What Is Your Opinion?

Hi Dr Nagler,

I can appreciate that you aren't able to provide me with a diagnosis for my ear trouble. I was hoping if I can provide you with some of my background you might be able to answer some of my questions. I really appreciate the time you take to answer peoples questions on this board. Thank you!

Six years ago I developed T. It started as a low buzzing sound for around two weeks before it was joined by its high pitched neighbor. It only affected my right ear. When the high pitched neighbor joined the party I noticed sharp pain in my right ear joined by what felt like blockage. I saw the local ENT who prescribed me with anti-inflammatory drugs and booked me in for an MRI. The drugs did not touch the pain and the MRI came back clear, the ENT also noted no hearing loss upon examination. The ENT also tested my balance and jaw function for pain and neither presented an issue.

The blockage and pain eventually subsided and my ears recovered with the exception of the T. I recall the process taking around six to twelve months. I have been playing white noise, specifically the sound of waves crashing on a beach to aid in sleep, since I have become deprived following the onset of T and my fear around the pain. Once the pain stopped and I began sleeping better my anxiety dropped off and life returned to normal. After a few years I was back enjoying loud environments without hearing protection because I wrongly through it was all over.

Fast forward to last October when I awoke startled to the intense loud ringing in my right ear. It totally caught me off guard and I thought I was going to die. I had been staying at a friends place and brought my 400w speaker (because it was mobile) and had been using that to play the masking sound at night for the two weeks prior. I didn't have the volume up terribly loud, but maybe it was the intensity of the sound and being in a small room with a large speaker that changed everything. In the build up to that fateful night I had been having pain in my right ear, but I discounted as a temporary infection.

Following from that night I began to experience the exact same symptoms as I had the previous six years earlier. Ear blockage and pain. Again I didn't know what was going on, so I went back to the same ENT who checked the same things as before, i.e. hearing, balance and jaw and prescribed the same treatment. Again the drugs didn't touch the pain and the MRI came back clear with the exception of having some kind of prominent vascular function in both ears.

In the first month of the re-occurrence I did little to change my lifestyle because I didn't recognize what was going on. The pain and blockage continue, the former being more prevalent than the latter. I also noticed that my T was reacting to loud environments by dialing up. I also encountered additional notes which joined the mix.

I then stopped visiting those loud environments and made a genuine attempt to give me ears a break. A week after that I noticed that the blockage issue I had been experiencing had gone and the pain had backed off from what felt like a stab in the ear to a bothersome toothache. The T in my right ear has now dialed back down although it has been joined by a new pulsing variety that becomes constant if I focus on it. I also now have T in both ears, a faint hissing that is immediately alleviated if I press my fingers firmly under the ear lobe behind the jaw.

One of the most troubling things I have is that my T will change with sound stimulus. After listening to music or even masking the T in my right ear will become more noticeable. It got to the point where last night I turned off my white noise masking because it was too bothersome and ended up sleeping without it.

I thank you for reading this far, I realize that the thesis I am writing is taking up your precious time but I wanted to provide you with as much information as possible before I moved on to questions.

I have come here because I have been unable to find a health professional here in Wellington, New Zealand, either ENT or Audiogist that has experience with what I am experiencing.

Hyperaccusis:
Does this sound like hyperaccusis to you?
(I recognize the symptoms are there, but one of the descriptions was that loud sound caused discomfort. I have found myself covering my ears when loud sounds are near, but this is not because the sound itself bothers me, it's because I don't want to further damage my ears and is more a fear response rather than an actual hatred towards the sound. I do hate high frequency sounds like car breaks, they tend to make me wince...and they always have).


Tinnitus Reactivity:
My T reacts to sound, it seems to be from more constant noise than an instantaneous sound. Two months ago I was trying to tone match my T using an app on my phone, despite this being very quiet, running through the different frequencies, especially those above 10,000 caused sharp pain and brought on a new high pitch T that stayed with me for a week. I haven't had a reoccurance of that but I haven't attempted a tone match since. Lately being outside around busy traffic causes my existing T to become louder usually settling within an hour from when I find a quiet space. My white noise masking has been affecting the T in my ear and generally being annoying so much so that I turned it off to sleep rather than put up with it. Yesterday when playing music at a low volume on my computer whilst working the ringing frequency in my right ear heightened and took around an hour to wind down. Right now I am playing pink noise at a volume as low as the computer electrical sounds and it seems to be OK, although I had tried yesterday with whitenoise and experienced the same problem. I can go into a busy supermarket at lunch for around 10 minutes and walk out totally fine. So I am quite perplexed by all this.

Is the sound reactivity of T related to the hyperaccusis and will it eventually go along with hyperaccusis if given enough time?

Is there a mental element to T increase, i.e. is my anxiety causing it to flair up?

Is there anything I can do to aid in its departure of this reactive T?


Pulsing T
One of the new T's that joined the party this time around has a tendency to pulse, unless I focus on it where it becomes a flat sound.

Have you heard about this type of T before?


Head Movements that affect T
If I clench my teeth or poke my tongue out, my T increases in intensity albeit until I stop clenching. Furthermore if I press my finger firmly below my ear lobes and above the jaw the gentle whistling of T that affects both ears stops.

Is this common?


Fizzing in the Ear
One last thing I wanted to note was that sometimes I experience a physical sensation of fizzing in my right ear. Usually when I lie down to go to sleep. It will last a few seconds then resolve.

Do you know what this is?


Thank you so much for taking the time to respond to this message. I know it's big and I know you have lots of important things to do. Words aren't enough to describe my appreciation and I hate to trouble people. I am just trying to understand my situation. I suppose with understanding I will be able to recover.

Kind Regards,
Mark Beehre

Medication History:
I am not currently on any medication and was not on any prior to the reoccurance of T. Once it started I was prescribed Doxepin by my GP to aid in sleep and Diclofenac along with some steroid based inflamatory by my ENT. I took both groups of the anti-inlams for 1 week and Doxepin for around 3 weeks before ceasing of my own accord due to its ottotoxic nature. Coming off was hard on my anxiety and my T was very loud for the week before balance was restored and I found sleep. I have recently been prescribed Fluoxetine for anxiety but have not taken it, instead I have been focusing on positive thinking and putting aside negative thinking. Given that Fluoxitine is also ottotoxic I didn't want to touch it.

 

Hi Mark -

I have been struggling with how to answer your questions. It's like a puzzle with many interlocking pieces - and I am really at a distinct advantage by not being able to take a detailed history or evaluate you myself.

I do have a solution for you though. Although your options in Wellington appear to be limited, the train ride to Auckland is spectacular - and that's where Dr. Grant Searchfield has his clinic. Grant is a personal friend of mine and happens to be one of the world's leading authorities on tinnitus and related conditions. So my suggestion would be for you to make arrangements to be seen by him.

Hope this helps.