Tinnitus Constant 24/7 in Head and Some in Left Ear

[Former newyorker]

Dear Dr. Nagler,

I am not sure if my tinnitus was originally noise induced in December 2018 as I was trying to fix a CD player and when the cd kept infecting I tried the tuner and didn't realize the volume was way up and got a big blast in my ears and then ringing. I went to ENT a week later and he told me I had mild to moderate hearing loss. My tinnitus then was either roaring in head or sizzling clicking in left ear. I developed very bad anxiety, loss over 30 pounds because the anxiety make me not want to eat. My husband couldn't go anywhere because I didn't want to be left alone. Minutes felt like hours and I was having a hard time dealing with everything. Even a very expensive preplanned European vacation which included a Rhine River Cruise with friends (May 2019) was hard because I was also weak from everything. I had tried the antidepressant Mirtazapine to sleep but stopped before cruise as I was having eye problems with it. I only have vision in one eye due to being a preemie at birth. When I returned from vacation anxiety was worse and I was getting no sleep. Xanax made tinnitus worse. My GP gave me another antidepressant generic for Effexor and Zolpidem to sleep July, 2019.Well I was having a hard time with the Effexor - brain zaps and funny sensations in my head. He kept telling me you need to give it time to work. I quit the drug after 3 weeks because I do this drug was not for me. That is when my tinnitus changed and continues to this day 24/7 sizzling all over my head, with a creepy crawling pulling sensation on my scalp. I also have ear tenderness. I have had MRI at beginning, went to a neurologist before this new tinnitus. Went to endocrinologist because I have a hashimoto and a nodule on adrenal gland but he said just watch size with repeated ultrasounds.

Fast forward, I ended up in ER at the end of July and was given Clonazepam 0.50 twice a day as needed. I started to reduce to .25 as it wasn't helping tinnitus and did help anxiety but was afraid of getting addicted to it. I then cut .25 in half again after a few months as was starting to eat better and gain weight. I also stopped Zolpidem as found out Melatonin will eventually make me fall asleep most nights. I quit Clonazepam in December 2019. Then the world changed with Coronavirus. I suffer immensely with this constant head tinnitus. Some days I feel I can't take it anymore. I am retired and no matter what I do nothing distracts me from this maddness.

My question to you do you think the change in tinnitus is from the Effexor or from anxiety? I am definitely better with the anxiety than in the beginning. I am no longer afraid to be alone and I can eat anything now and have gained back 15 pounds. I have the Clonazepam and wonder if I should try .25 once a week to see if it changes the noise in my head. I even was prescribed medical marijuana but was afraid to try it a lot for fear it would make the tinnitus even worse but I don't think it can get worse than I am dealing with right now and it will be a year in July that I have this change. There isn't really much information if it is safe with tinnitus. I know it is supposed to help anxiety though.

I try to be positive for my family but it is hard. I want to habituate but the minute I wake up it is there. I miss my adult daughters, my SIL and 2 year old granddaughter. I live in NJ, they Brooklyn NY. and because of virus they are afraid they may bring virus to my husband and me.

Sorry for the long story. I just want to live the best normal life I can. Please give me any advice you can? Take the Clonazepam or try the tincture of medical marijuana which has CBC and THC? Any doctor that may be able to help after coronavirus gets under control?


Thank you!

 

[Dr. Nagler]

Hello @Former newyorker. Sorry to hear of your tinnitus difficulties, compounded by the Covid-19 challenges we all face these days.

You asked:

My question to you do you think the change in tinnitus is from the Effexor or from anxiety?

As I understand it from your post, you last took Effexor back in July. While Effexor can (rarely) aggravate tinnitus, the drug does not cause auditory damage - so any effect it might have on your tinnitus can be expected to be temporary. Thus, I do not think Effexor is playing any role in your current situation; it long ago disappeared from your system.

In terms of anxiety, while it can certainly play a role, there are numerous factors other than anxiety that might be considered. The good news is that whether or not the steps you can take to gradually decrease your anxiety over time will also serve to decrease the intensity of your tinnitus, such steps can be very beneficial to your overall health. So go for it!

My suggestion would be to take your tinnitus out of the equation for now and perhaps take a look at this very inexpensive book that can be readily ordered from Amazon:

Applying the principles outlined in the first third or so of the book can be very helpful for most everybody with anxiety issues. As far as the rest of the book goes, it is boring enough to put you to sleep in minutes! So you get two-for one: (1) excellent, insightful, practical advice for anxiety, and (2) a drug-free treatment for insomnia!

All the best with it.

Stephen M. Nagler, M.D.