Woke Up with Tinnitus — Could Amitriptyline Have Caused It?

Hi everyone,

Been a lurker for a while, finally decided to sign up and introduce myself, maybe get some feedback. Specifically, thoughts on what a possible cause could be, what evaluations I might ask for, and what treatments I might try.

Onset: May 2021 (8 months ago)
I fell asleep on the couch one night; I woke up a couple of hours later and had a loud ringing in my left year.

I was on a very low dose of Amitriptyline at the time (for abdominal pain, not depression, which is far below therapeutic depression doses), which could have caused it? I stopped the medication the next day, but the ringing never stopped.

When it first started, I'd say it was a 6/10 or so. Extremely anxiety-inducing, difficult to concentrate. Over the first three months or so, it gradually decreased to about 3-4/10. It's been hanging around that range since then, fluctuating week-to-week between 2/10 and 4/10.

There have been some odd changes and symptoms over time.

• About a month in, I had a day where hearing in my left ear was very distorted. Sounded like people around me were talking through a speech synthesizer. For the next few weeks, sounds in a specific frequency band were a bit distorted, but that has since (mostly) stopped.
• It started as 100% ringing in my left year, which has since morphed into about 40% ringing in the left year, 20% ringing in the right ear, and 40% "head noise" that feels like a weird auditory pressure inside my brain.
• A couple times per week, I get this very odd "bubbling" sensation in my left ear. Kind of like popping your ears after a change in altitude, except it's several "burps" in short succession. It does this on its own, not from yawning or moving my jaw or anything.
• Moving my jaw or neck in specific movements that tense the muscles makes it much louder (only when I'm tensing).

I saw an ENT (took me months to get in) who said my audiogram was normal (small notch in hearing loss, left ear, but even at the lowest point of the notch it's still above the "normal" level) and he didn't see anything abnormal when he looked in my ear. He was incredibly useless though, just looked in the ear and didn't bother doing any other kind of evaluation. Said "you just have to try to ignore it." Thanks doc. I'm quite jealous reading about these people in other countries who saw an ENT within days, got CT/MRI scans, etc., just as part of the "normal evaluation."

Anyways, I'm 100% confident that there are people here who are much more knowledgeable than this ENT was, so I'm curious to hear any suggestions that I might try for further evaluations or potential treatments.

Thanks!

Jason

 

Did you get the COVID-19 vaccine? If so, when?

 

I did, first dose on April 8, 2021. The tinnitus started on May 21, so 6 weeks later. I thought about the connection, but seemed like too far apart for it to be related.

 

I think the fact that the volume has been cut in half in time is a good sign and I hope it continues. The first point is indicative of some hearing issues, going forward be vigilant about volume and if you're in a loud area there's nothing wrong with popping in some earplugs.

Sadly, it's not like the treatment or cure is hidden behind a paywall. There's Shore Device incoming and if it turns out tinnitus is 1:1 related to hearing loss in some particular cases then there are some drugs in the pipeline (FX-322/OTO-413/OTO-313/PIPE-505) to look forward to contingent on them being successful.

Hope it works out for you.

 

How long were you on that SSRI before waking up to ringing? That matters a lot as it's a bit of a dirty drug. Less than a couple weeks or so I'd assume no contribution unless you were ramping up the dose.

In fact one could argue something in your auditory neurons hit tolerance and that's why it started. Though it should've worsened then when coming off for a good while.

It sounds almost as if you had a hydrops or sudden hearing loss episode.

Were you sick at all a week or so before this?

Thank god your distortions stopped. I get that synthetisizer sometimes as well in voices, especially bass voices on TV.

 

Most of yesterday was pretty much the normal 4/10 for me. Last night I went over to a friend's place, had a nice dinner, played some Mario Kart, a couple beers. Came home and chilled for a bit.

Got ready for bed and noticed that I wasn't hearing any ringing... odd. Got into bed and spent a half hour just enjoying the silence. For the first time in 8 months, I decided to turn the fan on my bedside table off, just to re-live what sleep used to be like

Slept like a rock, woke up with no ringing. I mean, it's there, waaaaay in the background if I try hard to hear it, but pre-tinnitus I wouldn't have even noticed it. Had a shower, went back to lay in bed and stare at the ceiling, enjoying the silence for another hour.

It's 1pm here now and still no ringing. Amazing. I know 100% it will be back tomorrow, if not tonight, but damn if it isn't an incredible feeling to re-live the pre-tinnitus life for a day.

Gives me a bit of hope though, knowing that it's at least possible for my body to not have tinnitus. Makes me optimistic that this new neuromodulation device might work for me.

As enjoyable as it is though, it's also super depressing; a reminder of what life used to be like, that makes it just that much harder to accept what life is now.

Although, it's interesting that it's so quiet when I have the house to myself for the weekend... coincidence?

 

I was on the SSRI for about 7 to 10 days before this started, but the dose was gradually ramping up over that time (although even when it started, I was only at 10mg/day, which is 10-20% of the normal therapeutic dose).

I wasn't sick at all that week, as far as I can remember.

 

Damn, your story and description of symptoms are very similar to mine. I even got it around that time of 2021 too. In my case, the tinnitus is hopefully very mild (a 1/10) except for 7 days in June when it somehow flared into more tones/volume. Volume dropped to 1/10 again though, but the texture of my tinnitus changed after a few months.

I also went through a distortion/diplacusis episode 2 weeks ago (10 months in) where a band of frequencies was pitched down a bit in one ear creating dissonance with the other ear.

Your description of "head noise" auditory pressure fits so well with what I experience too. The "bubbling" thing as well.

I also don't have any hearing loss, except for a small (-20 dB) dip at 2-3 kHz. Neither ear pressure, vertigo or anything like that.

I don't know where I'm heading here, as I still don't know the cause of my condition too. Note that I didn't have any notable noise exposure/event that I related to my tinnitus or any medicine or any infection. But it's always good to come in touch with people that share similar symptoms.

Glad to hear that yours is improving! With some hope and luck, you will continue having those silent times!

 

It is looking more like the SSRI triggered it.

It's a long shot but you could try out Cyclobenzaprine. It's a serotonin antagonist.

Or just keep waiting it out. It probably didn't do any actual damage. Akin to benzo withdrawal tinnitus.

 

Yeah, I can't think of anything else that may have done it. I guess I'm just very sensitive to those drugs.

Is there something in particular that makes you say it probably didn't do actual damage? It's been 8 months, I haven't heard of tinnitus subsiding after that long.

 

Hi Jason,

I got severe tinnitus after 10 days of Amitriptyline on 10 mg and twice at 20 mg.

It’s not uncommon as that drug is extremely ototoxic to some people. My tinnitus is a 10/10 or at least what I would assume is as bad as it gets. Before taking Amitriptyline, it was a 2/10 for 5 months after onset. It ramped up to a 10 over 3 weeks after quitting the Amitriptyline. I also get a heavy metallic taste in my mouth, distortions in my hearing like you described, head pressure and the bubbling in my right ear. My tinnitus feels like it comes from my brain stem, it also creates heavy dizziness.

Glad to hear yours eventually went down. I get the feeling I won’t be so lucky as I’m 6 weeks in and need to have a masker on at all times. It completely ruined the hearing experience for me.

Hopefully this gives you some peace about where it all came from.

 

Hello Jason,

I see a few parallels with the situation of my wife (she finds it hard to write here at the moment, so I'm taking over).

She took Amitriptyline 10 mg/day (for chronic pain and not for depression) for about half a year when the tinnitus suddenly started. She stopped taking it immediately, but the tinnitus stayed (for almost 3 months now), though it decreased.

There are other factors which might have caused it, but in the end we don't know.

She usually has a high-frequency hissing in the top/top-left of her head. Also, sometimes a ringing in the right ear or a whirring in the left ear. But she usually only hears those when the hissing stops o subsides to an almost not hearable level?. The ear noises seem to get more prominent when there was exposure to louder noises like road traffic during the day. But we're not sure.

She doesn't have the distortions and the bubbling that you describe, but tensions in the jaw also increase the volume for her.

She feels that the location of the noise is mostly in the brain and not in the ears. But it sometimes moves and we don't understand why.

We wanted to ask how you feel today and if you had more such silent days like you described here? Was it complete silence? No noises?

There are success stories where the tinnitus subside even after years. But not sure how prevalent that is.

Good luck furthermore and kind regards,
Simon

 

I got tinnitus from Amitriptyline. The serotonin in the drug is the culprit. Mine goes up and down too. Some days it is barely audible, most days it is hell.