago - I had aural fullness, sound distortions, some hyperacusis and tinnitus and I also had Temporary Threshold Shift (TTS) i.e. I could not hear much after we exited the club.

The TTS went away by the time I woke up after a couple of hours, sound distortions stayed for a few days, and aural fullness stayed for a few weeks - I am not sure when exactly it went away but it was completely gone at the 1-month mark. Hyperacusis stayed for a bit longer, and I am still sensitive to louder sounds but it is almost back to normal now, however, I am still careful around louder sounds. Tinnitus is decreasing slowly but it is not a massive change, it quiets down for a few days then goes back up and so on.

It sounds like you are doing everything you can, going to the doctor, sleeping and eating well. I would expect the aural fullness to go away first, then hyperacusis and hopefully the tinnitus as well eventually. I have the same experience with GP telling me it would go away after a few weeks, and when it didn't, she said that it SOMETIMES goes away for some people after a few months. Seems like there are no guarantees with this but as long as you have no further sound exposure it can only get better from here.

I wish you a speedy recovery and a safe flight home,
Paulina

 

Hi @Playdohh.

I'm sorry you have all these symptoms. I have had them too, since early September, so we are both new to this and learning as much as we can.

You mentioned aural fullness. I agree with you that people don't talk about this as much. You might get some tips on dealing with aural fullness by searching this board (and Google in general) for the phrase "Eustachian tube dysfunction" or ETD. One of ETD's symptoms is an ear that can't be "popped," i.e., aural fullness, so it is kind of similar to the aural fullness caused by noise exposure.

Holding a hot, wet washcloth to the affected ear(s) for 20 minutes at a time is soothing. If that isn't convenient, you might also try holding your affected ear(s) over any kind of gentle heat source, such as a light bulb. The heat will relax any muscles that you are involuntarily clenching deep inside the ear and skull.

Some people with ETD try to pop their ears using the Valsalva maneuver or Toynbee maneuver and a few other things like that, but if you try that, be as gentle as you can because it doesn't always work and it's possible that you might do some damage by being too forceful. I never had much luck with this, so I stopped.

I have had the best results from gently massaging the area around my ears, including the area of the skull slightly above the ear, while very slowly opening and closing my jaws. Just be aware that some people, myself included, experience temporary changes to the pitch and volume of tinnitus while manipulating the jaws, so don't be surprised if it happens to you.

If you have access to an acupuncture clinic, see if they can help. For most ear disorders, they will want to work on points that fall along the gall bladder meridian and the san jiao (triple burner) meridian, plus any points related to anxiety. Some of these points are clustered directly on the pinna of the ear and on the area surrounding the ear. I've had several sessions, and they always gave me some relief. Not permanent relief, but enough to relax my nerves and make the pain a little more bearable.

I admire your equanimity. I've been traumatized by my symptoms, and they happened here in the city where I live. You are far braver than I am to deal with this while being far from home.

I hope you feel better soon so that you can go home and look into some long-term plans for treatment.

 

I had aural fullness after noise damage and it did go away. Took almost 2 months.

 

Thank you for the replies.

@Pauli, I hope all your symptoms disappear soon! I am glad you see improvement though - slow improvement is better than no improvement. At least that's what I'm telling myself to try and stay positive through this. It's interesting how you had the same experience with the doctors. It seems like their answers constantly change "It'll go away the first week", then when it doesn't "it usually takes a few weeks", then "it can take a few months".. which can get very frustrating.

@ECP, maybe it appears I am calm, but I assure you I've had my fair share of mental breakdowns over the past 6 weeks with this. It is incredibly difficult to deal with and I wouldn't wish these ear issues on anyone. Thank you for the info on how you've been dealing with it with tips and tricks. I will look more into these. What I find interesting is there is fullness and pressure, but it feels slightly different than the normal ear pressure, say when you fly or go up a tall elevator real quick. If I go up a fast elevator (e.g. 30 floors), I will feel my ears block up like normal, I swallow a couple of times and it relieves the altitude pressure, but there is still this other pressure that is there that won't release. It almost feels like it is a bit deeper, or a slightly different pressure sensation... if that makes any sense at all.

@Blackbird1016, I appreciate the feedback that you had aural fullness and it went away after 2 months. It gives me some positive hope since I'm not noticing to much improvement in it yet at 6 weeks. Did the aural fullness go away suddenly or was it gradual? Did you have other symptoms too and did they go away?

Wishing you all a speedy recovery and hope you feel better soon.

Cheers.

 

This weekend is the 6-week mark.

There seems to be progress in some areas, but not so much in others.

Tinnitus:
It is primarily my right ear at this time

Right ear: it is constant, although when I'm out and about I don't seem to notice it. When I'm in my hotel room it is quiet so I can definitely hear it.

Left ear: It is usually either very quiet or at times I won't hear it, even when in a quiet room.

Aural Fullness:
There doesn't seem to be much improvement here. I'm having a lot of trouble with this currently. The constant pressure/pain, and constant popping/crackling of the ears. This is in both ears, but the right ear is worse. Out of the 3 symptoms this is the one causing the most discomfort/issues the last few days.

Hyperacusis:
There seems to be some improvement. When I go for walks or to a restaurant (no music), I don't need to wear earplugs. My ears seem to be tolerating more everyday sounds without getting irritated and feeling pain or uncomfortable. Any louder noises do cause discomfort though.

 

Ask your doctor if you can try Deflazacort. It's a corticosteroid, in theory less powerful than Prednisone, but for me it worked better. Do not expect miracles, but it will help with aural fullness etc... However, in the end your baseline hearing will probably be very similar whether you take medication or not.

There are certain foods that can help you with your hearing: I used to have raw garlic sliced on a toast with olive oil. That did help somehow. Also fruit, and some food items like smoked salmon, avocados, dry fruit like nuts, hazelnuts, almonds, curcumin, ginger.

Do not eat junk food and try to avoid loud noise (South East Asia should not be a great place to be with full blown hyperacusis).

It is very important what you do the first weeks after damage. Aural fullness is likely to stay for a few weeks. In 10 weeks maximum it should go away, probably sooner.

Another important piece of advice: even if aural fullness subsides and / or your hearing gets better, DO NOT be around loud noise. The noise damage is cumulative and your hearing can worsen very fast.

 

The ear sensation feels slightly different to me too. I haven't ridden any elevators, but when I drove across town to the doctor's office, I felt my ears pop very easily while driving up and down hills on the freeway. Afterward, a vague discomfort was still there, which is why I think aural fullness and ETD are similar but not the same.

The urgent care doctor who treated me said I had ETD in the right ear, but I remain skeptical of the diagnosis because I've had no history of ETD or ear infections in my whole life. I'm no expert, but I think the fullness in my right ear is the kind that goes hand in hand with acoustic trauma. This is also the ear that has hyperacusis. (The left has tinnitus.)

I am glad your symptoms are improving with time. The three members of my "trifecta" vary from one day to the next, so I'm as curious as you are to see which of the three typically improves first.

I do still admire your composure. If it weren't for this board, I'd feel very alone and misunderstood.

 

It was gradual. At first it was a lesser concern because the ringing was so bad. But after the first few weeks I noticed I had a horrible aural fullness and I could not hear correctly out of that ear. It did not go away for two months. I can hear normally out of that ear now (but I'm still suffering from ringing) and I have no fullness.

I was put on a double round of Prednisone which I believe helped. I believe the aural fullness is directly related to inner ear inflammation from the noise trauma.

Wait it out and avoid loud noises. I put earplugs in while using my kitchen fan and when the lawn guys came during this time. Aural fullness needs time to heal. It's more visceral than tinnitus and in my experience more likely to fully resolve.

My user profile fully outline the whole horrible experience and dosage of Prednisone if you need.

 

The time to rescue the hair cells with steroids, calcium or sodium blockers or Lasix is pretty much done. The steroids will likely help temporarily.

Regardless you're a very classic case and should get fading over the next couple years barring you assault your ears with 120 dB again.

If anything you take makes it worse, obviously stop. I found personally benzos work (please don't use them unless things are unmaskable and suicidal), as well as Cyclobenzaprine/Amitriptyline for getting the volume down a touch.

I'd be curious if Betahistine or B vitamins did anything whatsoever for you, worse or better.

It sounds like you have just the pure "ringing" type, a.k.a. central tinnitus, dead hair cells/nerves. That definitely gets better with time. You likely notice it's almost non-existant upon waking for a while.

 

@Juan, thank you for the info. I will look into Deflazacort - I understand it won't help my baseline hearing, but even if it helps improve just one symptom (aural fullness), I'm sure that would be a step in the right direction to making things easier to deal with day-to-day.

Southeast Asia is definitely not the best place to be when having hyperacusis - it can be incredibly loud outside. I would much prefer to be back home in Canada to deal with this. But I'm hesitant to fly with the aural fullness. When that resolves I will be on my way back home. If it doesn't resolve, then at some point I'll just have to bite the bullet and jump on a plane and hope for the best. I'm at the 6-week mark right now, so hopefully your timeline of about 10 weeks max is correct and it disappears over the next month - otherwise I'll be panicking that maybe it is permanent and that will drive me insane.

Even if everything resolves, I can't imagine I won't ever be cautious of loud noise and avoiding it as much as possible. I wouldn't want to ever go through this again. Thanks for the tips on the food and everything else. Much appreciated.

@ECP, I agree with you - I think ETD and aural fullness are similar, but not quite the same. This has me wondering if I am able to fly back home or not - I feel like there is a chance I could without issues. But I'm also hesitant and don't want to risk making it worse if maybe it would resolve over the next month.

Similar to you, my "trifecta" symptoms vary day to day, heck they can vary from hour to hour sometimes.

I agree that this board can definitely help mentally. Not many people understand the types of things we are going through. I really hope everything improves for you soon.

@Blackbird1016, thank you for the update. I've been reading through your story - I'm really sorry to hear you've had to go through this. From my understanding, using steroids at this point is too late to help with the hair cells, but do you think the 2nd round of Prednisone helped with your aural fullness? If it did, then I would likely try and get another round of it from my ENT with hopes that it would do the same. I think your hypothesis that it is related to inner ear inflammation is a good one - my ENT seems to think the same thing; essentially that the inflammation in the inner ear is causing the aural fullness. Logically I would think that another round of steroids would/could help with that.

@Matchbox, thank you for the reply. I understand the time has passed to use steroids, sodium blockers etc. to rescue hair cells is over. When you say they would help temporarily, what are you referring to? Would they likely still help with things like the aural fullness? If the aural fullness is caused by inflammation in the inner ear, would the steroids not still help with something like that?

Regarding the Betahistine and B-vitamins, I don't think they have really done anything... but I figure it doesn't hurt to try.

Yes, the type of ringing I have is a constant ringing like an "eeeeeeee". It is uplifting to hear that the odds are it will continue to improve with time. Thank you. And I will definitely be avoiding any loud noise exposures in the future.

 

It is possible that you feel more sensitive to sound when the aural fullness subsides, as it means your ears will "open", or your hearing system will conduct sound more efficiently again. This depends on individual factors. If you can cope with a short flight, I would advise to just go somewhere quieter than SE Asia, or at any rate to move to the quietest area you can find in your surroundings; this will benefit your recovery.

After your ears "open" again, your hearing system will search frantically for the "lost frequencies" if any, and here is where hidden hearing loss plays a role.

An audiogram may say "normal hearing" or "almost perfect hearing" BUT... this is a pure tone audiogram, and what you want to measure is not input of sound but quality of sound, and this is better tested by an speech in noise test, or an audiogram with background noise, masking noise etc... and even so, at the very beginning stages of hyperacusis you may ace all those tests.

If you notice a change in the nuances of sound, the roundness, depth, the multi-layered quality of multiple sounds or competing or overlapping sounds (i.e. the different instruments you can hear in a song if you concentrate on the drumbeat, or the guitar, etc etc), do not focus on those nuances, try to listen without searching for what it's missing. Because if you do, your hearing will search for a missed quality that it cannot recover and your brain will very likely turn up the volume (= more hyperacusis).

 

Thanks. It has really sucked. I regret the concert. Lol I really wish I had known about this all beforehand.

Anyway, it seems that no one really knows what to do for any of it.

The perspective of my ENT was that the first round of Prednisone had helped without giving me bad side effects and that a 2nd round would leave me under 30 days of use (after 30 days you can get more serious side effects - I had none after several days of use) so in attempt to improve my quality of life he said if I wanted to try repeating the Prednisone for a 2nd round I could.

So I agreed and we did a second round.

I think the Prednisone did help resolve the inflammation and I feel it was probably inner ear inflammation that caused the fullness but I'm not a doctor.

Even my ENT said all its really going to do (the Prednisone) is systemically lower inflammation in the body. It's not targeting anything in particular, etc.

I would say it's worth a shot. I don't see a lot of stories about chronic aural fullness so I would think it will pass regardless.

...I hate the ringing though. I'm really hoping it goes away...

 

@Juan, thank you for the reply. Good point about trying not to focus too much on certain tones and sounds, especially if I think they are missing. It will probably be easier said than done, but I will try to not focus on that.

@Blackbird1016, thank you for the reply again. I am happy that the second round of Prednisone helped you (or appears to have) in getting rid of the aural fullness. I really hope the ringing subsides for you in the very near future. Ear issues are no joke and can be devastating to quality of life.

 

Currently, I'm 7.5 weeks out from the incident that caused hyperacusis, tinnitus, and aural fullness. The last week has been very tough for me mentally.

I saw the ENT again yesterday for a follow-up. To say it was a waste of time and money would be an understatement.

• 1st appointment (3 days after the incident): give it 3 or 4 more days and you'll be back to normal
• 2nd appointment: try giving it 1 or 2 more weeks and you'll be back to normal
• 3rd appointment: let's try waiting 3 more weeks and you will be back to normal
• 4th appointment (yesterday): hm, I think we should wait 1 more month and you will be back to normal

I told him that it is actually getting worse, my sound tolerance is going down, and my pain is increasing. I suggested trying another round of prednisone for the aural fullness. He said no, but he knows what I need to help reduce the pain and repair the nerve. He gave me B-vitamins, which he has already had me on for the past 2 months.

I was so frustrated by the above appointment.

I found another ENT that has hyperacusis listed under their special interests. I'm hoping they may actually have some knowledge of it and be able to help. I meet with them tomorrow.

Does anyone have experience flying with aural fullness from hyperacusis/acoustic trauma? I would really like to fly back to Canada so I can get home, but the constant pressure in my ears makes me nervous about it. I asked the ENT and his response was "Not really sure. You can try it. Even if it goes wrong you won't die." What a confidence-inspiring statement.

 

I have had aural fullness since my tinnitus onset 11 months ago. I did fly a few months ago with no issues. I wore EarPlanes during takeoff and landing and earplugs during the flight. Seats by the front of the plane are less noisy. I did chew gum and relieved pressure throughout the flight. I'm not able to fully pop/open my ears but swallowing and yawning will relieve some pressure to a point. I had no issues with the flight.

 

Thank you for the reply @Ngo13, that really helps. I will try to sit as close as I can to the front of the plane to avoid the noise as much as possible and bring some earplugs. I'm not sure if I will be able to find EarPlanes in Southeast Asia. I've tried looking them up but couldn't find anywhere that sold them here.

It is reassuring that you didn't have any pressure issues on the flight.

Thank you again.

 

I'm so sorry to hear you're still stuck halfway around the world, waiting for your symptoms to subside well enough for you to be able to fly.

Have you by chance spoken to any flight attendants or customer service reps from the airlines to ask what is their first-aid procedure in the event that a passenger experiences an ear problem during a flight? I just wonder if that would help solidify your decision to fly now or wait a little longer.

Best-case scenario, you speak to someone who can confidently say that they treat this type of emergency in mid-air very often and that most patients fare quite well.

 

@ECP, that is a really good idea. I hadn't thought of that. Thank you.

Last weekend I actually found a quiet hotel to stay... finally. I hope I'm not jinxing it, but traffic is minimal, and people here seem to be mostly people visiting the hospital themselves or families looking after people at the hospital. So overall it is quite quiet. I'm isolating myself here so I can control all sound (as southeast Asia is ridiculously noisy outside or even in malls), and then hopefully increase my tolerance level by controlling volumes inside without risk of setbacks. I plan to do this until early to mid January and then we'll see where I'm at and if I jump on a plane then.

 

That's great that you found a quiet hotel where you can control your sound exposure. I wish you the best as you continue to work out a plan for getting home.

 

Update after about 12 and a half weeks:

Aural Fullness: Still there.

Hyperacusis: Using a phone app as a guide, my comfort level at its worst was around 40 dB - sometimes lower. My own voice caused irritation. Conversations were difficult to have as they usually increased the pain. Fridge was too loud. Laptop fan was to loud. I couldn't watch TV with the volume loud enough to understand any words; I was purely using subtitles. The only time I was going outside was to go downstairs to pick up food/deliveries.

Now I seem to be closer to tolerating 50 dB for extended periods. I can have conversations, but if they are long, it can cause problems. I can watch TV with a volume where I can understand maybe 50% of the words. Each day is up or down on how bad it will be. Sometimes I go across to the 7-11 late at night when it is quiet (about a 1 to 2-minute walk) - even with hearing protection, I have really learned to hate that beeping sound when you walk through the door.

Tinnitus: Still there in both ears.

 

It sounds like you're making progress, which is great! Be gentle with yourself as you continue to experiment with your noise tolerance.

Your 7-11 story really resonated with me. Last week, I went to the dry cleaner (a very noisy place by objective standards), and even though I wore my earmuffs to prepare for the experience, I was still taken by surprise by the loud buzzing sound that the door makes to announce the arrival of a new customer. I've been going to this dry cleaner for years, so it's certainly not the first time I've had to deal with that noise, but this was my first time going there since I got sick. I'd forgotten all about the noise that the door makes, and I didn't realize that it would be so painful.

I have to go back there today, but I don't think the noise will hurt as much, since it won't catch me off guard this time. I'm actually seeing it as a form of necessary sound therapy with a built-in reward, LOL. If I can enter the dry cleaning establishment, I will be rewarded with clean, tailored clothes.

Even though your aural fullness hasn't gone away yet, I wonder if it will start to lessen in severity as your hyperacusis continues to improve. Hopefully you can fly home by February, if not sooner.

Fingers crossed for your continued healing.