Q. Do burning pain, hyperacusis, and tinnitus suggest a secondary ear infection?

Hello doctor,

After loud noise exposure, I have had burning ear pain, hyperacusis, and tinnitus. I wonder if I also have a secondary issue or infection that could be causing these symptoms. I want someone to interpret the otoscopy. Kindly help.

Hello doctor,

Thank you for the reply.

The noise exposure occurred and lasted for 20 minutes. It was an MRI scan of the thoracic spine, and they gave me earplugs, which had no music or noise-canceling sound played during the scan. It was very loud and uncomfortable, but they told me it would be loud. However, by the end, when they removed the earplugs, my ears were burning with pain. I was dizzy, almost shell-shocked, and had a buzzing sound in my head.

By the time I got home, I noticed that the most trivial moderate sounds, like a boiling kettle, would cause intense pain. My hearing was muffled, and my ears felt clogged. About four days later, I attended the emergency department and was prescribed Betahistidine for two weeks. Two days later, I talked to another doctor and started on Prednisolone 60 mg. I was seen by an ENT the following week, and he continued the Prednisolone for two weeks with a slight taper.

Since then, my symptoms have not improved much. I still have the following symptoms.

1. Bilateral ear pain.
2. Burning sensation.
3. Clogged sensation.
4. Muffled or distorted hearing.
5. Tinnitus.
6. Difficulty sleeping.
7. Hyperacusis.
8. A feeling of discomfort and pressure any time I am stressed or trying to concentrate.

I had a pure tone audiogram and had attached the results. I am not sure how well the tests were done. I also tried a diuretic for three weeks, Bendroflumethiazide, 1.25 mg per day. But no effect, so I stopped.

I have pictures taken from an otoscope and am wondering if there is any evidence of a secondary issue, like otitis externa, that could be causing some of the issues, and if any other issue is evident.

I asked for the otoacoustic emission tests, as I hoped they would help clarify the nature of any damage that has been done, by the noise exposure: such as damage to the outer hair cells. But the audiologist told me she did not have much experience interpreting DPOAES and TEOAES for adults. The image she sent is not very clear. So I am wondering if you can offer any insight, as to the nature of the issue, if there is obvious permanent damage, or if it might resolve.

I have read that noise injury can sometimes be helped by addressing different issues, such as

1. Blood flow to the inner ear, via vasoactive or hemorheological agents.
2. Oxidative stress, by using magnesium, vitamins C, A, and E.
3. Addressing the neurotransmitters, such as excessive glutamate activity by using compounds that would calm the issue, such as low-dose Alprazolam or Clonazepam.
4. Using Nortriptyline to help with pain and hyperacusis.
5. Doing hyperbaric oxygen therapy.

Please suggest your opinion on this.

Hello doctor,

Thank you for the reply.

I have tried listening to various tinnitus therapy sounds that I found online, and will look into tinnitus retraining therapy in more depth. So far, I have not noticed any improvement, though. The most bothersome symptoms are hyperacusis and a feeling of pressure in my ears whenever I experience stress. The latter sign feels like it is caused by an increase in blood pressure or an increase in fluid pressure or inflammation, which aggravates any inflammation or fluid buildup, that is already in the ear. I was on a diuretic, Bendroflumethiazide, for about three weeks, but it did not help, so I stopped it last week.

The tympanometry showed that there was not any fluid buildup in the middle ear, but sometimes there can be endolymphatic hydrops in the inner ear, so I was hoping the diuretic might help. But I did not notice any improvement.

Should I try something like Clotrimazole drops? Or would you recommend something else?

White plaques are along the external ear canal, and the area feels sensitive. I have burning pain in both ears, and I am not sure if this emanates from the inner ear and is the same pain that I initially experienced from the noise exposure.

Or maybe, it is caused by a secondary issue, like a fungal infection of the external ear. Perhaps it would be worth trying some medication for that. I tried corticosteroids and antibiotic drops a few weeks ago. I think it was called Betnosone, but it made no difference.

I will attach a few more pictures of the external ear canal, where you can see some whitish plaques in the ear.

I am hoping that I can resolve the situation medically, and avoid getting into a legal case. All of this stems from having an MRI scan of my back, and something went wrong. Either the earplugs were insufficient, or the machine malfunctioned and emitted louder noises than it should have. I wrote to the hospital to let them know and asked them for some help getting treatment, but they have not replied yet. So, I am planning to take legal action on this issue.

Please review the reports attached and suggest your opinion.