Acoustic Trauma from Sleep Paralysis — Hyperacusis, Reactive Tinnitus, Distortions

[J96]

My journey began last weekend when I fell asleep with a headphone in my right ear. I had turned off my music & subconsciously set my alarm to max volume as I do every night, forgetting I still had a headphone in. In my dream I recall hearing a terrifyingly loud high pitched noise, only to be stuck in sleep paralysis and could only move about 30 seconds - 1 minute later to rip the headphone out. At that point the damage was done.

I immediately had SSHL and could only hear things at about half volume for the remainder of the day along with fullness, high pitched sound sensitivity, reactive tinnitus, and dysacusis. This was not my first rodeo with tinnitus, as I have previously had a mild case of it for the last 5-10 years or so. However, I now have multiple tones of it. Scared that my eardrum had been damaged, I went to urgent care who said there was too much wax to see the eardrum and had it removed. This was extremely painful and made the sensitivity 100x worse afterwards. Later that day I realized that sounds had an additional 'ring' to them like the A/C or fans. I also was terrified that even the sound of a plate clanking in the kitchen seemed to be amplified 3 fold. Panicking, I googled to see what I had and hyperacusis was what came up. In the next few days I protected the ear whenever I would encounter an uncomfortable noise. What I didn't realize though, was how severe this would get.

The very next day I went to the gym and brought my earplugs, and after a few minutes I realized that I had to put one in. Another oddity that I noticed was that my headphone in the left ear sounded a bit off. Throughout the next few days I kept protecting my right ear, only to realize that my left started to become affected. Confused and scared, I scheduled an appointment with an audiologist and ENT. They told me that I had slight high frequency hearing loss, but everything was still in the normal range. At this point about 5 days later my right ear was in constant pain for seemingly no reason. They diagnosed me with acoustic trauma along with hyperacusis and I implored the ENT about a steroid treatment since it was still a few days after the incident, but they said no.

Now I am here around a week later and am seeking some guidance. I feel that my sound tolerance is decreasing by the day, despite avoiding what I believe is any volume level that could hurt my ears. 2 nights ago I was watching TV at normal volume with my spouse with the right ear plugged, and today I felt like even with both ears plugged that it was too much. I do not have any reactive pain from sound, but it is feeling increasingly uncomfortable. The medical professionals told me only to plug up when the noise would be harmful and since that advice I've been overly cautious and felt like it's been counterproductive. Should I be letting the good ear breathe to prevent this? Is discomfort (not fullness) a reason to plug up?

 

[Cmspgran]

Welcome. Sorry you're going through this. I would do nothing other than stay away from any loud to medium noise for now. Give it at least a few weeks of as quiet as you can. I don't want to advise on steroids as it's something with contrasting opinions, I guess you would need to press on the ENT if you want them.

Try to calm your anxiety and work on getting good sleep and rest. You may want to try sleeping medication during this acute phase.

In all likelihood you'll be OK but it may take a while to recover, fingers crossed it's a quick recovery.

 

[J96]

Do you recommend to slowly introduce myself to sounds now or just wait a few weeks? Also, is the gym safe with earplugs in? Currently anything very high pitch or above room level talking is uncomfortable.

 

[Cmspgran]

Do you recommend to slowly introduce myself to sounds now or just wait a few weeks? Also, is the gym safe with earplugs in?

Stay away from the gym and any sounds/places that are uncomfortable for at least a few weeks.

 

[Jupiterman]

Do you recommend to slowly introduce myself to sounds now or just wait a few weeks? Also, is the gym safe with earplugs in?

Silence will not damage your tinnitus or hearing.

During the acute phase, post injury, do you really want to take noise exposure risks?

Did the ENT give a reason for not giving you steroids? This sounds like an ENT from the UK.

 

[Michael Leigh]

Do you recommend to slowly introduce myself to sounds now or just wait a few weeks? Also, is the gym safe with earplugs in? Currently anything very high pitch or above room level talking is uncomfortable.

I am sorry to know of the difficulties that you are going through @J96. If I were in your situation, I would try to calm things right down, because if you're not careful, your symptoms could become a lot worse. Sorry to sound so sobering but the reality is, you have had noise-induced tinnitus since 2018. Even though you have managed to cope with it relatively well for a number of years, this recent setback could cause you to develop variable tinnitus.

Variable tinnitus is my definition of a more serious form of noise-induced tinnitus and it's not something to take lightly. It can be ruthless and very unforgiving and difficult to habituate to.

Please click on the link below and read my thread: Can I Habituate to Variable Tinnitus?

The fact that you have been listening to audio through headphones for quite some time albeit without any adverse affects - in my opinion you have been playing with fire.

It might be a good idea to keep away from the gym for a while to give your ears time to heal, I wouldn't tempt fate going there for now, even with using earplugs.

Try listening to low-level sound enrichment during the day and especially at night by placing a sound machine by your bedside. The idea is to have sound enrichment playing at a low level so it's not drawing attention to itself. Go to my started threads and read: New to Tinnitus, What to Do? Here you will find more information on sound enrichment.

Try to keep calm and take things slowly.

I wish you well,
Michael

Can I Habituate to Variable Tinnitus? | Tinnitus Talk Support Forum

 

[HearingHell]

Do you recommend to slowly introduce myself to sounds now or just wait a few weeks? Also, is the gym safe with earplugs in? Currently anything very high pitch or above room level talking is uncomfortable.

The best way to heal is with silence and time. You should stay in silence as much as possible for the next few months to give yourself the best chance at healing.

Avoid the gym for a while. And no more headphones or earbuds.

 

[RHL]

I've twice reduced acoustic damage/tinnitus to my ears by getting a Prednisone injection into the eardrums. Once, I had to show the studies on this to the ENT, after which she agreed. Another time, I was speaking to a smart ENT about this, and he mentioned that I was lucky to do it within a month of the incidents, because that's when the benefits decrease sharply. Ideally, it is in the first week or two.

 

[J96]

My question is why did this suddenly transfer to my other ear? What I mean is that the acoustic trauma was 100% localized to my right ear and had distortions ONLY in that ear for a few days. The loudness amplification was also only in that ear. I am struggling to make sense of why my left is now affected even though it completely avoided the trauma. I noticed distortions started in the left ear only after I started to panic and overthink everything. I'm guessing the limbic system is causing this, but I would like some guidance from others who are more experienced.

The good news is that the pain in my right ear is completely gone, but after any high pitched or loud exposure my ear will get full and 'ache'. I noticed that this 'bandwidth' seems to be decreasing by the day (this seems to be true with both ears, but mainly the right).

With that said, I downloaded a dB app and it seems that my LDLs are between 70-80. The shower is slightly uncomfortable and has a reactive tone to it, but it does not hurt or cause any pain. Is it safe to shower without earplugs?

What is the rule on avoiding sounds, is it anything uncomfortable, period? What about anything with a reactive tone, despite if it is bothering me? This seems to be localized to fans, fridge, and high pitched frequencies ONLY if they are above a certain sound threshold at the moment.

In terms of digital audio, my phone seems a bit abrasive on speaker (only without earplugs), meanwhile my audiophile soundbar does not seem to be causing me any discomfort on low volume despite the duration. Are these okay to continue if I am not noticing any discomfort?

Apologies for all the questions.

 

[J96]

I've been struggling with extremely unstable, reactive, and volatile tinnitus for a few weeks now. I'm looking for advice and am interested in knowing if anyone has experienced anything similar.

For some background, I had stable single-tonal tinnitus for years until I experienced acoustic trauma in December. I was on Propranolol (10 mg, 2-3 times daily) for about a week after developing Visual Snow Syndrome two weeks prior. I had never taken any pharmaceuticals before, and my tinnitus spiked from this. I made a mistake by blasting a tinnitus relief video at maximum volume on my phone speaker into my right ear. Within a week, I developed hyperacusis, with Loudness Discomfort Levels (LDLs) in the 60s dB. My long-term ringing got slightly louder in the affected ear, but there were no other changes. However, I immediately noticed dysacusis, which has mostly faded by now.

Two weeks later, I took Prednisone (25 mg), and after the first dose, I developed an intermittent tone in my left ear that hasn't gone away. Since it was a low dose, I was told not to taper, although, in retrospect, I probably should have. At the end of December, I developed severe noxacusis after listening to a song on my soundbar (not very loud, maybe 60-70 dB). This has led me down the polypharmacy trap, which I believe has caused all of this.

Medication History with Stable Tinnitus (December to March):

• Clonazepam (0.25 mg), twice daily for one week, with no taper in December. I developed noxacusis on the second-to-last day of using this.
  
  
• Clonazepam (0.25 - 0.5 mg) as needed thereafter, and I used it maybe 3 or 4 times from January to the end of March.
  
  
• Gabapentin (600 mg in January-March). I increased to 1,500 mg in about 2 weeks as directed in March. After about a month, I reduced it to 1,200 mg, then 900 mg three weeks later. I've stayed at this dosage since.
  
  
• Carbamazepine (200 mg) for a month in January. I stopped cold turkey as directed when I developed a rash.
  
  
• Baclofen (5 -10 mg) a few times over a week and a half period at the end of February/beginning of March.
  
  
• Clomipramine (25-50 mg). I stayed on 25 mg for nearly two months, then increased to 50 mg.

Things took a turn for the worse at the beginning of March. I had a severe incident and had to use NSAIDs for 2-3 days. During this time, I took 2 Advils + 2 Tylenols for 2 days, and on the last day, I took 3 of each plus 0.25 mg of Clonazepam and 5 mg of Baclofen. My tinnitus usually has a 'rebound' after Clonazepam that goes away the next day or, at worst, two days later, so I didn't think anything of it.

Two days later, I was half-asleep and, attempting to grab my blanket, I tipped over my exercise mat, which slammed on the floor loudly (I had foam earplugs in). My tinnitus developed a new tone within a minute or so (which had never happened before), but it went away after I went back to sleep. When I woke up again a few hours later, it was gone.

Since then, my tinnitus has been unstable. Some days, I wake up with some tones; others, I don't. In an attempt to calm this and noxacusis setbacks, I started using Clonazepam more (2 mg combined across four doses in the first half of April). After the fourth dose, I noticed my tinnitus was getting more unstable, so I decided to switch to the supposedly safer benzodiazepine, Valium. I was also interested in trying Riluzole (an extremely potent Glutamate antagonist) for my Visual Snow Syndrome, OCD, and its neuroprotective properties for tinnitus.

I had an appointment to leave my house for the first time in months a few days later and took 1 mg of Clonazepam along with Valium. Four days after my last Clonazepam dose, I tried Valium. Unlike Clonazepam, Valium did not reduce my tinnitus but lessened my noxacusis pain, so I continued with it. I'd take Valium after setbacks from noise and noticed I would get a temporary tone afterward. At the time, I mistakenly attributed this to the setbacks and not the Valium. Ignoring the warning signs, I noticed a reactive tone in my right ear two days after my fourth pill of 5 mg of Valium over two weeks. It only appeared for continuous noise, such as brushing my teeth. I thought nothing of it until I experienced another 'trauma' five days later when I pulled my musician's plug out too fast, causing an extremely loud pop. I panicked and took another 5 mg of Valium. Within 30 minutes, the tone reacted to everything.

I was oblivious to what was causing the reactivity, so I assumed it was from the 'trauma'. I had an at-home dentist appointment four days later and took 7.5 mg of Valium with no adverse effects, but I decided to do a micro taper after only having 5.5 pills over three weeks. Following my psychiatrist's instructions, I took 2.5 mg two days later and then 1.25 mg two days after that. However, three days after the micro taper, my spouse closed a door with the window open, causing it to slam shut at over 90 decibels. Despite wearing double protection, I panicked and took 2.5 mg of Valium as I didn't want to deviate too much and restart a taper. Again, within 30 minutes, I noticed a new brain-based reactive tone that fluctuated between one ear or both. Two days later, I took the last 1.2 mg of Valium and haven't touched it since.

This was around a month ago, and now I have extremely volatile and reactive tinnitus that I cannot explain. I haven't heard of this variation before. I have my baseline ringing, a low-frequency tone, and a reactive one in the right ear (the latter disappears in silence). In the left ear, there's an intermittent tone from Prednisone, along with another reactive tone that is always present. This one is peculiar, as it switches between the brain, left/right ear, or all three and changes daily in terms of frequency, volume, and intensity.

What really confuses me is that this tone is present most mornings and varies in how it presents itself daily. Depending on my daily noise exposure, I often end up with 10+ tones screaming in my head by the evening. The existing tones can even become tonal, increase their volume, or change their frequency!

Due to the severity of my loudness hyperacusis (30 dB LDLs) and noxacusis, I can't see how this was noise-induced unless the trauma weakened the pathways, and these events were the last straw. On the second day of noxacusis, I had around 50 dB LDLs and went in with double protection to get a CT scan done, and I was exposed to my car, which was above 95 dB, without any change in my tinnitus. Other than that, the loudest sound I have been exposed to in the last five months was that door slam with double protection in. Again, I don't believe this can possibly be noise-induced, but I am now thinking it was the benzodiazepines despite not using many of them. I'd like to think I have some hope since I don't think the volatility was noise-induced, but on the other hand, benzodiazepines truly are a wild card, even with low-dose usage twice a week for a few weeks.

I feel immense guilt for not researching that benzodiazepines can have paradoxical effects at random, and now I feel doomed. Even if, by some miracle, my Visual Snow Syndrome doesn't leave me blind and I can get a disarticulation to be free of noxacusis, I'll still be hopelessly trapped with this tinnitus. Again, sorry for the long post, but has anyone experienced such volatility like this? Has the tinnitus improved at all by some miracle?

TL;DR: I experienced acoustic trauma late last year, had stable tinnitus for the next four months, and after some setbacks from medium-level sounds and biweekly low-dose benzodiazepine usage for under two months, I now have catastrophic volatile and reactive tinnitus.