My Tinnitus Took a Turn for the Worse After a Visit to the Gym

[Backpacker]

Isn't PLF the same thing as the "third window" problem?

PLF is one of them. So is SCCD. PLF cannot be seen on CT. SCCD can usually be seen (but not on a regular CT, only on a HRCT of temporal bone). PLF is a tear on either round or oval window membrane.

And what about a membrane rupture inside the cochlea? Would a basilar membrane or Reissner's membrane rupture be referred to as PLF? Is it in the same category? Are the symptoms the same?

I don't know, if it is inside the cochlea and not between inner and middle ear, then it would not be referred to as PLF.

 

[Greg Sacramento]

When I was employed, we had a therapist that had association with Michael Weintraub of the New York Medical College who studied exercise per inner ear problems and tinnitus. I still have some brief notes about this. Regular exercise nourishes the auditory system and stimulates the release of endorphins.

Exercises that involve jarring movements and jumping should be avoided or at least wear very high impact shoes to absorb shock. High-impact jarring exercise and sometimes strain can cause inner ear dysfunction. Jarring of the head can cause or increase the otoconia to loosen calcium deposits out of place. This process from strain can also interfere or have association with the facial nerve or reverse. Also other related VII CN problems - processes - as well as small nerve networks of the face and neck.

Exercise is good for the heart, but with tinnitus and pulsatile tinnitus, too much can be a problem depending on physical problems. One treatment for when tinnitus or PT increases is to treat the circulation system, heart - hypertension.

 

[Samir]

PLF is one of them. So is SCCD.

PLF is a tear on either round or oval window membrane.

The oval window (OW) and round window (RW) are two of the normal windows or opening that are present in a healthy patient. So the so called "third window" appears when you have a third opening and this can present itself as SCCD or PLF?

I just want to get this straight. These terms are very confusing and ambiguous.

OW rapture: PLF
RW rapture: PLF

Third window: SCCD, PLF

So SCCD is a third window rapture but it's not the same as PLF?

It would be useful to have a Venn diagram right now.

I don't know, if it is inside the cochlea and not between inner and middle ear, then it would not be referred to as PLF.

Combined rapture? I found this article:
https://www.ncbi.nlm.nih.gov/pubmed/10100519

OBJECTIVE:

Hearing loss caused by combined rupture of Reissner's membrane and the round window (RW) membrane (the double-membrane rupture) may differ depending on the site of the lesion on Reissner's membrane. The purpose of this experimental study was to reveal the relationship between the hearing impairment and the site of the lesion on Reissner's membrane.

BACKGROUND:

According to experimental studies on perilymphatic fistula (PLF), profound hearing loss is not induced by rupture of RW alone, but by the double-membrane rupture. However, the mechanism responsible for hearing loss in the double-membrane rupture remains unclear.

 

[Backpacker]

The oval window (OW) and round window (RW) are two of the normal windows or opening that are present in a healthy patient. So the so called "third window" appears when you have a third opening and this can present itself as SCCD or PLF?

I just want to get this straight. These terms are very confusing and ambiguous.

OW rapture: PLF
RW rapture: PLF

Third window: SCCD, PLF

So SCCD is a third window rapture but it's not the same as PLF?

It would be useful to have a Venn diagram right now.



Combined rapture? I found this article:
https://www.ncbi.nlm.nih.gov/pubmed/10100519

RW membrane tear is PLF
OW membrane tear is PLF
That's it about PLF, either it is on the RWM or on the OVM.

Third window is technically SCCD but not only SCCD, there are several places where a hole can be, and there are doctors who claim PLFs don't exist (partialy because most SCCDs are visible on HRCT and PLFs are not) so that is why some doctors use the umbrella term third window. At least that is how I understood it.

I do not know about Reissner's membrane rupture. I guess it is possible to have them both ruptured at the same time but I don't know. I know that PLF can be on one of the windows, or on both windows, and even on both ears as well but this is more rare.

 

[Samir]

RW membrane tear is PLF
OW membrane tear is PLF
That's it about PLF, either it is on the RWM or on the OVM.

Thanks for clarifying. Here is my best attempt at illustrating this. It's not a Venn diagram exactly but it's something...

• PL: Perilymph
• EL: Endolymph
• OW: Oval window
• RW: Round window
• RWM: Round window membrane
• OWM: Oval window membrane

I tried to illustrate it to look like the entrance to the inner ear. So the PL is where perilymph is and these two ducts have natural openings into the middle ear, whereas endolymph is enclosed in its own duct and has no opening into the middle ear. So PLF is just a rapture of one of these two membranes. I used a green dot to illustrate a hole in a membrane.

Third window is technically SCCD but not only SCCD, there are several places where a hole can be, and there are doctors who claim PLFs don't exist (partialy because most SCCDs are visible on HRCT and PLFs are not) so that is why some doctors use the umbrella term third window. At least that is how I understood it.

I see. With emphasis on "some doctors", right? Why believe in something you cannot see, right? I wonder what these doctors have to say abut tinnitus... does it exist? Or is this also just in our heads? Well... technically it is... ever since they realized that it's wrong to believe in their own dogma that tinnitus is in our ears. They still can't see it, but that's beyond the point. The point is, they readily believe in what they are told to believe by their superiors, even when they have no visual or other form of evidence for it. Yet when a patient presents a description of symptoms and medical history, they readily dismiss it if it doesn't agree with the medical books. Change of mind is very difficult... for some people it's impossible.

I do not know about Reissner's membrane rupture. I guess it is possible to have them both ruptured at the same time but I don't know. I know that PLF can be on one of the windows, or on both windows, and even on both ears as well but this is more rare.

So basically... in conclusion, we are left with this:

Hole in a membrane.

• PLF
• OWM
• RWM
• (Possibly Reissner's and basilar membranes.)

Hole in a bone.

• SCCD
• (Possibly other hole formations in temporal bone.)

I used the word "hole" but it's the same as a rapture or a tear I guess. Also, it should be noted that most of these membrane raptures or holes appear to be healing on their own. Rest is the preferred treatment option.

 

[Backpacker]

Why believe in something you cannot see, right?

Not all doctors know how to diagnose or treat these conditions.
It is easy to say "everything is OK" especially if patients cannot prove their symptoms (some holes are not visible on CT, nystagmus is present only with vertigo, not with subjective dizziness, not with derealisation or a loss of focus).
All of these third windows' symptoms are similar and all of them can cause auditory or vestibular disturbances (and some of them pressure headache, visual disturbances, cognitive impairment) and it is difficult to fugure out what is what.
If after a month and a half of "head elevated, no straining etc" the symptoms don't reduce on their own, and if vestibular symptoms are severe, doctors might have to do a surgery, and the surgery does not guarantee a permanent fix even if they know where the hole is, some people later do 5-6 surgeries if the symptoms reoccur due to another pressure altering event, acoustic trauma, hit in the head etc.
By the way there are some German studies which showed 30% of patients with SSHL had PLF confirmed at the exploratory surgery (patching of the oval/round window) but then again, what with these 70%? They underwent unnecessary surgery (It is possible some of them had a fistula which started healing but still).
And that is why I am saying if people have SSHL and/or weird vestibular symptoms etc which start immediately or gradually after a severe acoustic trauma, scuba diving, airplane barotrauma, upper respiratory infection, weightlifting, excessive straining, hit in the head etc, and their doctors don't see anything, they should try sleeping in a reclined position and restrain from anything that can slow down spontaneous healing of a potential tear/rupture.

 

[Reggie123]

Hello, so I am new here but I feel the pain most are going through. I too love to plank but since my tinnitus started in my left ear only back in February 2020, if I plank it becomes very loud.

From everything I've been able to determine this has to do with neck and jaw tension. The neck tenses up and pulls on the jaw, the jaw then irritates the TMJ joint that sits directly next to the ear canal where many nerves pass through.

It may be that your original tinnitus is caused by an injury and these new sounds may come from a new condition. I know that sounds awful but what you are describing after working out is what I have experienced but I have no injury to my eustachian tube. And I've had the MRIs.

As a test to determine, get in a hot shower and let it run on the effected side of your neck for at least a half hour. Do the sounds improve? If so that suggest neck tension is probably the cause or a factor at least.

Dr. Jay Hobbs of Synergy on YouTube has a video for testing if your tinnitus stems from your neck. They also want an expensive $95 for a PDF that shows you what muscles to massage to lessen or stop the tinnitus. I haven't yet payed for that.

One of the reasons I believe, at least mine and many others, tinnitus stems from neck tension is because mine started when I had a neck/jaw injury. And while seeing a PT my neck was non-stop massaged for about 40 minutes one visit and it took my tinnitus away completely. Of course it returned but it put me on the path of fixing my neck first.

Anyway, I am only sharing this in hopes that it helps someone desperately reading this forum trying to get their life back. Or maybe some of you know more about this than I?