Tinnitus from an Ototoxic Reaction to Sertraline / Hydroxyzine — Now on Second Round of Steroids

Hey all.

I want to introduce myself and situation, but first wanted to say -- I'm sorry that you all have experienced this. I've come to Tinnitus Talk because I know how it feels to experience a sound no one else can hear and understand. I know how it feels to be worried it might never go away, and to have it be so loud that you can not hear/focus. I consider myself lucky in that mine has lessened in volume, just over 2 months out, but I know that many here have struggled with it for years. I salute you and deeply respect that you have been able to survive an affliction I didn't myself understand until having it.

I'm a 34M, father of one, and one on the way. Last summer I developed severe anxiety and depression, to the point I turned to medication to assist. I was thrown several medications. First Ativan (worked great, not a long term solution), then Hydroxyzine (didn't help at all.) I started having serious issues with early waking insomnia. I was given Propranolol, but the LPN didn't mention how it might make someone with low blood pressure to begin feel (zombified/like I was going to pass out.) This drove me to 25 mg Sertraline. Day one was fine. I was amped up with anxiety and felt weird. Day two seemed okay, issues with sleep persisted. Day three I exhibited some weird symptoms. Muscle twitching, spasms, extreme insomnia (didn't sleep night before or that night) and so I popped 3x 10 mg of Hydroxyzine. I assumed I was having a panic attack, but what was really happening was I was having a bad reaction to either Sertraline, Hydroxyzine, or a combination of that and stress.

I was a mess. Not only was I exhausted, I had a loud ringing (8/9/10, around an 8-9 kHz noise) in seemingly my left (but later I would find both, lesser in right) ear. I also experienced a sensitivity in my right ear upon dishes clanging or loud noises in my right ear that triggered my stapedius muscle (reactive.) All day, all night, all morning. It took me a couple of days to recover to even realize I needed help. By the time I got to the ER my body had recovered, all tests/blood were fine thankfully, and they sent me home. I did all of the things. I read everything from Lenire to Susan Shore. I started to see the comments of the past where people had been so excited only to be let down about treatments and cures, and while I am hopeful there will be some day -- from the pain I saw in others I HAD to make peace that it might not get better. It's a thing I feel most days I am doing better with. For me, I am lucky enough to be able to say it has objectively gotten better. I know others haven't, but holding on to that has helped be more present around others and not grab my phone searching for cures. I also started laying off the temp fixes (the head tapping, the tinnitus maskers that are effective for 10-15 seconds but mostly make me sad about how I used to be able to hear like that without issue...)

Unfortunately, I was so concerned about my body/organs being alright that tinnitus took a back burner. I didn't have a PCP (lol I'm healthy, why do I need a... oh.), and was only able to establish care a month after the event, when I was given Methylprednisolone. I also had about an inch of earwax impacting my left side, which was removed with otis media behind.

I couldn't tell over the Methylprednisolone taper whether the tinnitus was getting quieter or I was simply habituating, but I started noticing that it was nearly gone (and sometimes, scarily completely gone in the morning.) It seems to ramp up from around 2-3 PM until later at night. I can certainly modulate it slightly in pitch (higher pitch with jaw opening.) Tinnitus exacerbated depression as I felt I had tried to improve my condition and by doing the one thing I had tried to avoid in taking an SSRI ended up giving me a reminder I might never be able to forget.

I saw an ENT yesterday (I made up my mind that I would regret not trying everything, especially after the PCP had identified impacted cerumen), which marked roughly 2 months and a week from onset. I have minor hearing loss in the 6 kHz range, and they don't test further up. I'm assuming if they did, I wouldn't be able to hear it because the tinnitus seems to mask noise in that range. The doctor gave me a Prednisone taper (60 mg x 3, 30 mg x 3, 10 mg x 3). So far (day one) it definitely seems to have calmed down my tinnitus a little, or oddly transitioned from the high frequency tone to a lower frequency tone. I had hoped it might turn into the "hiss" I see people talk about when it's going away, but we'll see if it gets better/stays better.

 

Welcome to the forum and I'm sorry you're here. The good news is you recognized you needed medical attention and you got it fairly quickly. Sounds like you're on you way to healing.

Please give an update when you can.

 

Day two of Prednisone 60 mg.

My tinnitus has stayed at what I would call "wake-up" low. It hasn't disappeared. It does occasionally seem to "flare." I keep getting foolish moments where I don't even notice it but as soon as I search for it, it returns. The high-frequency tone that has been most bothersome is receding and is being replaced with a more solid lower tone. I am cautiously optimistic that there is an impact being had. However, I am trying to temper that optimism with the many accounts here of it returning to baseline after the course ends (9 days).

My left ear is definitely more prominent. I have to consciously think about the right ear to hear the phantom noise because the left side is just plain louder/ a more noticeable tone, but to anyone who has seen improvement or has habituated, I imagine I am feeling some relief in that "it can get better," or "it is actually not as bad as it was."

I'm hoping it keeps up.

I have been having a hard time with irrational thoughts like if this will keep me distracted from enjoying my time with my kids, now and at future events, but outside of this am trying to ride it out!

 

Day three:

It's still there, but it does appear to be softening at times. Sometimes it goes back up to where it has been. I'm on 30 mg of Prednisone for the next three days. Not sure if it would stay lower if I asked for another round of steroids.

 

Lately around 5-6 PM my right ear goes through this "grenade" type of sequence where all tinnitus ceases except for the right ear over a 3-10 second period and then reverts back to its normal status. On bad days this happens like 2-3 times in the span of a couple of hours before settling down.

I keep seeing terminology about tinnitus spikes, but they seem to refer when tinnitus increases in volume.

Is there another more accurate term for what I'm experiencing?

 

I have now been struggling for a little over 2.5 months with loud, chronic tinnitus stemming from what I believed was an ototoxic reaction with Sertraline that did not go away upon discontinuance.

I have been to an ENT, have been on two rounds of steroids, and need help adjusting in that this might be permanent.

My particular brand of tinnitus is constant. There are two real modes. One is a singular 8-14 kHz pitch tone that is primarily left head side but if that fades can be heard right side quieter. Second is multi-tonal, where multi-tones play primarily left side.

I know that technically I am still somewhat early on in the journey, and that while there is technically still a chance it might dissipate or disappear, I think those thoughts have hurt my ability to cope with it. If it does get quieter, like it seems to in the morning -- I find myself searching for it to see if it's gone. When I find it, I get upset/sad. When it's bad (which it seems to get in the afternoon/night,) I find myself concerned that it's getting louder and never going away.

Some days it seems like I can just ignore it, but... some days I can't because it's just unnerving/loud.

Please, any bit of reassurance or tips help.

 

I got my tinnitus after 2 doses of Escitalopram (Lexapro). I don't know if it has gotten any better in the last 8 months, but my ability to deal with it has gotten somewhat better. Mine too is quieter in the morning than in the evening, I have a tone that sits somewhere in the 8-14 kHz range I believe. I do not have multiple tones except the occasional low hum, but it is reactive to white noise and things like it.

You are still early on, and perhaps it will go for you, and I hope it does. Either way I think you will need to learn to accept it, which is easier said than done. I am still trying to do that myself. You will have OK days and bad days. As time goes on I usually have more OK days than bad ones.

My best advice to you is... learn to accept it now. If it fades, great! If not, you have started the process. It's hard not to have a reaction to the sound, although I understand it's best not to, acknowledge it and move onto something else (for mild to moderate cases, severe/catastrophic is another story I imagine). Don't go looking for it as that will not help you "habituate".

Best of luck.

 

I appreciate the response.

I think I'm just having a hard time when the bad days / elevated volume comes. It's like a self-fulfilling rabbit hole where I go from "oh, I can barely to hear it," to "oh wow, I can't possibly not hear it."

I hope you continue to have success in your journey.

 

I'm having bouts of fleeting tinnitus/SBUTT, reinforcing the idea that this is here to stay based on literature that SBUTT is more common in those with chronic/permanent tinnitus. I would say on unlucky days I have multiple events in a day, but am averaging about 2-3x (each ear) per week. It usually occurs in right ear first, then like half an hour to hour later in the other ear. I never had SBUTT before having tinnitus. SBUTT freaks me out because for a brief few seconds it's like all noise in the world but the weird high-pitched isolated ringing disappears and I'm left worrying if I've gone deaf and if my hearing will return to normal. Huge anxiety spiker for sure.

My ears still react fairly frequently to dishware, definitely my daughter's high-pitched screams are triggering as too loud. Thankfully not painful like I see for some with noxacusis but it's obvious it shouldn't bother me the way it does and I think it's fair to characterize it as hyperacusis. It really saddens me that I will have a visceral unpleasant reaction to her playing that I can't control, and think I need to invest in some earplugs. Everything I read is so counter-intuitive on hyperacusis. "You need to let your ears be exposed to loud noise," and then other people can barely make it through the day without hearing protection.

My Eustachian tubes seem to act very weird with no rhyme or reason. I wake up and they'll click more easily with yawning/swallowing, then other times not at all.

I have a follow-up appointment with an ENT in 8 days, but based on a prep message I sent, explaining that while the steroids helped a little, the tinnitus returned to baseline, they already referred me out to an Audiology clinic. I feel so hopeless since I know they can't really offer me anything but maskers or hearing aids and insurance won't even cover the initial consultation, so I haven't even scheduled the appointment. I'm so frustrated and saddened that there are no good answers/solutions. While I had hypertrophied turbinates and ENT suspects possible ETD (which makes sense based on symptoms), everything I read says ETD self-resolves.

Based on many things I've read, I feel like it's possible the reaction I had damaged nerves that somehow impact the TTTS symptoms I'm having + tinnitus. The thing is the more I think on it, I had symptoms of TTTS for months, I believe even possibly a year before ever having tinnitus (daughter playing the drums would cause the reactive thump in my right ear.) I have absolutely no idea what to make of it.

My sleep has been affected recently. Having the type of insomnia where I wake up earlier than intended by like 1-3 hours. Last night was a good night so I got 6.5 hours of sleep. Would be nice to get more.

I sometimes have good mornings where the tinnitus is virtually non-existent to the extent I get my hopes up it's gone, and then, like clockwork, as the day starts moving, it returns and gets louder throughout the day until bedtime.

 

My ENT follow-up appointment was useless. He spent approximately 15 seconds examining my nose and ears, and on to an MRI of the brain w/o contrast. I am fortunate in having decent healthcare and there is a place nearby I can get it done cheap, but it feels like a pointless exercise and that I'm just throwing $ away. I am going through with it for the peace of mind.

I was also referred to an audiologist for a "tinnitus consultation." The lady who does it has tinnitus and hearing loss, and two cochlear implants. I just feel like I'm going to get sat down and sold maskers.

Just kind of frustrated at this point. My tinnitus has been slightly elevated lately.

 

I had a brain MRI with and without contrast today. I have had ongoing Eustachian Tube Dysfunction, but I think it's something neurological. I don't feel any fluid draining throughout the day and am able to manipulate it with yawning/Valsalva. I do get runny noses in the morning. Dear God, I was terrified my tinnitus would be louder after that horrendous machine, but I had earplugs and didn't notice an increase in tinnitus after (thank whatever created us.) I have been taking Nasacort and Azelastine; no real improvement. I do the Nasacort in the morning and Azelastine at night. I wouldn't wish a brain MRI on my worst enemy, especially with built-up anxiety from tinnitus/ETD.

I looked at the brain MRI, but outside of identifying a skull fracture in an unrelated region I never knew I had, I'm not expecting anything remarkable. They had focus on the auditory canal but can't see anything obvious there.

The next appointment is in April. I don't hear back on the MRI results until next week.

 

It took about a day after my MRI in December before my tinnitus spiked. Fortunately, it returned to baseline within a month. What it showed me is that there are many levels of catastrophic tinnitus and I'm grateful that it eased off to my normal catastrophic level.

 

You know, oddly enough (knock on wood), today has been a quiet day. By quiet, I guess I mean a relatively lower volume high pitch that is more easily maskable/ignorable.

Dear God, the MRI itself, though? I can only think of that being essentially a torture device. The whole time "I'm paying for this? I HAVE to stay still. Can I swallow? What am I doing here. Is my tinnitus going to get worse?" I don't think the techs understood when I took the earplugs out and breathed a sigh of relief that I just had my normal tinnitus.

I'm hoping someone tells me my brain is unremarkable.

 

Good to hear that it hasn't affected you. Sometimes, after an acoustic trauma, I will get a brief 'honeymoon' with lower volume tinnitus, and the nastiness level subsides somewhat but then spikes after. Hopefully, you missed the spike.

 

The 'honeymoon' (day) sounds VERY familiar.

 

Correct me if I'm wrong, but both Sertraline & Hydroxyzine increase Serotonin levels in the brain, so maybe the combination of them was problematic? Did you verify with your GP that it's OK to take them concurrently?

Just a thought...

 

Yep. The same person prescribed them and said it was fine to take both. I'm not sure it matters outside of a time machine at this point.

 

So, let's assume my brain MRI comes back "unremarkable."

What are the next steps? What do ENTs do when the MRI says "welp, no giant tumor."

Do I get the "welp, good luck, learn to live with it, thanks for the $$?" speech next?

 

My ENT just recommended Lipoflavonoid & Melatonin and sent me to an audiology clinic, which confirmed moderate hearing loss. They offered to sell hearing aids with masking technology.

Sertraline and Lexapro caused me stomach aches, so I stopped each over three months ago and still have stomach discomfort. The only side effect of 25 mg Hydroxyzine at bedtime has been a dry mouth, and it makes me a little tired, but I still wake up and have trouble sleeping.

I only had TTTS flutters once in my first 1 1/3 years since my tinnitus increased to severe, but the TTTS symptoms became more regular after that, and having my most persistent thumping episode of 6 hours just days ago. Hyperacusis became an issue after the first year.

So, all said, there's been no improvement, and I'm still dealing with anxiety and insomnia, taking meds as little as I can get by with. The only real treatment I can look forward to is the Shore / Auricle device, hopefully within the next few years.

 

I blame Hydroxyzine and Sertraline for my issues. I had serotonin syndrome in response to starting Sertraline, and the following morning, tinnitus began, but I had been having loudness sensitivity and reactivity before, so to be honest, I can only be sure that's when the tinnitus began, though not necessarily my ear issues.

Anyway, I'm in the same boat. On good nights, I will wake up 5-6 hours wide awake as if I just had a cup of coffee. On bad nights, I'll lie awake with my eyes closed, and it will feel like I'm asleep as time passes (and I may be, just lightly) but will be up with the same feeling in 3-4 hours. Each time unable to go back to sleep. I think, sadly, my body is adjusting to the sleep deprivation, but it is maddening. I typically don't have trouble falling asleep; it's just when I wake up, my heart is running.

I don't know if I have true loudness hyperacusis or just a type of sound sensitivity, but I get the near-pain threshold fullness of a sound being loud when it should not be. I used to get reactive thumps to certain types of noises, but those have largely subsided in favor of this sensitivity. I guess, technically, that is probably an improvement, not that it helps my anxiety about it getting worse.

@RunningMan, do you happen to get any bouts of dizziness or have you noticed that your balance in the dark has degraded? I was extremely fit a few years before the onset of these issues.

 

I can't say that I've experienced any dizziness or balance issues in recent years. I'm never walking in complete darkness much, though; maybe a few steps. I still walk for miles many days, some running in there, and plenty of bicycling, so that all feels the same as in years past as far as balance goes.

 

MRI results: Completely unremarkable.

The imaging office had the results for a week, but apparently, the ENT office never got the fax. I picked it up but now am perplexed.

While it's a relief somewhat to know you don't have a tumor or schwannoma, it's also incredibly disheartening. I am continuing to struggle with the fact that there is no cure. While tests continue to rule things out, I am just at a point where maybe I need to accept my fate. I have bad tinnitus, ETD, possible TTTS, and a bit of sound sensitivity. It may get better, but it more than likely will worsen with time. I am struggling to accept that just half a year ago, I felt on top of the world, with no doctor's visits, no worrying, no ringing, no ear crackling, or negative pressure.

Now, I am just constantly feeling down or hijacked by conditions that no doctor is truly helping me with, and no one can visually see my suffering. There are worse conditions, but I am struggling to cope with this. I get dark thoughts about how I can possibly continue to live like this and am struggling to push them to the background. I am only 34 and feel like a lot of what brought me joy could worsen me.

 

I know the path you are on as I have traveled it as well. I understand your frustration that doctors aren't helping you and that no one can visually see your suffering. I've regretted my past lifestyle and the acoustic traumas that stole my happy life. The only things that have allowed me to continue to live are the continued love and support from my family, along with acceptance.

You are suffering from the loss of your past life and are grieving. Acceptance is the is last of the five stages of grief. You may be currently in one of the stages of grief before acceptance - denial, anger, bargaining, and depression. A therapist helped me navigate my grief, and you might benefit from counseling, too.

As you probably know, protect your ears with earplugs/muffs when you're in noisy situations and your tinnitus symptoms should lessen as your brain adjusts and hopefully you will habituate.

It's a tough road we're all on. Fortunately, Tinnitus Talk advice and understanding are always along for the ride when we need support and encouragement.

 

I feel the same way, even after more than two years into my worsening of tinnitus, which later included hyperacusis and TTTS. I already had moderate hearing loss. The severe tinnitus is the worst of those for me, which causes anxiety and insomnia. There's never a good age to be hit with these conditions.

After two years of severe tinnitus, I've certainly accepted that I'm stuck with this until some potential treatment comes along, but that doesn't help my anxiety because the sympathetic nervous system is always kicking in automatically from the continuous tinnitus, especially on the loudest squealing single tone days. And if the anxiety is bad enough long enough, that brings on depression.

I didn't have much anxiety to speak of (and really no depression) until my tinnitus increased two years ago. The tinnitus was the cause. Like you, I tried to treat the anxiety/depression with medication including Nortriptyline (a few months) and later Sertraline (1 week) immediately followed by Lexapro (7 weeks). Unfortunately, I didn't get any relief from anxiety with any of them, just side effects and continued daily stomach discomfort over 3 1/2 months after weaning off Lexapro.

You mentioned taking Ativan at first. Are you still taking that or any medication at this point? I started taking Ativan occasionally months ago, and a 0.5 mg pill helps some with the anxiety, but I'm afraid to take it more than once every third day because I don't want to build tolerance and dependency. So, I'm having a bad day today, but I am not taking it. Trying to get through this on days like this on pure willpower is difficult. I feel like I need something else.

I have trouble with sleeping, mostly with just waking up overnight and not getting back to sleep. Partial Zolpidem tablets help me get back to sleep, but I still don't get enough - like 5 to 5 1/2 hours on average. Another concern with Ativan (or any benzo) is that there is some cross-tolerance with Z-drugs like Zolpidem.

I've tried a dozen or so different supplements, as well as THC, CBD, CBD/CBN, which haven't helped.

 

My PCP prescribed Ativan (1 mg). I took it for four days as a lifeline when my tinnitus was new and 9/10. It melted my anxiety, I was like a new person. I saw why they could be addicting. I eventually saw a psychiatrist, and they were a hard no on benzos. If they had prescribed them, I wonder if I would ever have got tinnitus. Anyway, after abandoning the psychiatrist after their meds caused my tinnitus, my PCP wrote me a 2-week script for Ativan. I haven't touched them because I'm afraid of it worsening tinnitus.

Frankly, I have lost the no-med battle and am re-evaluating.