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Tinnitus after a noisy party!
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schalke posted:
Hi Dr Moser,

Sorry if you don't understand exactly what I write, as English is not my native language.

I am 27 yo and never had auditive problems. I'm healthy and have no comorbities. Last time I got a medication was 6 months ago, when I had a headache. So, what am I doing here? Last Saturday night I've been to a wedding party (hopefully not a rock concert) and I sat down too close from a soundbox (about 5 meters). I guess I stayed there for 90-120 minutes. I guess the sound was +/- 90 dbA. It was not the loudest sound I've ever heard, but I guess I had never stayed next to big a soundbox for too much time.

Well, it didn't bother me, except in the end of the party, when I started feeling a fullness in both ears. When it started, I said goodbye to my friends and some minutes after I went away. When I arrived home, it was too tired and I immediately went to sleep. At that time I had hearing loss, a boring tinnitus in both ears and the ear fullness. As I was very tired, I didn't have problems to sleep.

On Sunday, when I woke up I realized how noisy my tinnitus was, it looked like a broken radio that could not find the right frequency. On that day, I still had hearing loss and fullness, and the same tinnitus all day. I had to watch TV louder than I use to. As I am a resident physician (internal medicine), I studied a bit about noise-induced hearing loss and decided to start taking, by myself, 60 mg/day of prednisone and 160 mg/day of ginkbo biloba. It surely wasn't a good day and I had some difficulty to sleep due to the tinnitus.

On Monday, when I woke up, the tinnitus in both ears was still there, but in a different frequency. But no more sensation of ear fullness. This day I do not go to the general hospital, but to a small clinic to work. I noticed that my hearing loss had gone, but I still heard the same tinnitus all day.
On Tuesday (today), I woke up better, without tinnitus, but only a sensation of ear fullness. As this day I go to the general hospital, I was able to be examined by the ENT resident, who told me my otoscopy was ok. I had an audiometry that was also ok (result: normal). I worked happy for the rest of the day, as my ear fullness was going away and I thought my problems had been solved. No tinnitus all day! Anyway, when I arrived home, 8 PM, I noticed I had a tinnitus (another different frequency from SUN and MON, less annoyable) that got a little bit worse up to now (midnight). Well, I and my girlfriend are worried (she was at the party with me, but just had the tinnitus the day after the event). I had to study to present a clinic session tomorrow but I could not. It's disturbing my concentration. I started searching through all the web about noise-induced hearing loss/tinnitus, and came to this forum, having read all topics about tinnitus.

(continues)
Reply
 
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schalke responded:
(continuation)
Besides the fact of being a physichian, I don't have a deep knowledge on ENT, nor tinnitus. My current focus is internal medicine, particularly cardiology. I found it very difficult to find randomized studies about noise-induced hearing loss/tinnitus on the web. And I could see you have a great knowledge in this area, and is always willing to help people who post their doubts here, what is very kind and appreciated. So, I was wondering if you could help me sorting out the following points:
- Is it commom to have this kind of lesion even not being exposed to a very loud sound (a rock concert, for example)? The other friends who were next to me at the party had hearing loss/tinnitus for less than 24 hours and are ok right now. And not all of them! Can it be a sing of good prognosis for me?- Is it common this tinnitus disappearing and appearing again, in a different frequency? I was VERY happy today when I noticed it had gone, and SO disappointed when I started listening to it again...- Even if I didn't have hearing loss (audiometry ok), do I still have the risk of getting a permanent tinnitus due to this noise exposure?- If not, how many days does this tinnitus take to go away? I've read up to 14 days, but can it take longer?- Do you think is it reasonable to continue taking prednisone? I got only 3 doses, but I'm already afraid of having side effects... I don't know but about ENT, but as a generalist I know it has many side effects of PDN... Would you recommend it's withdrawal, or a dose reduction (currently I'm taking 60 mg/day)? The ENT resident I was with yesterday didn't have an opinion about that. What about the ginkgo biloba?- Is there any exam I can do to check out if my inner ear is ok? I hard about Distortion product otoacoustic emissions, can it help me to find out if I had any permanent trauma?
Sorry for taking your time and writing so much, but after a full day working I'm tired and I couldn't sleep up to now due to the tinnitus. It's frustrating! I turned on the fan to have another "noise" in my room, but it didn't help. Maybe I'm paying too much attention to the tinnitus...
Thanks in advance and greetings from Brazil for your good job at WebMD.
 
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Rod Moser, PA, PhD replied to schalke's response:
You have clearly experienced acoustic trauma, but there is a good chance that you will recover from this incident. When? I have no way of determining how long your tinnitus might last. Every person is so different and it would be impossible to even guess. It could be a few weeks or more than a month. As a future internist, I am sure you understand the variability of healing.

Acoustic damage to the ear from this type of incident can be severe, but unfortunately, I have no way of determining the excact decibel level you experienced, or know if you permanently damaged your ears. Many experts feel that prolonged levels above 85dB can cause permanent damage to hearing. Knowing this, why are movie theaters blasting our ears with levels that often reach 100dB? Concerts have levels that start at 100dB and rise to levels above 130 dB. Even echoing sports arenas have 80-100dB levels, depending on the enthusiasm of the crowd.

My guess would be that you will eventually heal and your tinnitus will resolve, but again, that is just a guess. In the meantime, your tinnitus may interfere with your auscultation ability, especially in the higher frequencies. I have tinnitus myself, but not as a result of acoustic trauma.I would appreciate if you post and let me know how you are doing in the next few weeks.

The use of prednisone is controversial and not every one is convinced that this will change outcome. It is okay to use it for a week or so, but then taper the dosage and stop. This short term use should not cause any adverse problems for you. I dont' recommend Gingo biloba, but then again, I don't condemn it either. Again, it may or may not help. The real "healer" in acoustic incidents is our body's remarkable ability to heal itself after our abuses. If you get better (and you probably will) it really doesn't matter what intervention, if any, truly orchestrated the cure.

Acoustic damage is usually in the inner ear -- not an area that can be imaged or viewed, at least at the microscopic levels where the damage (or inflammation) has occured. Trust that you body is not happy about this damage either, and will try and repair itself. If you are still having tinnitus months from now, you will need to see a neurotologist, but between you and I, there is not a lot that can be done medically.

I know you wont' put yourself in this situation again. You will move away from those speakers, use earplugs, or leave the venue. Your ears are too important to take any more chances. If you are granted a spontaneous resolution of your symptoms....over time...then this will be a lesson-learned, and something you can share with your patients.

Time is the great healer.....so cross your clinical fingers and hope that the tinnitus just fades away.
 
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schalke replied to Rod Moser, PA, PhD's response:
Hi Dr Moser,


Thanks for your fast reply. You are surely helping many people here!


Well, the tinnitus is still there. It becomes worse at night, but as I read in other topics here, it's quite normal. I noticed many people in old topics complain about tinnitus for 2-3 weeks after sound exposure and "disappear" from the forum, so I guess they got recovered. That's surely encouraging. I will not "disappear" if I recover, since I want my story as an "example" for other people.


I've done audiometry and otoacustic emissions exams. Apparentely, both are ok. This means my audition is normal and I probably didn't damage my inner ear, what could lead to permanent symptons. Fullness is gone and I just experienced hearing loss for the first 1-2 days. I had an appointment with an ENT yesterday, he examined my tympanus and said everything was ok. As both inner ear (otoacustic emissions) and tympanus are ok, he explained that I could have damaged some ligaments/tendons in middle ear, and I was supposed to recovery. That was his explanation why I still have tinnitus. He also reccomended that I keep using prednisone for a while. I'm still taking 60 mg/day.


The only concern is that tinnitus is really disturbing my life. I've been working about 60 hours/week (you know I am a resident physician, and you know how our life is) and I really need a good night of sleep. During the day, I'm usually in noisy places and it doesn't bother me a lot. But when I am quiet in my bedroom, it seems tinnitus gets worse every night. I turn the radio, fan, TV on, but doesn't help much, I still listen to it. I have never had problems to sleep. But last 2 nights I had many difficulties to sleep (took benzodiazepines for the 1st time in my life). But this current night was especially bad. I woke up in the middle of the night (3AM) due to an external noise (a big truck passing nearby) and couldn't sleep anymore. Everything is calm since that time, it's 6AM now and I could not sleep. Even after taking some more more drops of benzo. Tinnitus right now is as annoying as it was in my first day of symptons. This is what I am worried about. My wife is scared, too. I thought tinnitus would improve with time, and not get worse. That's my disappointment right now. I worked 12 hours yesterday, have more 12 hours today, and only could sleep 3:30 hours! I am really tired, I had enough time to sleep but could not! Sorry about getting things off my chest like that, but I am very tired and frustrated, besides having the hope that it will improve with time.


Dr Moser, do you think that is there any more exam I can do, or should I just wait? It's really impacting over my quality of life, and, besides having the hope that it will improve with time, I am very tired about it. I've slept only ~25 hours in the last 5 nights. It's almost time to return to work at the hospital and I am absolutely tired and stressed! My alarm clock will beep in 30 minutes, so I will make another try...


Thanks for your attention and keep up the good fight.
 
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Rod Moser, PA, PhD replied to schalke's response:
You are experiencing a valuable lesson that will help you some day in dealing with your patients. Many will be facing medical challenges that you will not be able to help or cure. Tinnitis, as you know, is a symptom, not a disease. Like many medical disorders that you will encounter, it is totally unpredicable. Statistically, you will get better over time, but like many things in medicine, that is just a guess.

A few suggestions: Take your prednisone ONLY in the morning or it will definitely interfere with your sleep. Take the benzodiazepam as close to bedtime as you can, put on some soft music or white noise for the background (if you can find a background sound that matches the pitch or frequency of your tinnitius, this would be better), AND....read some boring medical study. All of these things should overload an already-exhausted mind, and help you to fall asleep. Make a nice nest, too....comfortable pillow, cool sheets, proper temperature, take a shower before bed, etc. You wife can also help relax you a bit, if you get my hint.

This is going to be a challenge for you, but I think you can handle it. Take it from someone who has had tinnitus 24/7 for the last dozen years or so......
 
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schalke replied to Rod Moser, PA, PhD's response:
Hello Dr Moser,

Again, thanks for the advices. You've been very helpful.

Yes, tinnitus is still there in the right ear, but I am dealing better with it. It's still a bit annoying but becomes less audible when I stop caring about it.

One interesting issue is that when I obstruct for a while my acoustic meatus I have a good refief of tinnitus. So I thought it could be something related to the sound transmission in the middle ear, and not to the inner ear itself. Anyway, it's just a guess, as I am not an especialist.

I will be visiting ENT again this week to see if it's necessary any other exam, investigating any other cause for this symptom or just wait. But I have a good hope of getting better, and that's the most important.

Cheers.
 
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Rod Moser, PA, PhD replied to schalke's response:
Let me know what your ENT has to say after your exam....

Attitude is the key and I think you have a good, optimistic outlook right now.
 
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schalke replied to Rod Moser, PA, PhD's response:
Hello Dr Moser,

Just to update you and the other participants on this forum. I still have the tinnitus in the right ear. But it's less disturbing (I don't know I am getting better or if I am getting used to that boring noise). I saw the ENT again this week, he said my tympanus and nasoscopy were both ok. He explained that tinnitus could persist for some weeks after an accoustic trauma (the same you had already told me). As I had normal audiometry and otoemissions exams, it would be less probable (but not impossible) that tinnitus could last forever, as hearing loss and tinnitus usually (but not always) happen together in this setting.

I stopped prednisone and g biloba after a week of use and it didn't seem to make a big difference.

Another possibility is that I already had tinnitus before the accoustic trauma, for another reason, and didn't notice it, didn't pay attention to it, as I have been working too much last months. So the ENT asked that I have a bera and a mri if tinnitus doesn't go away in the next 1 or 2 weeks, to investigate other reasons for this symptom.

I'm more confident now, sleeping better with benzo and trying to do more pleasant activities in my free time. So I do not pay attention to the tinnitus for most of the day. I think that's the key.

Again, thanks for your advices, Dr. I will keep you informed.
 
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Rod Moser, PA, PhD replied to schalke's response:
And, thank you for your update and kind comments. I agree with your ENT and do expect, based on what you have shared, that you will have a good outcome
 
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Mahdi89 replied to schalke's response:
please i have your same situation ! i need your help! i had tinnitus 7 days ago i started taking prednisone @ the 4th day (2 tablet=40 mg @ morning) and vastrel @ morning and evening
i got tinnitus after my 1st party i go in my life what a luck!
now on the 7th day i feel pain in my left ear and i feel like water in it ..
pls tell me did your tinnitus goes away?! if i stopped the medicament it will come back ? it will ruin my life my work! my social life
 
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Rod Moser, PA, PhD replied to Mahdi89's response:
Unfortunately, everyone's acoustic injury is different; and everyone heals in a different way. For you, it has only been seven days, so it may take longer for your ear to repair the damage. Please see the ENT again.......

There is really no way for me, or any medical provider, to predict your outcome. I am sorry. Statistically, most people do recover, but again, it is not possible to know when this might happen.
 
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schalke replied to Rod Moser, PA, PhD's response:
Hello, Dr Moser and Mahdi,

I can say tinnitus has not gone yer, but now I feel ~70% less than in the first days. It's not bothering like in the beginning and I don't need diazepam to sleep anymore. So I expect it disappears next weeks. If not, I will do the exams my ENT asked for.

Mahdi, I recommend that you keep calm, start doing pleasant activities in your free time, so you will pay less attention to the tinnitus... it worked for me. Don't stay in the internet searching for "tinnitus" @ google or you'll feel desperate. Read Dr Moser's advices, they were very helpful for me. And return to the ENT if you don't get better in a week or so.

Good luck!
 
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Mahdi89 replied to Rod Moser, PA, PhD's response:
live in a village ..but i will move to city for study and work
do you think i should postpone the move?! it will affect my tinnitus?
 
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Rod Moser, PA, PhD replied to Mahdi89's response:
I don't have that answer. I suspect that no one could accurately predict the future.
 
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Mahdi89 replied to schalke's response:
Please Schalke keep me informed i need some Morals


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