Tinnitus for Over 3 Weeks Now: Possible Ear/Throat Infection — Have Been Prescribed Clarithromycin

[GammaAlpha]

Hi Everyone,

I'm not sure if this is the right forum but I'm looking for a bit of support and advice. Apologies if I got it wrong.

The tldr; is that I've had unilateral tinnitus since the beginning of this month and possible signs of an ear/throat infection. I've been prescribed Clarithromycin but not yet started the course after scaring myself with the horror stories here.

To preface this: I'm a 37 year old man in the UK and I have abused my ears with earphones at extremely loud volumes for years. Regardless of the outcome of any of this I will never ever do that again.

I noticed a high pitch ringing in my right ear only at the beginning of August (so about 3 and a half weeks ago) but with no obvious cause I can think of. After a few days with no change I called my local GP but because of COVID-19 I could initially only speak to a nurse practitioner over the phone. She initially recommended "Ear Calm" spray which I took for a few days with no apparent effect.

I'm incredibly lucky to have private health insurance through my job so in parallel to all of this I managed to get a private referral to an ENT consultant via a private GP online video consultation, however due to COVID-19 the ENT is currently only doing telephone appointments so I booked one at the earliest date available of 21st August just in case.

I managed to get seen in person by another nurse practitioner on 10th August who noted that through an Otoscope my eardrum looked quite pink (also, I noticed at the time that when he inserted the Otoscope it was quite tender/painful in that ear) so he prescribed a 7 day course of Amoxicillin for an ear infection. For what it's worth I considered this great news because my fear was that he'd look in my ear and say everything was normal. From my point of view the fact that there's an actual physical issue in that ear gives me some sort of chance to cling onto that my tinnitus could be temporary/cureable.

At the end of the 7 days (17th August) the tinnitus was still there so I phoned up again and managed to see a GP this time. He looked in my ears and noted that everything looked normal (which was obviously pretty gutting based on what I wrote above). As I had the ENT appointment booked he essentially suggested waiting to see how that went and getting a high street hearing test in the meantime.

I booked a high street hearing test which came back that I had a slight hearing loss in my right ear (-20 dB @ 2 kHz and -25 dB @ 4 kHz compared to -10 dB and -15 dB in my left ear). I did find the test quite difficult though because some of the sounds were masked by the tinnitus and it was only a few seconds later I realized "oh - I did hear a sound there which i didn't press the button for" and a few where I'm pretty sure I pressed the button for imagined sounds underneath the ringing). The audiologist there also did a quick Otoscope check beforehand which showed nothing abnormal. He thinks the tinnitus is related to NIHL and is possibly my brain overcompensating for the imbalance.

Since then I developed a mild pain in the right hand side of my throat when swallowing. Once every so often I'll feel that pain in my right ear too. Honestly it's been a comfort. It was something else to cling onto as a sign that maybe there was still a physical issue. Every morning when I'd wake up and realise that the Tinnitus was still there the next thing is do is swallow to make sure it still hurt.

I relayed all this history to the ENT in my telephone appointment last Friday and he plans to bring me in for a full examination and audiogram as soon as they're allowed to see patients in person again (hopefully early to mid September) but mostly focused on how he wasn't concerned that it sounded like anything "nasty" based on what I'd said (which honestly wasn't even a thought that had crossed my mind until then!)

Last night when lying in bed I realised that the pain when swallowing was much much worse and mostly focused inside my right ear rather than my throat. Even when not swallowing I could feel like a sort of painful "pressure" in my ear (hard to describe though - not the type of pressure you get when on an aeroplane or that is fixed by yawning/popping your ears but almost a feeling like my eardrum was bulging). I eventually managed to get to sleep and it was better this morning, although still worse when swallowing than on previous day's.

So, this morning (25th August) I called up my GP surgery again who brought me in for a quick examination. The Doctor (a different one today) looked in my ear with the Otoscope and noted that my right eardrum was slightly pink compared to the left one and also slightly dull. Because she wasn't sure whether it was an ear or throat infection or something else she decided to write me a prescription that would target both an ear or throat infection: "Clarithromycin 500mg tablets" twice a day for 5 days.

I've not yet picked up my prescription but I've now made the mistake of googling "Tinnitus Talk Clarithromycin" and been presented with all the horror stories there of permanent tinnitus spikes from it which has slightly terrified me. I'm kicking myself for not asking about otoxicity when she mentioned something other than penicillin/amoxicillin.

Right now, I think my tinnitus must be relatively quiet. I can usually mask it with birdsong from my iPhone at relatively low volumes and I've been trying to spend time without masking it where possible to try and start the process of habituation in case it really is permanent, but I will confess I'm very much clinging onto the hope that I just have an annoying infection going on and that fixing that means fixing the tinnitus.

My question now is what do I do? Do I start my course of antibiotics? Do I try to get another Doctor appointment to discuss my Clarithromycin worries, at this time when they are so stretched?

FWIW, I promise that whatever the outcome I'll update just for the next person that comes along from a Google search of relevant keywords.

Thank you so much for reading this far.

 

[Michael Leigh]

My question now is what do I do? Do I start my course of antibiotics? Do I try to get another Doctor appointment to discuss my Clarithromycin worries, at this time when they are so stretched?

HI @GammaAlpha

Reading your post it seems to me that you have noise induced tinnitus caused by using headphones over a long period of time. Noise induced tinnitus is the most common cause of the condition and typically headphones are often the cause. You are right to stop using them and I advise that you never use them again even at low volume. Since your ears have been examined by an ENT doctor and your GP, as long as there are no additional symptoms other than what you have mentioned, it's best to leave your ears alone and give your ears time to recover. Take the medication you have been prescribed to clear up any infection and soreness in your ears, but I doubt that has anything to do with causing the tinnitus - although ear infections can cause tinnitus. The fact that you are a long term user of headphones and using them at high volume, leads me to believe the tinnitus is noise induced.

Whilst it's good that you were able to consult with private ENT doctor you will get the best help and long term aftercare for your tinnitus in the UK under the NHS that no private practice can match that I assure you. So don't be tempted to spend money on private treatment for tinnitus in the UK because it's a waste in my opinion. Since you got the help through your job that's fine. The best treatment for now is to leave your ears alone. Try not to mask the tinnitus because it's possible to make the situation worse. Please click on the links below and read my articles. Take your time and read them thoroughly without skimming. Use low level sound enrichment set below your tinnitus and not to mask it. More about this is explained in my posts.

All the best
Michael

https://www.tinnitustalk.com/threads/new-to-tinnitus-what-to-do.12558/
https://www.tinnitustalk.com/threads/hyperacusis-as-i-see-it.19174/
https://www.tinnitustalk.com/threads/tinnitus-a-personal-view.18668/
https://www.tinnitustalk.com/threads/the-habituation-process.20767/
https://www.tinnitustalk.com/threads/acquiring-a-positive-mindset.23969/
https://www.tinnitustalk.com/threads/tinnitus-and-the-negative-mindset.23705/

 

[GammaAlpha]

So, an update as promised. Sorry. It's a long one.

I phoned my GP surgery the next morning to discuss my concerns and a doctor called me back. Although she was skeptical of my reasoning she instead prescribed me another round of Amoxicillin. Thankfully that seemed to do the trick and after a few days the ear and throat pain every time I swallowed went away.

So, where am I now? Well, since my last post I managed to see an ENT in person and do a full hearing test in the hospital, and now I don't know what to think. This hearing test showed completely different results to the high street one I took. Hearing in my right ear (where the tinnitus is) was completely normal. Hearing in my left ear showed a bit of a dip at 4 kHz. They performed a masking test where they played static in my right ear and measured my left ear. That little "[" mark from that result wasn't on the dip and was roughly similar to the 2 kHz and 8 kHz levels. I have no idea what this means. I asked the ENT but he just said something about people sometimes getting scarring from childhood ear infections.

I keep going back to the hearing test in my mind though. I was feeling quite claustrophobic due to my face mask and the big headphones and I definitely panicked a bit (I don't normally get claustrophobic and I just continued to sit there quietly and try to complete the test even though I was panicking in my head). I distinctly remember that there were a lot of times where I couldn't hear a tone above my tinnitus but as soon as the tone stopped I'd notice its absence so I'd hit the button then after the sound had stopped. Did I mess up the test? I just wanted to get out of the room so I didn't get to ask the audiologist which I now keep coming back to again and again in my head.

When I met with the ENT I was all smiles because that's how I deal with stressful situations. He went through my hearing test results although I didn't really understand. He asked house I was coping. I said it wasn't too bad when I played birdsong from the calm app on my phone. I mentioned a new symptom I'd noticed of feeling my left eardrum twitch every other day or so. He said he didn't think that there was any further action required but offered to do an MRI scan for my peace of mind if I wanted which I took him up on. That was the end of the appointment.

I did the MRI the next week and today I received a letter from the consultant that was two sentences long and just said "The MRI scan result was totally normal. I hope this sets your mind at rest."

So, I guess that's that. I knew that there was a strong chance that an ENT wasn't going to be able to suddenly cure me, but I thought that there would have been some opportunity for follow up. I'm sure I misled him because I was all smiles in the appointment so he must have thought the Tinnitus wasn't bothering me. Now I've hit a wall. Yes, I'm just about coping by living my life with the sound of birdsong everywhere. I have no idea how I could continue to go on for the rest of my life like this though (I'm not suicidal or anything. I have too much else to live for, but I honestly don't know how I'm going to cope if it doesn't go away). I thought I'd have had a chance to discuss different types of treatment. TRT or CBT or whatever else there is out there.

The day after that appointment I was woken up in the middle of the night by my left eardrum twitching which continued for a few hours and kept me awake the rest of the night. I'm not sure how to describe it. Google always takes me to pages on pulsatile tinnitus but I don't think it's that. It's not in time with my pulse and not a steady rhythm and it's more of a sensation than a sound. I can hear it if I concentrate on it when it's happening (like a very soft bass drum hit) but it's the feeling of movement that irritates me. I went through a few days of it happening extremely regularly before it dropped off again to just a few seconds every couple of days. I've not felt it in a few days now though. My partner suggested it could be stress related.

I've made a dentist appointment for next week to rule out TMJ type issues. My jaw has always popped and clicked when I open it. In order to open it I always have to click it into place first or it won't open. It's not something that bothers me and it's not hard to open my mouth once I've clicked my jaw into place. There's no pain. I thought it was normal. I figured it was worth ruling out as a cause.

I have a friend who's going through a similar thing although she was diagnosed with sudden moderate hearing loss in her case. She's getting a hearing aid, but her ENT suspected it could be COVID-19 related which is an interesting thought. I booked a private antibody test for myself for next week just out of curiosity, as although I never had any COVID-19 symptoms there is a specific possibility I was exposed a few weeks before my tinnitus started. I don't know what I'd even do with that information but I wanted to be able to find out before I lost my chance to know for good.

I don't know what to do now. I'm still hopeful that maybe my right ear tinnitus will fade as it does appear it started with a nasty ear infection. The volume has definitely started to fluctuate. Today it's on the louder side. Some days I don't notice it that often. I'm aware that this makes me so much luckier than a lot of the people on this forum.

I have no idea whether my left eardrum twitching is anything to worry about or whether it is related to my right ear tinnitus. The ENT has basically discharged me in a letter and I'm left second guessing myself about whether I messed up the hearing test and my one chance to look at treatments like hearing aids. Out of desperation I ended up trying every iPhone hearing test I could find and while I would never trust some app above a hearing test administered by a professional audiologist in a hospital, every single one says the same thing the high street one did: some hearing loss in my right ear. I'm so confused.

Totally confused at my next steps now.

Thanks for reading!

 

[GammaAlpha]

Here is my best effort MS Paint approximation of what my left ear audiogram looked like from memory. I don't remember exactly what levels the 4kHz dip was to. The right ear was about the same but without the dip (and with no masked version as they didn't perform that test on my right ear).

 

[n_li808]

@GammaAlpha hey! How is your tinnitus now, compared to your onset? And What kind of fluctuations are you experiencing? I'm about 6 weeks in and my tinnitus fluctuates a lot as well. Not sure if it's triggered by noise or diet...

And when the ENT said the situation may be due to COVID-19... what did that mean?

 

[GammaAlpha]

Hi there,

Thanks for replying!

For the most part I can't tell whether the volume fluctuations are "real" or just my perception changing (if such a distinction exists).

I did have a very real and horrible spike a couple of weeks back where I was just sitting on the sofa with my partner one evening watching TV at pretty low volume and then suddenly out of nowhere the ringing in my right ear increased to the loudest I've ever known. It was like someone had upped the volume from a 2 to a 7 or 8 in the blink of an eye. For all my life this has been a thing that has occasionally happened to me, followed by fading after a few seconds or in the worst case a couple of minutes. This one lasted the rest of the evening and even until the next morning but thankfully faded back to around where it had previously been over the course of the next day. That was pretty scary at the time though and I hate the idea that it might happen again.

Other then that, some days I get more of a hiss than a tone. These are good days. Yesterday I had quite an annoying tone all day that seemed to me to be a little bit lower (maybe a semitone or two) than usual. Today I've had a pretty good day where I didn't even need to have my birdsong app on for most of the afternoon and I didn't even think about it, although I've turned it back on since putting my toddler to bed which as usual involved needing to sit in an otherwise totally silent room with him for up to an hour (often after he screams loudly at me about me making him have a bath which I'm sure doesn't help. lol).

I hope things are well with you. For now, for me at least, it's all about just maintaining the hope that there's a way out of this at some point. Ideally from just natural fading over the coming months, but even just knowing that one of these experimental treatments might be able to help in 5 years time would be enough to keep me positive about it. Weirdly enough I can cope with the "now". It's the idea of "forever" that scares me. As I said above I'm definitely far far luckier than many people on this forum in terms of the severity. I hope too that yours improves soon. Don't give up hope. We'll come out of the other side of this at some point.

 

[GammaAlpha]

In terms of the COVID-19 question. This is all second hand from what an ENT told my friend, but there had been an uptick in hearing related symptoms this year, specifically from people who had recovered from mild COVID-19. I think this was entirely anecdotal rather than having come from any sort of peer reviewed literature.

I honestly don't expect it's at all the case for me, although as I mentioned there was one possible exposure soon-ish before my tinnitus started although my partner, son, and I never developed any typical COVID-19 symptoms whatsoever so we don't think any of us caught it. I found that a local private ultrasound scanning place is offering antibody tests, and I'm lucky enough to be able to afford it so I figured what have I got to lose from finding out before any potential antibody levels drop and it's no longer detectable. I'm pretty certain it's going to come back negative though.