Sudden Onset Tinnitus 4 Weeks After Head Trauma / Mild TBI — My Story So Far

Hello Tinnitus Talk community,

I've been lurking, reading, and finding hope in all the Success Stories from this amazing community. I thought it was about time to introduce myself and try to contribute to this extensive vault of information about tinnitus and ear issues. For the sake of brevity, I'll try to sum up everything as much as possible and include keywords for the search results.

On March 20th, 2024, I suffered head trauma / mild TBI after an accident while riding an electric Lime scooter. I slipped and hit my forehead on the metal handlebar and hit my occipital lobe when I fell backward. This caused fractures in the orbital floor of both eyes and an occipital fracture in the back of my head. There was internal brain bleeding and a cerebellar contusion. I was hospitalized on March 21st, 2024, and discharged on March 25th, 2024.

On April 20th, 2024, I woke up in the middle of the night with muffled hearing; my ears felt stuffy and clogged. During the day, I noticed a large discharge of earwax. The next night, I woke up in the middle of the night again with similar symptoms and some ear pain on the left side. That same morning, I started hearing a very loud ringing in my left ear. At the moment, I didn't pay so much attention because I had so many other symptoms from my head trauma that were a priority to take care of. Around this same time, I started experiencing parosmia, and some flavors started tasting distorted or different. As head trauma is such a complex injury, I thought they could have been related and didn't pay too much attention to it.

During the week after the onset, I noticed that the ringing would only get loud when I was lying down or sitting down. It was a very difficult week since I had to rest to recover from my injury, yet I couldn't stay still for long.

At the time, I had an appointment with an Ear ENT who specializes in head trauma, but I would only be able to see him one month later; this included a Vestibular Evaluation and an Audiometry prior to seeing him.

I did what anyone would do and got an appointment with the earliest ENT I could find. This first ENT told me that my ears were fine and that I should download an app with white noise. I did audiometry in his office. They found mild hearing loss in my left ear. He said that was the reason for the ringing and that I should get used to it.

As the following week went by, my symptoms intensified: I couldn't equalize my ears, I had fleeting moments of pain in my left ear, swollen lymph nodes in my neck, the feeling of water or liquid inside my ears, and the feeling of talking inside my head. When I tapped my head, it sounded as if I was tapping a drum. The same happened with my changes in taste and smell. I knew it was time to get a second opinion immediately.

The second ENT did a more thorough evaluation that included using a camera to watch inside my nose and diagnosed me with Eustachian Tube Dysfunction. He squirted a decongestant liquid inside my nose with a pressurized hose, prescribed me a 6-day Medrol Pak (Methylprednisolone), and gave me three refills. As I mentioned the smell and taste issues, he suggested I probably had COVID-19 after my hospitalization or some viral infection. He told me that the hearing loss from the audiometry was normal and wouldn't cause tinnitus, much less at my age: 41 years.

After I began taking the Medrol Pak, I experienced immediate relief about 24 hours later. The ringing during the day disappeared, the liquid from my ears drained, and the feeling of stuffiness resolved completely. When I woke up in the morning, I could only hear a slight staticky noise inside my head. My taste and smell slowly started coming back. After finishing the Medrol Pak, I thought my crusade was over.

About ten days later, the ringing came back in full force, desperate. I reached out to the second ENT and asked him if it was OK to do a second Medrol Pak. He said yes, it's not ideal, but if I had experienced complete resolution of symptoms, I should give it a shot. So I did. Two days later, everything was gone again. My sense of smell and taste were almost fully recovered; as of today, I'd say they are 99% recovered.

As I was finishing this Medrol Pak, I went to the appointment with the original ENT, who specializes in Head Trauma. He reviewed all the CT and MRI scans I had done and prescribed another Inner Ear MRI scan. I was still experiencing dizziness and very mild vertigo from the injury at the time. This was a 90-minute appointment that included his experience with head injury (he is a professor at the local university), the contribution of a fellow who is studying under him, and my wife (who happens to be a family physician). He believes the hearing loss is so mild that it can't be responsible for the tinnitus. Also, that's within the normal parameters.

He then decided to do five Dexamethasone shots in my left ear, spaced every two weeks. He believes there's inflammation of the auditory nerve potentially caused by the head trauma or a viral infection, but he can't be sure. What he can be sure of is that, due to the symptoms, it's the auditory nerve.

A couple of days after the intratympanic steroid injection in my left ear, I experienced 90% remission of all dizziness and vertigo that were still lingering after the head injury. Particularly when lying down on a flat surface. About a week later, I began experiencing silence for the first time in almost two months, to the point that I started getting confident that it would eventually clear up with this treatment.

I also visited my Primary Care / Family Physician a few days after the steroid injection; I needed to start making sense of all this. I told him the whole story, and he agreed that the most likely cause for the ringing was inflammation and that it was probably connected to the head injury, even if it manifested itself a month later. I should be patient, and it will heal with time. He prescribed Nasal Steroids and Zyrtec (Cetirizine) daily. I am due to see him again in July.

My tinnitus now goes on and off. It's somewhat quiet and can mostly be heard in absolute silence. When this whole ordeal started, it was a 5/10. Nowadays, it lingers between a 0.5 and 1/10. Sometimes, it spikes to a 2/10 but then settles back. I am now even able to hear the ringing in my right ear at times, which is very quiet.

As of now, I am a bit scared that it will come back in full force; I can't deny it. I noticed I've been sleeping better and haven't been waking up three or four times a night as in the early days.

I am visiting the ENT tomorrow for my second Dexamethasone injection. I will ask to have a shot in my right ear as well as update this thread with the results, hoping it could help someone else who experiences a similar situation in the future.

As a side note, I also visit an acupuncturist once a week and take herbal supplements. He used to be a Traditional Chinese Medicine ENT in China; he practices acupuncture here in the US. I have also noticed that getting back to working out and getting my heart rate up after being sedentary for so long is helping with healing the ears. This could be a pure placebo, though. I take Melatonin and Magnesium every night before bed, which still regulate my sleep cycle post-injury.

 

Jun 21, 2024 update:

Yesterday, I had two intratympanic Dexamethasone injections, one in each ear. I am unsure about the dosage used and cannot find any information about it in the doctor's notes. The previous injection was 60 mg.

For those who are not familiar with the process, a very fine needle is used to pierce the eardrum and deposit a small amount of steroids (or antibiotics) into the middle ear. The liquid is expected to drip into the inner ear through the round window. The procedure takes about 10 minutes and is mildly painful. During the procedure, you are advised not to swallow or talk to prevent the liquid from dripping into the mouth through the Eustachian tubes.

Results are not immediate; at least they weren't in my case. With the last injection, it took roughly seven days to start experiencing improvements. This was specific to my condition. The doctor offered weekly shots, but since my body appeared to respond a bit later, we settled on having the next three injections every two weeks.

One day later, the first effect of the injection resolved the very mild ringing in my right ear. It also slightly reduced the volume in my left ear, which is the side where I have the most issues.

A few hours after my doctor's visit, I went to my acupuncture appointment. I have two more appointments scheduled, as they seem to be helping; I have completed four sessions so far. During this session, I experienced intermittent silence. The TCM doctor focused particularly on the ringing yesterday, as all my other symptoms have already resolved.

 

I hope everything works out for you and that you get back to silence.

 

Thank you so much. I hope yours goes away as well!

June 25, 2024 update:

A few days ago, everything seemed to be on the right track. I posted my last update in the morning, but throughout the day, I experienced some side effects from the steroids, including GI distress, hiccups, and reflux. By the following day, these issues were resolved. I believe some Dexamethasone might have dripped through my right Eustachian tube into my throat, causing these problems.

For the past four days, I've had trouble getting a full night's sleep, waking up at 2:00 am and 6:30 am like clockwork. I've experienced this same pattern before when I was on oral Methylprednisolone, along with jaw muscle pain extending into my temples. Steroids also have an emotional impact on me, making me feel depressed or sad.

The most notable benefit so far is that all remaining dizziness and vertigo have been completely resolved with these two shots. I'm truly grateful for that, as dizziness can be debilitating and scary, striking at any time and place.

Now, onto the details:

The Right Ear (originally with very mild ringing):

The ringing in this ear went into overdrive on Saturday (two days after the injections) and didn't stop until Monday. It was a high-pitched sound louder than anything I've ever experienced, especially when lying down. It was tough on my nerves and made me question whether I had made the right decision to get the steroid shot in this ear. Fortunately, today, it's very mild, although still not back to where it was pre-shot.

The Left Ear (the troublesome ear):

This ear also got louder on Saturday, but it wasn't as bad. I've experienced increased sensitivity to loud or monotonous sounds, like fans. Today, it feels better, and I struggle to hear the ringing except in a very quiet room. It's still present with a weird staticky/hissy/foamy vibe but isn't super intrusive. After the first injection in this ear, I experienced a very odd new sound for a few days, which I assumed came from the perforated eardrum. It resolved in roughly 4-5 days.

Thoughts and Next Steps:

Today, I had a long conversation about my lingering symptoms with my neuropsychologist. Her role is to guide me through the process of recovery and reintegration into regular life and my business after the trauma. I'm fortunate that she works for a large health system and has several years of experience working closely with patients with mild, moderate, and severe TBIs.

I had a series of symptoms that appeared around the same time (four weeks post-accident):

• Parosmia
• Ear fullness
• Muffled hearing
• Nasal congestion
• Ringing in the left ear
• Pain in my right temple
• Partial loss of taste and smell
• Inflamed lymph nodes in the neck

I had a series of symptoms that completely resolved after taking two Medrol Paks:

• 90% of all smell and taste issues
• Ear fullness, pain, and muffled hearing

Other symptoms resolved after taking Cetirizine, using antihistamine eye drops, and using the Fluticasone nasal spray:

• Mild forehead headaches
• Pain behind my eyes
• Nasal congestion
• Remaining 10% of smell and taste issues

The consensus among the medical professionals I've seen is that the ringing is due to hitting my head and the subsequent inflammatory process. While I partly agree, I also believe that the underlying cause may be different, given my symptoms and current events.

My neuropsychologist is the only one supporting my theory that this ear issue could potentially have an allergic, bacterial, or viral origin. I have a history of allergies that I forgot to mention during my medical visits. They weren't severe when I had allergies (typically in spring). She mentioned that patients with TBIs usually lose their sense of smell and taste immediately after their accidents, not weeks or months later, and they usually don't recover them. The same goes for ringing in the ears.

I'm considering two more theories: TMD and Whiplash/Neck issues and the potential for CSF (Cerebrospinal Fluid) leaks, which are not uncommon after TBI. However, I haven't experienced any of the more common symptoms other than the ringing in the ears. My neck was evaluated by my physiotherapist, who found it to be not too bad, though a second opinion might be helpful.

Laying out the history of events has helped me come up with a new plan of action in case my current course isn't the right one:

On Monday, July 1st, I will visit the ENT who diagnosed me with ETD and put me on oral steroids for a second opinion, and ask for a nasal swab to rule out any potential lingering infections.

I am also looking for an allergist and will get an appointment with my neurologist for bloodwork to test for inflammation, thyroid issues, and vitamin deficiencies.

 

On Thursday, Jun 27, 2024, my wife was able to get an appointment with my neurologist due to a last-minute cancellation. I wanted his opinion on the current treatment and the course of events. I needed reassurance that I was on the right track, not overdoing it or on a wild goose chase.

I went over the onset of events again with him. He disregarded the possibility of CSF leaks due to the symptoms. He went over my inner ear MRI and didn’t find anything abnormal.

He mentioned that Dexamethasone injections are his treatment of choice for dizziness and vertigo and potentially aid with inner ear complications. Most ENTs he works with do them, but he agrees that not every ENT is amenable.

We reviewed the accompanying issues during the onset of events: parosmia, loss of taste, inflamed lymph nodes, etc. From his point of view, the fact that steroids helped resolve these issues entirely speaks of an inflammatory process brought on by something other than the head trauma, and he confirmed my theory that there was no nerve damage. The same goes for avoiding headaches, head pressure, and eye pain by using Cetirizine and Fluticasone. He believes there could have been blood still trapped in the sinuses that caused congestion or that there may have been an immunological reaction, such as an allergic reaction or a viral infection. I also agreed that a longer course of oral steroids to knock it out would be beneficial, and it should be well tolerated and shouldn't have any long-term side effects or affect my recovery.

I also asked about doing blood work for the following:

• White blood cells
• Vitamin deficiencies
• C reactive protein (CRP)

He advised me to wait until I was done with the steroid treatment as the first two tests would be showing skewed results due to the way steroids suppress immunological function. He's also in disbelief about the possibility of vitamin deficiencies causing tinnitus, and honestly, I couldn't convince him.

He suggested that I try 100 mg of Gabapentin one hour before bed to aid with sleep. I gave it a shot, but even though it was a minimal dose, I had some side effects when waking up: dizziness, a skin rash, and the ringing seemed very loud in the morning. The upside was that once the drug kicked in at night, the ringing went to an imperceptible level and allowed me to fall asleep quickly. I was able to have some seriously restful sleep, too.

An odd development was that after I woke up, I took a shower, did some steam, and followed these instructions for a lymph drainage massage for the ears, and the volume went down to a minimal level, almost disappearing:

Lymph Drainage for the Ears from Louisville...

The ringing in my right ear today seems to be gone entirely. The left ear is present but at a very mild tone, getting louder when lying down and disappearing when I stand up.

Finally, I found an appointment for an allergist for July 8th.

 

Here I am, sitting on my living room couch in what I hope to be “almost silence.” It’s been 12 hours since my last round of Dexamethasone shots. There is a very mild static sound in my left ear, a 1 / 10. I really need to tune into it to hear it. I've experienced some moments of silence again in the past few days, which led me to believe things are going in the right direction. There is some background noise: the shower is running in the bathroom, and the air conditioner is running in the hallway. I feel hopeful today and more confident that there's a chance things will eventually resolve and that I am getting all the help I can get from very qualified professionals and experts. I was able to get a whole night of sleep and woke up to a very mild static noise in both ears.

On Monday, July 1st, I went for a follow-up visit with one of the ENTs dealing with my case. He had initially diagnosed me with Eustachian Tube Dysfunction and prescribed me two rounds of Methylprednisolone. These two rounds did wonders in more ways than one: the fullness cleared up, and they helped me return my sense of taste and smell to 90%; it also reduced the volume and changed the pitch of my ringing considerably.

To diagnose ETD, he performed a nasopharyngoscopy, used a pneumatic otoscope, and made me perform the Valsalva Maneuver and swallow to see how my eardrum performed. He disregarded the information from the tympanometry and took a hands-on approach to diagnosis. I truly liked that. He performed the second procedure again on this visit and confirmed that I still have ETD.

I originally chose this particular ENT because he is double board certified in Otorhinolaryngology and Facial Reconstructive Surgery, has an impressive curriculum with his training and fellowships, and has worked in a large city within a large medical system, which I find extremely important to base my decisions on. Doctors who work or have worked in these environments have the luxury of seeing and discussing many cases with their peers.

In our Monday conversation, I reminded him what I showed up for, what happened, his diagnosis, and which symptoms had so far resolved. He was happy to hear I pushed for a second round of steroids as several things improved with it. He supported the idea that I needed to see an allergy specialist and get tested to rule out any other inflammatory processes that could have flared up.

There was a change in the prescription for a nasal spray: he moved me to Mometasone 50 mcg now, twice a day for a week and then once a day moving forward; he believes it’s much better for treating ETD than Fluticasone and also believes there are still issues with my Eustachian Tubes; I could continue using Azelastine as well although there was no mention of its effectiveness; he gave me another round of Cetirizine and didn’t object to my use of Guaifenesin as a mucolytic to help with drainage.

He is not sure the ringing in my ears will completely go away when the ETD resolves since several other factors are involved in my etiology. Yet, he wants me to try a third round of oral steroids in a few weeks to a month from now if all other health professionals involved agree. I have a Medrol pack ready for round three.

I brought up with him the current course of treatment I am doing with the second ENT, specializing in head trauma. He wasn’t sure it was the right treatment, yet he also was humble enough to consider that his colleague may know something he didn’t know. He went over the results of my Inner Ear MRI. He didn’t find anything remarkable other than the fact that the neuroradiologist suggested that I could suffer from “Tullio’s Phenomenon,” a very rare condition that triggers vertigo and nystagmus when exposed to loud noises. Yet I’ve never had a symptom like that. We had a good laugh about it. I believe the neuroradiologist who did such a detailed reading of an MRI was most likely a resident sucking up a bit to the attending physician who oversees his work.

 

I wanted to post an update on my progress so far:

I have had four intratympanic Dexamethasone injections in my left ear and three in my right ear. After the last round, my neurologist wanted to wait a month before seeing me again to assess my progress.

Yesterday, August 5th, I had another visit with him and his team. We did an audiometric evaluation, and to my surprise, while sitting in the soundproof booth, I couldn't hear the ringing at all. During my first audiometry in May, the ringing was maddeningly loud during the test.

The tympanometry also showed improvements in pressure. I've been treating the ETD consistently by following Fauquier ENT's instructions with Mometasone, taking Guaifenesin, and using Allegra (Fexofenadine) daily, as suggested by my allergist.

I noticed that my right ear now pops consistently when performing a gentle Valsalva, and my left ear has finally started popping, although it's less consistent. I'll take this as a win. It's been almost two months since I've been using the nasal spray. My ears still pop and crackle when I swallow, move my jaw, or yawn, but it's not as loud as before.

I have recovered very little hearing in my left ear, around 5 dB in a few frequencies and in the bone conduction tests. I'll take this as a win as well and hope that once the inflammation completely clears, more hearing will be recovered. The hearing loss is still mild.

After the last round of injections, I was incredibly hopeful as I had several days of "almost silence," yet once the effects of the Dexamethasone wore off (about two to three weeks later), a new baseline emerged. I would say it's around 90% resolved in both ears. I've been experiencing some very quiet mornings on and off lately. My noise sensitivity has improved considerably, although I still experience temporary spikes after riding in the car or spending time around fans. I've been protecting my ears consistently over the past two months and staying away from loud environments. It honestly seems to be making a difference.

The neurotologist believes that since we've achieved a 90% remission of the ringing, it's time to stop the injections for a while. At this stage, he's concerned they may cause more harm than good. He also believes that over the following months, my body should take care of the rest, as he is still sure the root cause of the ringing is inflammation caused by an inner ear concussion from my head trauma.

He also prescribed a high-dose round of oral steroids (Prednisone):

• 7 days at 60 mg
• 7 days at 40 mg
• 4 days at 20 mg
• 3 days at 10 mg

He cannot guarantee the effectiveness, yet he believes there would be no harm in trying due to the etiology of my case. We may be able to completely knock out any lingering inflammation if we try.

I am scheduled to see him again on October 7th and will update this thread again then.

As a side note, I took a COVID-19 antibody test to rule out a past infection as the cause of the ringing and also an EBV test to rule out a flare-up or reinfection (I had EBV in the past). My vitamin D and iron levels are low, which I am actively treating. I am taking vitamin E as per the suggestion of the ENT since he believes it's effective in fighting inflammation. I also continue following a strict anti-inflammatory diet.

As a direct consequence of the reduction in the ringing, my mood and sleep have improved considerably. I'm confident I will be able to knock this out of the park or find a peaceful middle ground where the ringing and I can coexist.