Why Did My Tinnitus Start Out of the Blue? And Why Does It Change Multiple Times Throughout the Day?

[ScottRR]

Hello all, my name is Scott. I woke up the day after Christmas 2020 with ringing in my left ear. I didn't give it too much thought and just figured it would pass. Days and days go by and it doesn't pass and seems to alternate between high pitched ringing and loud hissing. Fast forward a couple of weeks and I have a hearing test done. My ears look fine and there's no sign of hearing loss. The ENT shoves a scope through my sinuses and sees some inflammation way in the back. She prescribes flonase and acid reflux meds. No change.

I spoke to my primary care doctor because a pill he gave me to sleep a couple of months before was listed as ototoxic. My dose was low and I had only been on it a short time, but I stopped to see if it would help. It didn't. We've tried muscle relaxers and antibiotics, and I've also tried loads of supplements and decongestants. Still nothing. Saw a neurologist and am scheduled for an MRI this week. I've avoided NSAID because of possible side effects, and then I've tried taking some for inflammation. Nothing seems to be a sure fire fix.

Here's where it stands. The issue is mainly in the left ear. It's never gone but varies throughout the day. It can be a relatively faint fluctuating sound like coins jingling or broken glass, and then can become an extremely loud hiss. After the first couple of weeks it started moving into my right ear but that is a more solid sound at a different frequency, and usually only happens when I'm physically active. Once I relax it moves back to the left ear. It seems to be worse in the evenings.

When the left ear is relatively quiet, it is irritated by sound. If I try to listen to low music the hiss in the ear increases with the volume, and when I turn off the music the ear is fairly quiet with just a faint jingling. Then later the hissing will kick up again.

So I'm absolutely confused why this started out of the blue, was strictly in my left ear for the first couple of weeks, and now wanders to the right ear when I'm active. Nothing is stable about it, it changes multiple times throughout the day and it's absolutely maddening. From what I've read on tinnitus, this does not sound like a standard pattern at all. Anyone have any idea? I'm going to call my doc on Monday and ask for loads of bloodwork to look for inflammation, infection or something else.

 

[Drachen]

Welcome, Scott!

In many cases, onset is often sudden and without any fanfare, aside from the noise you've come to hear. Onset can be nearly immediate and it can also be delayed; everyone's case is different. I'm entirely with you on this. I first heard my noise out of the blue on the evening of December 18th. I was doing stuff beforehand, and I didn't have any indication of this problem. That changed abruptly, and then as if in a frenzy, I began searching this problem up and down. It's really weird when you look at my search history how instant the shift was...

I've got to say, your noise pattern is certainly a new one to me, though I wouldn't be too worried by its novelty. Most people still have some varying degree of cacophony, and I don't think the more noises you have the worse off you or your chances are, though it may certainly affect your concentration and ability to get used to it. You do sound like you may have some degree of reactivity or hyperacusis. This often subsides in time as well.

A big issue with this symptom is that there is really no way to tell for sure what the cause was until it is addressed and hopefully reverted. You could have one factor, or you could have several that contribute to both its onset and proliferation. It is best to try and rule out the simpler causes first, such as earwax impaction or infection, and then start looking into the other possibilities. You seem to be on track doing this, and it's good that you're trying to get blood tests. I would keep an eye on any potential deficiencies, as while they don't often cause the problem, they can exacerbate it or affect your general health negatively.

It's also a good idea to avoid ototoxic medications. While there's absolutely no guarantee you will receive further damage, it's best to be safe unless absolutely necessary. I've been having headaches myself lately, and it's sucked not to be able to pop a painkiller to make it be less of a problem. You're going to become much more familiar with natural remedies you can try.

The best thing you can do, as difficult as this may be, is try to relax. Stress and anxiety are often comorbid with this condition and particularly brutal in the early stages. I'm still struggling with this myself. For the majority of people, this gets better with time, and whatever you can do to not feed the noise that's plaguing you is a viable strategy.

Hopefully you will receive other responses that may provide you some benefit. I encourage you to look around the forum, learn more about the topic, and take note of potential solutions or supplements you can try.

I wish you the best and hope you are able to put all of this behind you as a very awkward and uncomfortable yet fleeting chapter of your life.

 

[ScottRR]

Thank you for your response. I've read that stress can be a contributor, so I guess I should add more detail. I'm 50 years old, work a full time day job and run a small music related business in addition to that. My ears have always been very important to me and I've always taken good care of them.

I had several new releases coming out and was feeling very anxious about it. I was also at the tail end of a five year relationship, which finally ended a couple of weeks ago. So stress levels have been HIGH. In the weeks since my new releases came out, I was moving non-stop getting packages ready (over 600 of them), responding to email, and then adjusting to the end of the relationship. But the past week has been relatively quiet and stable but there's not really been any changes to the sounds in my ears. In the time that I wrote my first message here and am now writing this one, the hissing in my left ear has minorly reduced but is also now about 70% in my right ear as well.

Additionally, I was diagnosed with an inherited auto-immune condition that year, and have wondered if that may be flaring up and causing this. I have a tendency to get a sinus infection every year in late December/early January so that's why I asked for the antibiotics. I feel a sort of sinus pressure in my head, but not in my sinuses, if that makes any sense. I'm a very logical thinker so it's been challenging for me to have this condition and not be able to pinpoint exactly why and how to fix it.

 

[Drachen]

I try to do what I can to help.

You are right on the money that stress can be a contributor, though I do not think it can be cause. Considering how abrupt my onset was, it's very likely some underlying stress I had going on at the moment might have finally been the last straw. This may very well have been true in your case as well. The brain is so amazingly complex, and we humans still do not fully understand it as much as I think we should.

It is great to hear you have taken such good care of your ears, since that is incredibly important and often avoided by the general public. It's particularly helpful too, because now you'll really need to make sure your ears remain in top condition, because damage to them can exacerbate the symptom.

It goes without saying, but that's terrible to hear with regards to your relationship. Five years. That's a long time to suddenly end, and it'll be a stressful moment for anyone, no matter how tough they consider themselves. The workload certainly doesn't help. It's good to see you've been managing somewhat on that front, and I hope you're able to move past that all entirely.

The fluctuations in your intensity is often a part of the day-to-day. Some people have good days and bad days, and even more have good and bad hours within that period. With me, for example, the noise is a bit intense tonight. Conversely, I was doing alright earlier. The noise might have been the same volume, but it wasn't bothering me as much. This back-and-forth is unique to every person, and it can be difficult to adjust to since there often isn't a reasonable pattern to follow. Well, who am I kidding? Nothing about this symptom is reasonable. I understand completely how you feel by being a logical thinker and having to contend with a very illogical and unwieldy problem. It often contributes to feelings of despair that I can't quite shake, but all we can do is fight on, do what we can, research, and hope for the best.

I have not personally read much regarding autoimmune conditions and their effect on tinnitus, but that doesn't mean there isn't a case there. If you haven't already, I would be sure to bring this up with your doctor(s) when you discuss your symptom.

Saw a neurologist and am scheduled for an MRI this week

I just noticed this point in the original post that I must have missed when I wrote my original reply. Please be careful when you enter the MRI, as they are known to be loud, even for normal people. As we have discussed already, you want to protect your ears as best you can, and some machines are loud enough to where both ear guards and earplugs may not be enough. I would call your neurologist and determine the importance of such a procedure before going forward with it, because you will have to take a measured risk either way.

 

[Jrblovsky]

I try to do what I can to help.

You are right on the money that stress can be a contributor, though I do not think it can be cause. Considering how abrupt my onset was, it's very likely some underlying stress I had going on at the moment might have finally been the last straw. This may very well have been true in your case as well. The brain is so amazingly complex, and we humans still do not fully understand it as much as I think we should.

It is great to hear you have taken such good care of your ears, since that is incredibly important and often avoided by the general public. It's particularly helpful too, because now you'll really need to make sure your ears remain in top condition, because damage to them can exacerbate the symptom.

It goes without saying, but that's terrible to hear with regards to your relationship. Five years. That's a long time to suddenly end, and it'll be a stressful moment for anyone, no matter how tough they consider themselves. The workload certainly doesn't help. It's good to see you've been managing somewhat on that front, and I hope you're able to move past that all entirely.

The fluctuations in your intensity is often a part of the day-to-day. Some people have good days and bad days, and even more have good and bad hours within that period. With me, for example, the noise is a bit intense tonight. Conversely, I was doing alright earlier. The noise might have been the same volume, but it wasn't bothering me as much. This back-and-forth is unique to every person, and it can be difficult to adjust to since there often isn't a reasonable pattern to follow. Well, who am I kidding? Nothing about this symptom is reasonable. I understand completely how you feel by being a logical thinker and having to contend with a very illogical and unwieldy problem. It often contributes to feelings of despair that I can't quite shake, but all we can do is fight on, do what we can, research, and hope for the best.

I have not personally read much regarding autoimmune conditions and their effect on tinnitus, but that doesn't mean there isn't a case there. If you haven't already, I would be sure to bring this up with your doctor(s) when you discuss your symptom.

I just noticed this point in the original post that I must have missed when I wrote my original reply. Please be careful when you enter the MRI, as they are known to be loud, even for normal people. As we have discussed already, you want to protect your ears as best you can, and some machines are loud enough to where both ear guards and earplugs may not be enough. I would call your neurologist and determine the importance of such a procedure before going forward with it, because you will have to take a measured risk either way.

Ask for double ear protection. If they are imaging your brain, the noise is louder than hell.

 

[Lane]

I have a tendency to get a sinus infection every year in late December/early January so that's why I asked for the antibiotics.

Hi @ScottRR -- From my own research, I've come to believe virtually all sinus infections can be successfully treated without antibiotics (which are often ototoxic). Below is a link to just one video that describes a sinus cleansing technique that can work wonders. Whatever you do, don't EVER take a fluoroquinolone antibiotic for ANYTHING (they're often prescribed for sinus infections). Many people's lives have been destroyed by them, sometimes by taking just a single dose.

Chronic Sinus Problems? Try the Bulletproof Sinus Rinse

 

[ScottRR]

The MRI is to see if there's something physical in there, and I'll be very curious to know. The tinnitus in the right ear is solid and seems to start with physical activity (It's going on right now because I just got out of the shower). The tinnitus in the left ear is affected by head movement. If I bounce my head to the left the tinnitus volume increases with each bounce. If I bounce it forward the hearing becomes slightly obstructed with each bounce. When I'm stable is when I hear the distant jingling in the left ear or the inconsistent hissing. For a good while when I would get my regular headaches they could often be right above my left ear in the temple area. So the MRI will hopefully reveal something. They are also looking at my cervical spine because I had fusion in late 2016.

I've also wondered about TMJ. I do have an under bite and my jaws will occasionally crack and pop, but it's not often and I don't really have jaw pain. I also have a hugely deviated septum from getting punched by a school bully when I was 13, but it's never really caused much problem that I'm aware of.

The antibiotics (Azithromycin) didn't help, and neither have muscle relaxers, various antihistamines and sinus meds. Again, this came out of the blue the day after Xmas. The low dose Quetiapine/Seroquel is what the doc gave me for sleep a couple of months before this started, and it is on the ototoxic lists, but 25mg is very low and it was only for about 6 weeks, so I have no idea what the culprit is. I do seriously feel like there's something physical in there. I guess I will find out Friday.

 

[Lane]

The low dose Quetiapine/Seroquel is what the doc gave me for sleep a couple of months before this started, and it is on the ototoxic lists, but 25mg is very low and it was only for about 6 weeks, so I have no idea what the culprit is.

Hi @ScottRR -- I would give this drug some very serious consideration as the cause of your recent tinnitus onset. The timing may be coincidental, but it may not. Also, from what I can gather, when you have an underlying condition (such as you describe), even low doses of a drug can cause a lot of havoc, and potentially cause tinnitus. I got my tinnitus from a single dose of an anticholinergic drug called Promethazine, which is often prescribed for nausea.

 

[ScottRR]

I have no idea what to think. And this morning, I got a deep ring that blocked out most sound and gradually disappeared (back to the usual ring/hiss) in about a minute or two. I checked my ear carefully with a Q-tip and got a small amount of blood on both sides of the Q-tip. I emailed both my ENT and my primary care doctor. Neither has replied so perhaps they aren't concerned. I had a load of bloodwork done yesterday and still waiting for the results. The MRI is being done this evening.

The way the sound in the left ear changes constantly, and the fact that it seems to lessen when I take a muscle relaxer and a Meloxicam (anti-inflammatory) makes me feel it is an infection or something inflamed. When I grit my teeth or or move my jaw certain ways it increases the sound on the left side. Maybe the MRI will clear it up. The symptoms are not getting any better or any worse since they started last month, other than the little bit of blood this morning.

 

[ScottRR]

I had a couple of hours worth of MRIs last Thursday. They revealed nothing wrong in the brain or auditory canal, but the cervical MRI showed the two discs above my previous fusion have ruptured and are protruding (one significantly) on the left side.

I've been reading loads about cervical instability often being linked to tinnitus, although it seems to be a relatively modern viewpoint. It does make perfect sense because it is my left side that's been really, really bad. It's completely unstable and changes minute to minute, and something as easy as getting up for a second can change it from the hiss back down the jingling. The worse part is the screeching that still seems prevalent with any sort of solid noise or music, some times are worse than others.

The ENT put me on a 6 day course of Methylprednisolone 4 MG tabs, which I started today. No one can say anything else and they told me there really is nothing else they can do, but my hope is as the discs dry up (which I know from previous experience can take several months) that the sounds will at the least lessen.

 

[Lane]

I've been reading loads about cervical instability often being linked to tinnitus

Hi @ScottRR -- If you would be interested in a compelling and insightful story on one person's experience with CCI, check out this link, which is where I posted it here on Tinnitus Talk. I suspect it will give you some good insights on top of what you've already learned from your extensive reading on CCI so far.

 

[ScottRR]

Hi @ScottRR -- If you would be interested in a compelling and insightful story on one person's experience with CCI, check out this link, which is where I posted it here on Tinnitus Talk. I suspect it will give you some good insights on top of what you've already learned from your extensive reading on CCI so far.

That was an interesting read, though my symptoms are nowhere near as drastic. I do have heart arrhythmia in the form of daily palpitations and occasional AFib bouts, but that's generally put down to stress, and I concur.

I pulled out my old neck brace from my fusion a few years back, and anytime I've tried it on over the past month or so it seems to push the ear effects from ringing up to the hissing, which seems to be the further end of symptoms. Anytime I've had disc related issues in the past, I usually have woken up with them and then just have to live with them for 2 or 3 months at a time, until I finally have surgery (have had it on both lower and upper back). That's exactly how this hissing/ringing/screeching started, I went to bed fine and woke up with it, and here it is over 5 weeks later. Here are some of the actual notes regarding the current cervical disc failures from my MRI last week:

At the C3/4 level, there is a posterior disc/osteophyte complex more pronounced to the left of midline contributing to near-complete effacement of the ventral subarachnoid space without significant spinal cord deformity. Left-sided degenerative uncovertebral joint changes contribute to mild encroachment upon the left neural foramen.

There is no significant right-sided neural foraminal narrowing. At the C4/5 level, there is a posterior disc/osteophyte complex contributing to mild flattening of the ventral subarachnoid space and mild ligamentum flavum hypertrophy contributing to mild encroachment upon the dorsal subarachnoid space. There is no significant spinal cord deformity. There are degenerative uncovertebral joint changes contributing to mild encroachment upon the neural foramen bilaterally.​

 

[Forever hopeful]

@ScottRR and @Lane

Where did you see that Seroquel was ototoxic? Both my ENT and prescriber told me it was not and both of them researched it on PubMed and Epocrates respectively. I also looked it up online and didn't see anything about it being ototoxic either. I research all medications before I take them. I too was prescribed 25 mg for sleep and I took it very sparingly. I would be very interested in learning more about this.

Although my hearing issues are only related to one ear and according to my ENT, any medication that is ototoxic would affect both ears. I stay away from the mycin family of antibiotics. I know that some of those are known to be ototoxic meaning that they actually damage your hearing that can lead to tinnitus.

I know as a tinnitus sufferer, it's scary as heck when you think about taking any medication. Even on this site there's so many people that believe they got tinnitus from a certain medication that many many many other people take without problems. I'm not saying they are wrong, but it's hard to know what to do and what to take.

I had a private consultation with Dr. Stephen Nagler. I'm not sure if either of you know who he is, as he is semi retired now, but he is a physician with severe bilateral tinnitus and he has consulted on this site. He has probably dedicated the last 20 + years of his career to the study of tinnitus. And he, in his consultation with me, shared what medications were truly ototoxic. There were not many. Some antibiotics, cancer meds, loop diuretics, NSAIDs in high doses taken over a long period of time were the top ones I recall. I have them all written down somewhere. I have also had consultations with an audiologist who specializes in tinnitus as well as being a sufferer himself and with another medical professional with tinnitus, and both confirmed the same thing about ototoxic medication; that there are actually not a lot of medications that are truly ototoxic. I know the ATA, although well-meaning, has a list of medications compiled by a non medical professional they describe as "ototoxic" that includes just about everything under the sun, including topical Rogaine. I have discussed the ATA list with all three aforementioned professionals and they agreed that there is a lot of misinformation out there.

Obviously, people respond to medications differently and even if one person reported ear ringing they believed to be associated with a medication and it is reported to the FDA, they have to list it as a possible side effect.

Anyway, I am interested in any information you have on Seroquel.

Thanks in advance.

 

[Lane]

I am interested in any information you have on Seroquel.

Hi @Forever hopeful -- I can't say I know a lot, but I do know it's an antipsychotic medication that's often prescribed for "off-label" conditions. It has many potential side effects, one of them being tinnitus. I also know one of the side effects is blood sugar dysregulation, which can by itself be a causative factor for tinnitus. From the above link:

Special Senses:
Infrequent: conjunctivitis, abnormal vision, dry eyes, tinnitus, taste perversion, blepharitis, eye pain;
Rare: abnormality of accommodation, deafness, glaucoma.​

I myself got severe tinnitus following a single dose of an anti-psychotic medication Promethazine (Seroquel is also an anti-psychotic medication). The drug I took is an anticholinergic drug, and I made a POST at one time with a listing of anticholinergic drugs that can potentially cause tinnitus. Seroquel was on that list, though I don't know for sure whether it's an anticholinergic drug.

@GoatSheep on this forum has posted the following: -- "Seroquel knocked me out but gave me a massive spike the 2nd day." and the following from @NeoKortex: -- "Quetiapine aka Seroquel is ototoxic though." And this: -- @claudiacardiff I think I developed pulsating tinnitus from taking Seroquel low dose to help me sleep- never had the problem before and I dont do loud music."

I just ran across an interesting article that featured Seroquel. It's a sobering read, which gives insights into how loosely regulated many drugs are, and how adverse reporting requirements are woefully inadequate.

One of America's most popular drugs — first aimed at schizophrenia — reveals the issues of 'off-label' use

From a 58-year-old man, after taking Seroquel for four months for insomnia: "Severe ringing in the ears, raised cholesterol, blood pressure, heart rate, and sugar levels. Serious memory loss."
​

I had a private consultation with Dr. Stephen Nagler. I'm not sure if either of you know who he is, as he is semi retired now, but he is a physician with severe bilateral tinnitus and he has consulted on this site.

I am familiar with Dr. Nagler. Though I believe him to be well meaning, I usually find myself going into major cringe mode when I hear some of the things he has to say. Foremost is is his reluctance to acknowledge how severely people's ears and neurological systems have been damaged by various anti-depression, anti-anxiety, and other medications that alter brain and neurological function.

To summarize, it seems that many people trained in the drug oriented health care system do not consider "ringing of the ears" to be a significant side effect were it to occur. When I look at the many instances of people, just on this forum, describing how a drug they took gave them tinnitus, it would seem there's a distinct contradiction. If the probability is considered relatively "low" to begin with for most people, I'd say it's much higher for people that already have damaged ears. To me, if one out of a thousand develops a catastrophic case of tinnitus from taking a drug, then it's far too dangerous to have it be prescribed.

If you're interested, you can read a fairly lengthy account I made of my own experience from taking a single dose of an antipsychotic medication. It's a kind of reaction their listing of "side effects", but I was never told about it. It wouldn't surprise me if there are stories out there that are similar as a result of taking Seroquel. I also believe there are many who have taken it for years without any serious side effects. I just know I have a hypersensitive system, and I would recommend anybody else who has a hypersensitive system to avoid these kinds of drugs.

 

[Johan001]

Seroquel gave me a spike too.

 

[Greg Sacramento]

To summarize, it seems that many people trained in the drug oriented health care system do not consider "ringing of the ears" to be a significant side effect were it to occur. When I look at the many instances of people, just on this forum, describing how a drug they took gave them tinnitus, it would seem there's a distinct contradiction. If the probability is considered relatively "low" to begin with for most people, I'd say it's much higher for people that already have damaged ears. To me, if one out of a thousand develops a catastrophic case of tinnitus from taking a drug, then it's far too dangerous to have it be prescribed.

Post of the day Lane. You nailed it with medications. Were not saying any difference to the thousands of reports and not just medication concerns listed by members here.

I would listen to Neil Bauman, director of the Center for Hearing Loss Help in Stewartstown, Pa. before anyone in healthcare as to what is ototoxic or not. He has complied a percentage list for over 20 years from mail and online communication that he receives everyday. Since he is not a doctor, some in the health system balk at him. If he was a doctor, he would be black listed by pharmaceuticals and by hospitals that receive financial support from pharmaceuticals.

https://www.ata.org/sites/default/files/Summer-2018-62.pdf

 

[AliasM]

Your pattern is exactly like mine.

It started in my right ear and moved to my left about 2 weeks after onset. At the moment I have a high pitched waterfall of tiny shards of glass in my right ear, and a solid medium pitch ring in the left. From around 1 pm to 4 pm, both ears were hissing and I could feel the vibration as well. Between around 10 am and 1pm I had a high pitched kettle squealing in both ears. From awakening to 10 am it was an incredibly high pitched ring in both ears. I never know from one hour to the next.

Before I wake up properly in the mornings it is a hum and if I stay REALLY REALLY still, it will stay that way. If I so much as roll over, or worse, get out of bed, BOOM, change to loud high pitched ringing instantly.