Confusion and Misery After Labetalol Made Tinnitus Much Worse

[Jo Jackson]

Hi Dr Nagler,

First of all can I thank you for taking the time to respond to people's questions.
I am new to the site, I have been searching for answers for over a year now, I hope you may be able to help even a little.

My problem started in December 2018. I started hearing a constant buzzing in my head after a heavy cold. I presumed this would go away but didn't, it only got worse. I have chronic kidney disease stage 3 and have been on labetalol for 24 years. My labetalol was doubled in February last year and the noise in my head became unlivable. I managed for a couple of months before my doctor reduced it back down. This improved the noise and the weird feelings in my head somewhat.

It's so hard to explain, I have a constant electrical buzzing, which is louder at certain times. It seems to be much, much worse after a hot bath, exercise, stress, alcohol or on the day after I take zopiclone at night. (I take 7.5mg on 2 nights per week for insomnia caused by cptsd) the noise moves from side to side when I move my eyes, it often pulses with my heartbeat and feels so loud I feel my head may explode.

The doctor has tried steroid sprays, oral steroids and the ENT consultant gave me antibiotics and told me to get on with it. None of these have made any difference, in fact it is worse after the antibiotics.

Is it definitely tinnitus? It feels like it is in my brain not just my ears and if so could it be caused by medication? The doctors here in the UK don't seem to take it seriously but it really is scaring me so much and ruining my life. Hopefully you can help a little, but if not thanks for listening.

 

[Dr. Nagler]

Hi Dr Nagler,
First of all can I thank you for taking the time to respond to people's questions.

Glad to help as best I can. Like it says in my sig line: "The best way to find yourself is to lose yourself in the service of others." I really believe Gandhi's words there. And I believe that at 71 years of age, it is not too late to work on finding myself.

I am new to the site, I have been searching for answers for over a year now, I hope you may be able to help even a little.

@Jo Jackson, I'll give it my best shot.

My problem started in December 2018. I started hearing a constant buzzing in my head after a heavy cold. I presumed this would go away but didn't, it only got worse. I have chronic kidney disease stage 3 and have been on labetalol for 24 years. My labetalol was doubled in February last year and the noise in my head became unlivable. I managed for a couple of months before my doctor reduced it back down. This improved the noise and the weird feelings in my head somewhat.

Beta-blockers like labetalol can cause a tingling sensation in the scalp, but I am unaware of them causing the type of constant buzzing sensation within the head that you describe. Indeed the fact that you were on labetalol for more than twenty years prior to the onset of your symptoms makes it highly unlikely that it actually caused the buzzing. The fact that the buzzing increased when your dose was increased is of some interest. Perhaps increasing the dose aggravated the buzzing? But in any event you are back to the status quo both in dose and in symptomatology sort of makes that a non-issue. I guess you can ask your doctors to switch you to another beta-blocker just to see if the buzzing goes away - but I'm not so sure that it's worth pursuing from that angle since you have been otherwise doing well on the labetalol for so many years.

It's so hard to explain, I have a constant electrical buzzing, which is louder at certain times. It seems to be much, much worse after a hot bath, exercise, stress, alcohol or on the day after I take zopiclone at night. (I take 7.5mg on 2 nights per week for insomnia caused by cptsd) the noise moves from side to side when I move my eyes, it often pulses with my heartbeat and feels so loud I feel my head may explode.

Well, the first thing I would do if you were my patient would be to take you into a very quiet room (like an audiology booth) and listen carefully all over your head with a stethoscope to see if I could detect the buzzing myself. If so, that would make me think it might be related to blood flow, especially because it has a pulsatile quality to it. And if I were very concerned in that regard, I might order an MRA (Magnetic Resonance Angiogram) even if I could not detect it with a stethoscope. I am not saying this to alarm you in any way - because even if you had an MRA performed, it would most likely be normal. But it might give you some answers nonetheless, and here in the US that would probably be the next step in your work-up.

Is it definitely tinnitus?

It is either tinnitus or it is a somatosound. Either way, clearly it is bothersome to you - and I suspect you would like a better answer than "Get on with it." In my opinion you certainly deserve a better answer if there is one to be had.

It feels like it is in my brain not just my ears and if so could it be caused by medication?

In my experience the particular location of the sound is not a predictor of whether or not it is caused by medication.

The doctors here in the UK don't seem to take it seriously but it really is scaring me so much and ruining my life.

In the final analysis healthcare is a service industry, and it does not sound to me that you are getting particularly good service - not when your doctors don't seem to take your symptoms seriously. If you take them seriously, then your doctors should! As I see it, anyway.

Since your doctors do not take your symptoms seriously, perhaps you should consider finding a doctor who will! I am not in any way suggesting that your symptoms represent something that is a threat to your health. I do not know enough about your situation to draw any conclusions one way or another in that regard. I do, however, think you deserve some better answers than you are getting.

All the best -

Stephen M. Nagler, M.D.