A General Pondering About "How We Get Tinnitus" — Worth Repeating

[Zimichael]

Someone tagged me on this old post of just over a year ago.

Also, the issue came up again in another section I follow when someone had the realization: "By golly! I was taking ototoxic meds and exposed to loud sound too when I got my T!"

Thus I thought it would be worthwhile re-posting this general comment about "how we get tinnitus" (according to the book so to speak), and a pet theory I have to add to that list. I hope it helps avoid future damage for someone... SEE BELOW.

best, Zimichael

OK, this is something I have not heard anyone else say in any place or any time...yet. Maybe it's on this board, and I just don't know it. For me it's a biggie, and so super obvious I am stunned that it is kind of a "black hole"in relation to audiology/damage/drugs-meds.

Simply speaking this is my "hypothesis":

- Obvious...Sound exposure at 'dangerous levels' can and does cause hearing loss and/or tinnitus. OK
- Obvious...Different people get hearing damage or tinnitus at different levels of exposure to sound. OK
- Obvious...Some/many people blast themselves with mega decibels, often for years, with seemingly no ill effect and certainly no tinnitus. Maybe as they age they just go... "Huh??? Sorry I'm a bit deaf mate!" OK
- Obvious...Some people get exposed to one loud sound, once, and they get hearing damage or tinnitus. OK
- Obvious...Some people get exposed to averagely loud sound over long exposure time and get hearing damage or T. OK
- Obvious...Some people get hearing damage and/or tinnitus from ototoxic drugs. Medical, experiential fact. OK
- Obvious...Some people don't get hearing damage and/or T. from ototoxic drugs. Medical, experiential fact. OK
- Etc...
* NOT OBVIOUS - What the hell makes for the differences above??? Genetics? Big ears? Small ears? Brain make-up? "Personality" - like highly strung versus laid back? And so on... Not sure anyone knows. OK

OK, here's ONE thing I think is being seriously overlooked, and I have personal experience with, and I especially tell people about who are on IV Vancomycin or Gentamycin, etc.!

Could there just be a hidden, unconnected, unknown, un-warned about link between "Meds" and sound exposure while plasma rates are still positive for the med??? In other words, does any doctor ever say to a patient on one of the zillion meds with a "hearing signature" (and there are a helluva lot when you look in the professional sections of side effects): "Oh, by the way, until this med has cleared your bloodstream, avoid being around any loud sounds or long exposure time to elevated sound levels."...."Ummm, like what doctor?"...."Oh you know, don't go right back to your construction job without using earplugs, or an international flight for 10 hours in a noisy jet, or a rock concert, or a movie, or your screaming baby, etc."...."Ahhhhhh, why is that doctor?"...."Well, it's just possible that some people, can get let's say 'aggravated' or 'sensitive' in the hearing department. You know, sort of like having an open wound perhaps, and it's best to keep it protected and not full of muck and dirt. So sort of like that. If the hearing area is ahhhh, a bit 'on edge', let's say, it may be good to not 'over stimulate' it with a lot of 'dirt or muck'...Ha, ha...that would be, you know, the equivalent of loud sounds and so forth, that could be like hitting the tenderness with a baseball bat while it's a little 'raw' or 'susceptible'...Just a thought my dear chap. Just to keep in mind OK?!"

Has anyone ever heard this advice from a medical professional??? I sure haven't, and that was even when being given a four week course of Neomycin, one of the most ototoxic drugs on the planet AND by one of the best docs in N. California!

Now consider...Even plain old over-the-counter NSAIDs (Non Steroidal Anti-Inflammatories) like Ibuprofen have a "hearing signature", let alone the more heavy duty meds that are prescribed willy-nilly by the million every day.

Then consider that typical plasma clearing rates can vary from hours to weeks!!! The recreational drugs are well know...like plain pot varies from 1 to 7 days before you are clean on a tox test. Benzos are 1 to 4 days. Tricyclic antidepressants run 2 to 7 days. And so on. Plus this gets to be a highly complex subject because we don't even want to think about combinations of drugs/meds! (Just look at the clearance equations!)

Then consider that, quote: "Renal plasma clearance will vary with such factors as age, weight, and sex of subject, the state of cardiovascular and renal function, the nature of the material being excreted, species, etc."

WUNDERBAR!!! Just fantastic...Basically, like I said it's a "black hole" of ignorance on a functional, practical basis for the average Jane or Joe on the street (currently happy as clams without tinnitus), who goes and gets some meds from the Chemist's/Pharmacy or a doctor...Then carries on with life as usual (movies, bar, machine shop, etc.)...and then "somehow" ends up with tinnitus or hearing damage...Hello 'plasticity' - or whatever other coping mechanisms are required if it is severe! WUNDERBAR 2.!!!

Get the idea???!!!
And just to cap it off, here's a number...38% of all (US) combat war vets from the Iraq war have tinnitus...Oh, and how many of those combat troops do you think live on Ibuprofen or the like on a daily basis and eat them like candy? (You know, those heavy guns, packs, grunt equipment, etc. - up to 80 pounds (40 kgs) or more....can get to cause a few aches and pains). And you know, war is not exactly a "quite zone".

I think I have made my point...

 

[geg1992]

Very interesting.

I was taking ototoxic medication, went to a gig and got T.

 

[linearb]

The obvious counterargument to this idea is the many, many historical accounts of tinnitus which predate pharmaceuticals entirely.

I don't believe that there is any singular cause of tinnitus.

 

[Valentin]

We probably have a common gene that predisposes us to tinnitus no matter the cause of tinnitus onset.

 

[Zimichael]

The obvious counterargument to this idea is the many, many historical accounts of tinnitus which predate pharmaceuticals entirely.

I don't believe that there is any singular cause of tinnitus.

I fully agree with your statement, though my point about adding "strong meds" and "potentially dangerous sound levels" may be a new "addition" to the historical record...when we look back 25 years from now.
In my small circle it is surprising how many people I know with T (including me) that seemed to get it for the first time, or had a worsening, after that "double exposure mix" of a med and sound. It caught my attention finally, so I started asking more detailed questions.

A few examples...
- My first ex wife (good friends still ) has been playing music (marimba) in a band for a long, long time. She dislikes meds and avoids. Two years ago she had some back pain that was too distracting so took a rare week of Ibuprofen...and played in an outdoor gig, and then discovered she had tinnitus. Panic, freak out, etc. (She has since habituated but wears plugs now).
- A construction friend. Been banging nails forever, etc. Getting a bit older like us all, and hammer arm started to hurt. Took Ibuprofen and soon had tinnitus for first time...Sure, he had been around banging and such for a long time, but the "timing" is suspiciously coincidental perhaps.
Me...after stage 3 T and H, recovered enough to be around fairly reasonable sound levels (a dance show for example). Then was taking Itraconazole and exposed to a nearly 4 hour extended period of not so loud sound (not as loud as dance show for sure), but ended up with stage 4 T and H. Yes, I was NOT a happy camper!!!
All coincidence???
I'm not sure...and I could give more "known" examples. God knows how many happen where the 'potential connection' is not made.

It's a theory of mine...and my motto is: "Better safe than sorry". If taking "strong meds" or known "hearing signature meds" (look them up before taking) then be more 'sound exposure careful' than usual.

Just saying... Best, Zimichael

 

[linearb]

Yup, that makes perfect sense to me -- and I do have a suspicion that tinnitus incidence, overall, may be on the rise... perhaps because of a confluence of factors. Widespread use of relatively new drugs, and increasing noise levels seem like pretty obvious culprits, and then there are a host of things that seem possible but hard to map out (novel chemicals from industrial processes -- if you look at flame retardants, as a specific example, these things are now totally dispersed through the biosphere, they have found traces of only-invented-within-the-past-decade flame retardant chemicals in tissue samples from arctic bears!).

I'd taken hella drugs, prescribed and not, in the run-up to my T; also had a loud noise event, so I guess we're similar in that regard.

 

[Zimichael]

@linearb ...I have a suspicion that combo thing is "tip of the iceberg" stuff. The biggest mystery is how so many people get away with not getting T! Hell have you ever been to India for example (makes Bangkok sound like a quiet park, and it is by no means 'calm'!)...They must have genetically evolved ears resistant to hearing damage. Meds or no meds! Volume levels in cities and, well, most places I was, are unnnnnnnnnbelievable!

Best, Zimichael

 

[Street Spirit]

My dentist seems to think it was the copious amounts of advil I was taking that contributed to my tinnitus and not my tmj..

his assistant said it was my tmj..

I was under some of the worst stress of my life when it began though. I personally believe in this theory.

who knows.

 

[Fiore]

All this started after ear syringing one ear- now i hear it all around. Sometimes high sometimes low. On my way to get it syringed a man honked his horn LOUD held it down for more than 10 seconds it was a bus- really bad traffic and my good ear was towards it. Now my syringed ear has minimal ring but my good ear has that ringing (sigh) its like I was meant to have T. The steroids helped lower the sound its there sometimes a 2-10 or a 5-10 also while waiting to see an ENT for my ear ringing I waited 8 days to see him I stressed like i never have before. SO I also want to say stress/anxiety contributed to all of it as well. I will always remember Feb 2, 2015

 

[RichL]

@Zimichael , I, for one, think your on to something here, this has been bought up before elsewhere on this forum, (nowhere near the in depth and impeccably written way that you have posted ) @Telis is convinced that this is to blame for his T and has stressed his opinion on certain drugs being the part instigator in Tinnitus!

I must stress though, If you plan on pursuing this in a more robust and investigative manor, please be careful and be prepared to get dragged through the mud by the pharmaceutical companies if you get to annoying, if you know what I mean!

Rich

 

[Zimichael]

I must stress though, If you plan on pursuing this in a more robust and investigative manor, please be careful and be prepared to get dragged through the mud by the pharmaceutical companies if you get to annoying, if you know what I mean!

Thanks Rich...but I have no intentions of storming the gates of Big Pharma, though have come up against corporate lawyers before, and won, with zero budget while they get $600/hour to sit there loving that it all drags on for 18 months. (Sigh...Another lifetime though, as I did not have stage 3 and 4 T & H then!).

The above "meds/drugs/sound" is a personal doctor's education thing. My doc really took note when I brought it up, and said: "You know I think you are on to something there!" He has been in practice for a long time (semi-retired) and specializes in the tough cases other docs throw up their hands on...so knows his stuff. Decades of observation to pull on, and it rang true.
So, just bring it up to your own physician's as that is about the best we can do unless the ATA takes it up..."Ha, ha, ha, ha, ha..." We'll land on Pluto first!

best, Zimichael