Second Acoustic Trauma: Seeking Advice on Ear Fullness/Pressure

Hi Tom,

Thank you for the information. Now that I know more about your tinnitus, I suspect it may have been caused by exposure to loud noise. If you frequently used headphones, earbuds, or a headset—even at low volumes—or attended places with loud music before your symptoms began, this could suggest noise-induced tinnitus. If you're experiencing hyperacusis or sensitivity to sound, this further supports my suspicion. Exposure to loud noise is one of the most common causes of tinnitus.

The fact that you are, or used to be a DJ and have noticed increased pressure in your ears is another indication that your symptoms may be due to loud noise exposure. Some believe that wearing earplugs, even high-end custom-molded ones, will protect them from making their tinnitus worse. Unfortunately, this isn't always the case.

In my opinion, someone with tinnitus playing loud music as a DJ or attending events with loud music is not a good idea. External sounds can pass through the skull and reach the inner ear via bone conduction if external sounds are loud enough. If someone's tinnitus spikes, they might be lucky enough for it to return to baseline within a short time. However, frequent exposure to loud music increases the risk of permanently worsening tinnitus. I apologize for sounding so serious.

I've spoken with others who have noise-induced tinnitus, who have experienced pressure in their ears and muffled hearing. They believed this was caused by attending loud venues or listening to audio through headphones. When they stopped going to such places and discontinued headphone use, their symptoms improved.

I advise you to stop DJing if possible and stop listening to audio through headphones.

Please remember that overusing earplugs and avoiding normal, everyday sounds will not improve your symptoms. I suggest you see an audiologist specializing in tinnitus and hyperacusis management. You may also need hearing aids.

I wish you well,
Michael

 

Update:

Today, I had an appointment with another ENT specialist. She is well-known in the area for treating Eustachian Tube Dysfunction and was the first to suggest that fluid behind the eardrum, in my case, could be a result of acoustic trauma. She explained that as a natural defense mechanism, the inner ear muscles tighten, reducing the elasticity of the eardrum to prevent excessive noise from passing through when exposed to very high decibel levels. As a result of these tightened inner ear muscles, the Eustachian tube can close, causing fluid to build up behind the eardrum.

During today’s examination, the ENT noted that there is still some remaining fluid behind my right eardrum. She also examined my Eustachian tubes by using a camera to look deep into my nose. My left Eustachian tube appears normal, but my right one, despite the Valsalva maneuver working fine, still has significant swelling.

She advised me to continue using cortisone nasal spray to speed up the recovery of the inflamed Eustachian tube and suggested I wait another 2-3 months. This gave me a bit of hope that the pressure in my right ear might improve once the remaining fluid drains through the Eustachian tube after the inflammation subsides.

However, I’m concerned that the Eustachian tube is still swollen two months after the acoustic trauma. It seems like a long time for the swelling to heal, especially since I’ve been using the cortisone nasal spray daily. I’m unsure why the swelling persists.

The ENT also reminded me that ears need more time to heal, advising me to be patient and shift my focus to something else. Interestingly, she shared something I didn’t know before: if you have some hearing loss but the hair cells are still intact (for example, at 40 dB), the brain can adapt over time. Even damaged, though not completely destroyed, hair cells can recover somewhat because the brain changes its perception to compensate.

 

I hope she's correct with her theory; then the chances for better recovery would be intact. The idea of a tense eardrum could be accurate—I’ve had that feeling several times myself in my 20-year history of ear issues. I often experienced the sensation of a stiff eardrum after exposure to "noise" that was still far from being mechanically damaging. But then again, hearing is so complex that it’s currently impossible to say how something like this might regenerate.

 

Hi @matt89, how are you doing now? How's the ear pressure? Is the nasal spray helping?

I'm in a similar situation. I have hyperacusis and tinnitus due to acoustic trauma, along with ear fullness. The symptoms are very similar to what you're experiencing. I’m considering trying the nasal spray if it's working for you. What brand are you using?

Wishing you continued recovery.

 

For what it's worth, I am a little over four months post-acoustic trauma, and I've definitely noticed that, over the past few weeks in particular, the feeling of aural fullness has reduced. There was also secondary tinnitus and some reactivity that accompanied it, which now feels about 50% better than it was when it first started, and even compared to how it was throughout August. I’m not sure whether to attribute this improvement to natural healing or the nutraceutical protocol I’m following from NeuroMedCare, but it has been a welcome relief.

Next week, I’m seeing an ENT at the University of Minnesota-Twin Cities, where Dr. Hubert Lim has worked. Their website mentions more in-depth tinnitus care than a typical ENT would provide. One part of the website even discusses treating tinnitus using somatic stimulation, similar to the research Dr. Lim has conducted at the U of MN (which, I assume, is why the Lenire company hired him to lead that area). I’ll ask the ENT about the idea you proposed, @matt89, regarding the possibility that the eardrum may still be tensing up, retaining fluid, or causing inflammation in the Eustachian tubes.

 

I'm sorry to hear you're in a similar situation. Hang in there—you have a great community here to support you!

I'm not much better, even after 2 months and 3 weeks since the event. The first two weeks were a disaster because I had fluid behind both eardrums, though the fluid is almost gone now. The feeling of pressure has decreased slightly over the last six weeks, maybe by 20%, but definitely not by 50% (I would have noticed that).

I've also noticed a fluttering sensation in my ear sometimes when I hear sounds or music. This is most likely a spasm of the tensor tympani muscle (commonly called TTTS). It’s slowly improving over time. I've read stories from people who had severe TTTS, and after gradually exposing themselves to normal sounds again, it got better over the course of a year.

The fact is, ears need retraining after an acoustic trauma. You have to build up a new noise tolerance—slowly and carefully, but it's essential for recovery. I started exposing my ears to normal sounds two weeks after my acoustic trauma. I carry earplugs with me all the time as a backup.

One thing that helps me a lot is shifting my focus to something else and staying busy when I notice the fullness setting in. When I'm distracted, the fullness and pressure fade from my mind.

I'm still wondering what causes the sensation—is it inner ear issues (like cochlear inflammation), muscle spasms in the inner ear, or possibly a swollen Eustachian tube preventing proper air ventilation?

I'm also taking the following supplements daily to support my recovery:

• 500 mg Magnesium Chelate and 500 mg Magnesium L-Threonate
• 200 mg Ubiquinol (Coenzyme Q10)
• 240 mg Ginkgo Biloba (Extract EGb 761)
• Vitamin B coenzyme complex
• Vitamin D and other essential vitamins in a complex

If you're early in your symptoms, you could try HBOT (Hyperbaric Oxygen Therapy) sessions. I did seven 2-hour sessions within the first five weeks of my symptoms. It's hard to say if it helped, but I did it more out of desperation due to the severity of my symptoms (“Here’s my money, give me that high dose of oxygen!”). The US Army uses HBOT for soldiers right after an acoustic trauma, and it seems to be effective if done early.

I’ve also started ear training with my favorite music. Every day, during my 30-minute drive to work, I increase the volume slightly each week. From what I’ve read, this seems to be very effective in the long run. It teaches your brain that music and sound are positive experiences. Listening to your favorite music boosts serotonin levels, which helps your brain readjust and perceive louder sounds as positive. The key is to increase the volume slowly and carefully over time, so the brain loses its fear of loud sounds and builds up new noise tolerance.

Pink noise is another good therapy option, though it doesn’t boost serotonin levels like music does. I listen to pink noise occasionally, but not every day.

Wishing you all the best in your recovery!

Matt

 

The nasal spray I'm using is from a German brand called MometaHEXAL, with the main ingredient being Mometasone furoate. I don't think there's a significant difference if you choose another brand containing the same active ingredient.

It's best to use the spray before going to sleep, with two puffs per nostril per day. According to the package description (if available), the effect of the cortisone nasal spray typically takes about two weeks. I haven't noticed a significant difference yet, but I'm continuing to use it because my right eustachian tube is still swollen, as confirmed by my ENT.

Eustachian Tube Dysfunction (ETD) is a common side effect of acoustic trauma, and it can take a long time to heal. Acoustic trauma can cause ETD due to muscle trauma related to the inner ear. If the tensor tympani muscle isn't functioning properly, the eustachian tube may develop swelling or dysfunction as a result.

 

It's great to hear that the feeling of fullness is improving over time!

I suggest asking your ENT to check your Eustachian tubes through your nose. They can quickly determine if a Eustachian tube is swollen. Eustachian Tube Dysfunction (ETD) can cause a lot of issues in the ear, such as a feeling of fullness, pressure, and muffled hearing. Ruling this out is important, as it increases the likelihood that the fullness and pressure are coming from your inner ear (due to cochlea inflammation, which has no pain receptors and can cause a feeling of fullness) or from muscle spasms, most likely a tightened or tensed tensor tympani muscle.

By the way, a tympanometry (which measures the pressure in your middle ear) cannot detect Eustachian tube swelling or dysfunction:

(Source)

 

Update:

Today, I had my last appointment for now, this time with the director and professor of the ENT clinic where I’m a patient. We spoke for half an hour about various things. Here are his key points:

• He doesn’t believe I ever had fluid behind my eardrums, even though one of his colleagues diagnosed it and documented it. In his opinion, fluid behind the eardrums can never result from acoustic trauma—it’s just not possible.
  
  
• He also mentioned that examining the eustachian tube through the nose can detect swelling, but only about 20% of the tube is visible that way. So, detecting swelling in this area doesn’t necessarily indicate anything significant. If the Valsalva maneuver works properly, air ventilation is functioning, meaning the visible swelling doesn’t imply there’s dysfunction. It’s just one part of the puzzle, and in my case, the Valsalva maneuver works fine, so there’s no dysfunction.
  
  
• He advised me to give it another six months, and I’ll likely look back and laugh at this experience, as if it never happened. He assured me that ear pressure or fullness, whether due to a physical or psychosomatic cause, doesn’t last forever.

What do I think about this?

Medical professionals often have differing opinions and debate these matters. (As a lawyer, I understand what it’s like to debate varying opinions.) In terms of fluid behind the eardrums, there’s room for debate since many inner ear mechanisms are still not fully understood.

Given his experience, I hope and believe he’s right in saying that things will be much better—or even completely resolved—in six months. Most success stories I’ve read emphasize that time is the most critical factor in recovering from acoustic trauma with inner ear damage or inflammation. Many members who posted here have left the forum after a while (hopefully returning months or years later to share their success stories). This suggests that, for many people, things either improve or the brain adapts and learns to ignore it, like a software update.

 

Great news about your progress. Best wishes for your Dr. Lim's visit. Please let us know what you hear from him.

 

Thanks for the update. I picked up Flonase and Zyrtec from my local CVS today. I’ll give them a try and hopefully get some relief from this.

When I visited the ENT, they performed a tympanometry test and told me that my eardrum movements are normal. Does this mean my hyperacusis is not caused by muscle movements in the ear or TTTS, and is instead nerve-related?

 

Ah, I'm just hoping I can get referred for whatever in-clinic treatments they may have available—not with him directly, unfortunately. I'm not holding my breath, but I figure being in their system can't hurt.

 

Thank you for the update. I also asked my ENT if acoustic trauma could lead to fluid in the middle ear, but he said it's rather unlikely.

I'm now in week 9 after my setback from the DJ event, which I attended with custom-made, high-attenuating silicone earplugs, yet I still ended up having issues, especially with tinnitus and ear pressure.

Things have improved a bit: I can distinguish sounds and sound sources better again, and the differences in volume levels are becoming more "normal." Unfortunately, the tinnitus has gotten louder. The pressure A (which might be TTTS) has slightly decreased, but the pressure B on the left side—feeling more like Eustachian tube dysfunction and cracking three times during pressure equalization—has worsened again.

I had something similar 10 years ago, and back then it took about 18 months for pressure A to mostly disappear.

Time and patience are, unfortunately, the most important factors. But that's exactly what’s so exhausting... I’m completely drained of energy right now.

I believe TTTS can't really be measured, unlike Eustachian tube dysfunction. For example, if I had TTTS caused by my hyperacusis, it wouldn't have been detected during a hearing test. However, I hope it's a muscle causing this pressure sensation because, at least in that case, it can relax again.

 

@tomytl, thanks for the clarification on TTTS.

When I visited my PCP while waiting for my ENT appointment, I was told the same thing — that my tinnitus symptoms are due to fluid buildup in the middle ear. While researching this, I came across a condition called Endolymphatic Hydrops, which is fluid buildup in the inner ear. I read that, in rare cases, it can happen due to acoustic trauma.

However, my ENT ruled this out. I just wanted to bring it to your attention.

 

TTTS (Tonic Tensor Tympani Syndrome) is not caused by hyperacusis, but hyperacusis can be a result of TTTS. I also experience it in my right ear. There's a fluttering sensation inside when I hear sounds, and it's not my eardrum—it's a muscle spasm caused by the acoustic trauma I had. The tensor tympani muscle still tries to protect the inner ear and pulls on the eardrum, creating this odd sensation.

Exposing yourself to sounds and music can help with the recovery of TTTS because, over time, your brain may instruct this muscle to stop after you've retrained your auditory system and built a new tolerance for noise. For most people with TTTS, it improves with time.

I read your story, and it’s very similar to mine. I either forgot my earplugs at home or didn’t use them because I thought I was fine. In your case, it was a concert; in mine, it was a friend's wedding party. I even asked him to lower the volume, but he didn’t. I ended up cutting off contact afterward because, to me, friends who don’t take responsibility in such situations aren’t real friends. I would have lowered the volume if someone had asked me at my event.

Not bringing earplugs to that event is one of the biggest mistakes of my life. It was stupid, but I can’t blame myself entirely—I felt safe because all my friends were there, so I instinctively thought there wouldn’t be any risks.

Like you, I also have kids, and I struggle because I sometimes have to use earplugs when things get too loud. I hope that one day we won’t need earplugs anymore and can fully enjoy our time with our kids again.

I became a member here years ago, back in 2016, because this wasn’t my first acoustic trauma. I recovered within a year after my first incident, though I didn’t have issues with aural fullness back then—just tinnitus and hyperacusis. Without that experience from 8 years ago, I would be worse off now. Having dealt with ear issues in the past has made me more confident in managing the symptoms, although it’s still challenging at times. But I can see light somewhere on the horizon.

 

Yes, I have heard about Endolymphatic Hydrops.

Could Tonic Tensor Tympani Syndrome (TTTS) occur in people who have previously experienced severe hyperacusis (in my case, 20 years ago and again 10 years ago), causing the tensor tympani muscle to be affected for weeks after a new loud event? I often feel a strange pressure that fluctuates—sometimes mild, sometimes more intense, and occasionally extreme. Although it feels similar to Eustachian tube dysfunction, it apparently isn’t.

As I mentioned, about 10 weeks ago, I attended a DJ event and wore high-quality, custom-made earplugs. However, I believe that bone conduction still strained or overwhelmed my sensitive hearing. This experience has led me to recommend that anyone who has recovered from hyperacusis should avoid attending concerts altogether. While I had success a few times, the last experience was different, and it’s simply not worth the risk. After all, you can always watch concerts on YouTube.

 

I’m so sorry you're experiencing this again. I’m frustrated with myself, too, but I’m trying not to be too hard on myself. It’s not easy because the change can feel so overwhelming and life-altering.

I’m optimistic that handling things better day by day is starting to help me ease back into my regular activities, just with more precautions in place. I hope you keep moving in that direction, too!

 

Concerts are too risky. I haven’t attended one since my first acoustic trauma eight years ago. If you’re experiencing TTTS (Tonic Tensor Tympani Syndrome) symptoms, such as a fluttering sensation when you hear music, the likely cause is the DJ event from 10 weeks ago. Even though you wore earplugs, your inner ear muscles might have reacted to protect your ears.

TTTS often occurs after acoustic trauma because the inner ear muscles fail to relax once the protective mechanism is triggered. It’s similar to an airbag in a car: once deployed in a crash, the airbag can’t be reused and needs to be replaced. In my opinion, the protective mechanism of the inner ear muscles, particularly in response to high decibel levels, is extremely sensitive. Muscles like the tensor tympani are small and responsible for fine motor tasks, such as managing the eardrum's elasticity for accurate sound transmission to the cochlea.

Now imagine sounds at around 140 decibels or higher reaching the ear. The protective mechanism will activate, but these delicate muscles aren’t designed for such extreme noise levels, which are human-made and not natural. The loudest natural sounds, like a crying baby or thunder nearby, can reach 120-130 decibels. Interestingly, our ear’s pain threshold begins in this same range, aligning with the loudest sounds found in nature.

I believe that around this threshold, the tensor tympani can recover. However, at higher decibel levels, while the protective mechanism kicks in, the muscles become so strained that their recovery may take significantly longer—or might never fully happen.

Day by day is the way to go! Building new noise confidence and tolerance for your auditory system takes time and can't be achieved overnight.

 

Thanks for your message.

I wasn't exposed to any noise above 95 dB, and I wore my custom-made silicone earplugs with maximum attenuation, as I always do at louder events. However, this time it still seemed too much, possibly due to the bass being transmitted through bone conduction. I'm hoping now that the tensor tympani muscle has tensed up and will return to normal over time. It has improved slightly—I’m hearing a much wider dynamic range again—but I still feel pressure in my ears.

Yes, I know it takes time, but I’ve decided I’ll never attend a concert or similar event again. It’s just not worth it if it leads to hearing issues afterward.

 

I wanted to follow up on my appointment today.

I visited the University of Minnesota-Twin Cities ENT clinic, which has a tinnitus practice. Here are some interesting bullet points:

• The U of MN is conducting an ongoing clinical trial focused on neuromodulation. The clinician I worked with didn’t have specific details about the trial, and they are not currently accepting new patients. However, they mentioned it evolved from research led by Dr. Hubert Lim several years ago. The clinician said they would add any tinnitus patients to a file for the research team to review if/when new trials begin. They also shared that the research originated while studying deep brain stimulation for Parkinson's disease, where some patients with both Parkinson's and tinnitus experienced a resolution of their tinnitus.
  
  
• The clinician was at least familiar with the concept that a migraine protocol could modulate tinnitus. They mentioned (without prompting) that this is a possibility if the tinnitus fluctuates. They plan to refer me to their neurology department, which focuses more on this aspect of tinnitus. While the clinician didn’t feel comfortable prescribing Nortriptyline through the ENT department, they said neurology could conduct a more thorough work-up that may lead to that treatment.
  
  
• On my audiogram, they found a notch between my left and right sides at the 6000 Hz frequency, which also matches the frequency of my tinnitus. While this was still within the "normal" hearing range, there was a 15 dB difference between my left and right sides. This could explain why I hear more ringing on my left side at that frequency. They suggested I could try a hearing aid specifically tuned to that frequency for my left ear to see if it helps reduce the tinnitus. They also mentioned getting custom-molded earplugs.
  
  
• The clinic is relatively new, housed in a building that opened in 2021. Their otoscope is connected to televisions, so I could see what the doctor was viewing during the examination—something I had never experienced before. It was fascinating to watch.
  
  
• They mentioned Lenire, which is currently on the market, but noted that their clinic does not promote it and typically does not recommend treatments that require out-of-pocket expenses.
  
  
• I brought up Tinnitus Quest as a new initiative focused on funding research. The clinician agreed that more research is greatly needed in this area.
  
  
• The audiologist wanted to perform a "loud beep" test at 85-95 dB, which I politely declined

Overall, I’m glad I made this appointment. It’s reassuring to know there’s a local clinic that focuses not just on TRT and Lenire, but also on emerging research for a potential cure.