Dr. Shyam Kalyan. N
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I was exposed to a loud noise (gunshot). Since then, I have a static noise in my ears when it is really quiet, and I get a pressure at the back of my head that often turns into a headache. Sometimes, I also get a tone in my right ear. If I do some physical activity, I may have dizziness. This has been going on for six weeks now. I have been to an ENT and did various tests (attached). None are showing hearing loss, and since the tests are clean the ENT cannot determine what is wrong.
Hello,
Welcome to icliniq.com.
I have gone through the reports (attachment removed to protect patient identity). Like you said, the tests are normal. But still, you suffer from a ringing noise inside the ear which is more in quiet surroundings. Physical activity causes dizziness and there is sometimes pressure at the back of your head. I would like to know some more details regarding your symptoms. 1. What sort of noise is it? Is it a ringing, thumping, continuous, high or low frequency, or a whooshing sound? 2. Do you have a headache when you bend down? 3. Any facial pressure or pain? 4. Any post-nasal drip? 5. Any decreased sense of smell? 6. Any problems due to acid reflux? 7. Any thick nasal discharge or nose block? 8. Any difficulty in hearing? 10. Any fullness inside the ear? 11. Any ear discharge ever? I would recommend an MRI scan of the brain to rule out space-occupying lesions or any cerebellopontine angle lesion to rule out the cause for pressure and headache. Sinusitis also has to be ruled out as persistent thick mucus around the eustachian tube can also cause tinnitus and other ear-related symptoms. Do revert with more information. I will be happy to help you.
Patient's Query
Thank you doctor,
I have seen 2 ENTs. They both checked my ears and said that everything looks good, and eardrum looks healthy. I am scheduled for an MRI soon. In a quiet environment, it is like static. Imagine sitting in a very loud place like a dance club or bar, and then suddenly all the sound is turned off. You will have this sort of static in your ears that typically goes away after some time. That is what I have. This sound is also triggered when the back of my head is resting on something soft, like the back of the couch or a pillow. There is also a very soft tone that I hear in my right ear. This will come and go, but it is so soft that again I can only hear it in quiet environments. It may get louder depending on the stress or if I was exposed to some loud noise. I do not get headaches from bending. I also do not get vertigo. There is no facial pressure or pain, post nasal drip, decreased sense of smell, ear discharge or thick nasal discharge. I have had acid reflux before, but it has not been an issue recently. My hearing is good. On some days, I have a little fullness in the right ear. It feels a bit like the fullness you get on an airplane. It typically goes away after few hours.
Hello,
Welcome back to icliniq.com.
I have a couple of questions more. 1. Do you hear your own breathing? 2. Do you hear your own voices? 3. Do the above get relieved when you lie down? I have asked these questions to rule out a condition called patulous eustachian tube. The symptoms of this condition are not exactly like what you have described but nevertheless, it is prudent to rule this out. The MRI should throw some light on the problem. It should help us understand what is going on. If the MRI is normal, then we must think of inner ear pathology. When you hear loud noises (something more than 140 dB), the sensory cells inside the ear, namely inside the cochlea, get traumatised. If the acoustic trauma is not very devastating these cells recover after going through a phase of temporary threshold shift. However when the damage is heavy, the cells undergo permanent damage and this results in permanent threshold shift. Threshold shifts classically result in loss of hearing for various frequencies. In your case however, it has resulted in tinnitus. Tinnitus can be difficult to treat. Various drugs are being tried but none have been proved to be really efficient. Bioflavanoids like Tinnicare capsules are being advised and they can improve the symptoms. Tinnitus matching and masking are being tried and many patients experience benefits in my centre. I would suggest that you take a short course of steroids. Methylprednisolone 16 mg one tablet twice daily, tapered over 12 days, will be beneficial. Consult your specialist doctor, discuss with him or her and start taking the medicines with their consent. Steroids are anti-inflammatory agents, they can reduce edema and inflammation around the nerve and inner ear region which could be the cause of tinnitus. If you need details about how to taper the steroid, I can help you. Steroids are better if taken after meals. Do revert back if you need any further support.
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Otolaryngology (E.N.T)
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