Tinnitus Onset After Nerve Issues (Pain, Burning, Numbness, Pins and Needles)

[ChiggyT]

Hi all - wondering if anyone has any ideas/thoughts/similar experiences...

In February 2021, I was out for a run when suddenly my right hip, knee, and foot gave in. Over a week or two it was fine, but then suddenly I started experiencing pain in my right foot. The pain started travelling to my left foot, and all the way up my leg. I then started experiencing burning/numbness/pins & needles in my right leg. I thought this was sciatica but the burning/numbness/pins & needles/pain then spread up my spine, into my arms & hands, and sometimes numbness in my face as well. Multiple MRIs, blood tests, ECGs, etc., nobody has been able to find anything. So the doctor prescribed me with Nortriptyline which I have been taking since December, increasing my dose steadily from 10 mg to 40 mg.

In April 2022, I woke up in the middle of the night with my left ear ringing and I woke up with blocked ears. Having crossed off ear wax build up, trying antihistamines/nasal sprays to combat any Eustachian tube blockages, the clogging stopped. However the ringing has been progressively getting worse. Every time I swallow, both ears crackle. I get neck/shoulder pains, and pain right up the back up both sides of my head. The ringing is worse when I clench my jaw/bend over and pressing the area behind my ear also makes it worse. The intensity also fluctuates but with no real pattern/logic. I get passing but painful headaches and the pins/needles have returned down my left side.

I am undergoing tests with my ENT but now wondering if my tinnitus has anything to do with my undiagnosed nerve condition. The ringing came about from seemingly nothing. I thought it might be my Nortriptyline but my GP assured me it isn't...

Has anyone had a) the same experience with nerve conditions, or b) the same symptoms in terms of their tinnitus? I'm getting quite desperate and the medical experts don't seem to know what's going on....

 

[Greg Sacramento]

Very probable all this is caused from your lower spine.

Do you have swollen legs and/or feet?

Inflammation of your sinuses is very possible as tinnitus cause - curable.

You will notice that much you mention is in this one article. Your posture balance is off.

Read this article for background, answer the question above and then we should discuss sinuses and posture.

Ear and Neck Pain: Causes and Treatments for Pain Behind Ear (healthyandnaturalworld.com)

 

[ChiggyT]

Hi Greg,

Thanks for coming back to me so quickly. I have no swelling in the legs or feet, or anywhere else for that matter. I had MRIs of my back, hips, brain, neck, and shoulders all of which showed nothing wrong.

I did take sinuses nasal spray for about two weeks but made no difference, along with a steroid nasal spray and prescription antihistamines.

The nerve issues (tingling, pain, pins and needles, numbess, etc.) all started in my feet and slowly made their way up my spine and into my arms and even my face. Sometimes it hurts to smile. So my initial reaction is that the tinnitus, crackle in my ears when swallowing, and neck/shoulder pain has something to do with my neuropathy. But no scans or tests have picked anything up...

Appreciate any help you can provide...

 

[Greg Sacramento]

Hi @ChiggyT, in regards to nerve conditions, often the cause can't be determined.

We found most discovery to have relation with the following: Lower spine and uneven posture, diabetes, increased blood sugar, low vitamin B or D, sometimes low magnesium, excessive smoking, dehydration, chemicals that enter the body often from feet and this includes from walking barefoot, not changing socks daily. Any of this can cause damage to blood vessels that carry nutrients and oxygen to nerves. Once nerve conditions start, feet should not be in either a cold or hot environment. Elevation of legs may be needed if chemicals is not the cause. Diet changes may be needed - low salt and sugar. Try bamboo (loose) socks and avoid cotton socks.

It may be that ear, facial, neck and jaw nerves became stressed from inflammation from sinuses. This could happen much easier with mid and lower body nerve concerns. Your sinuses may be clear now, but nerves as mention including within and behind ears may have been weaken. Once this happens, certain medications can be added weight. Nerve areas mentioned in this paragraph may heal in time - months to a few years and tinnitus would then lessen.

To speed up the process, when your jaw, neck and behind ears is hurting, try using a moist compress, a rung out washwash - slightly cool on these areas for five or ten minutes.

Please stay in touch.

 

[ChiggyT]

Hi @Greg Sacramento, thanks for the above. I am waiting on a brain MRI and auditory tests with my ENT. I am also going back to a neurologist to see what other tests we can do. I am also going for acupuncture on Tuesday to see if that helps. I have indeed been told the reasons for nerve-related issues may not have a root cause, but I am 99% sure mine is a mechanical reason due to the run I did back in February 2021.

I've been tested for diabetes and all is fine. I was taking a Vit B compound pill but it hasn't helped, so I've swapped to taking individual Vit B1, 6, and 12 tablets as well as Magnesium and Turmeric to see what helps.

I should add that last week I flew to Portugal, and whilst in the air I was in extreme pain on both sides of my face, down past the back of my jaw, and almost down where (I assume) Eustachian tube is. I assume this has something to do with the pressure and if so does this provide any further clues on what may be going on?

What you mention about mid/lower body concerns causing issues higher up makes logical sense to me. Any thoughts on what medication I can use to help speed up the nerve healing process?

Yesterday I started neck exercises to see if that helped. If it tilt and hold my head to the left for 10 seconds and repeat on the right, I get some very temporary release. My Nortriptyline is helping with the nerve issues in my feet/arms but the stiff neck/shoulders remains... Does this mean my tinnitus has something to do with the muscles in my neck?

Just to add, I also seem to be able to "control" it (basically make it worse) if I clench my jaw or double up on myself and bend over... I assume this is a case of somatic tinnitus.

 

[CC_16]

Nortriptyline can cause tinnitus, potentially.

I would advise you to stop taking it for a little while and see how your tinnitus reacts.

Your nerve problem sounds like peripheral neuropathy. You could try Gabapebtin.

 

[ChiggyT]

@CC_16, yes I've heard that too but my GP has told me it shouldn't be the Nortriptyline that is causing this. Also, given it's not just tinnitus I am experiencing but also crackling ears when I swallow and tight shoulder/neck muscles, I'm thinking it may not be the drug that is causing the tinnitus...?

 

[CC_16]

@CC_16, yes I've heard that too but my GP has told me it shouldn't be the Nortriptyline that is causing this. Also, given it's not just tinnitus I am experiencing but also crackling ears when I swallow and tight shoulder/neck muscles, I'm thinking it may not be the drug that is causing the tinnitus...?

Is it constant? In both ears? I am very concerned with your nerve problems because it came out of nowhere.

You could also try Pregabalin.

 

[bobthebuilder]

@CC_16, yes I've heard that too but my GP has told me it shouldn't be the Nortriptyline that is causing this. Also, given it's not just tinnitus I am experiencing but also crackling ears when I swallow and tight shoulder/neck muscles, I'm thinking it may not be the drug that is causing the tinnitus...?

Don't believe the GP. Most are unfamiliar with tinnitus as a side effect of tricyclic antidepressants (mine refused to believe it as well).

While the underlying cause may be the nerve issues or some other muscle/structural issue, the trigger was almost certainly Nortriptyline. I would wean off of the Nortriptyline immediately (~3-5 day taper) if I were you and hope it goes away.

 

[Greg Sacramento]

I should add that last week I flew to Portugal, and whilst in the air I was in extreme pain on both sides of my face, down past the back of my jaw, and almost down where (I assume) Eustachian tube is

As fluid drains from the Eustachian tube, the tube opens and closes. This function is influenced by more pressure when flying.

If it tilt and hold my head to the left for 10 seconds and repeat on the right, I get some very temporary release.

Sternocleidomastoid muscle - this muscle can also increase Eustachian Tube Dysfunction and sinus allergies.

This muscle can cause a domino effect to what you describe from shoulders up. The sternocleidomastoid muscle can also increase involvement with Eustachian fluid travel to ears and jaw and from this - atypical facial neuralgia and jaw pressure or the muscle itself can cause this. It appears a sternocleidomastoid muscle started the fight. Fluid travel from ETD or ET function could cause tinnitus or a sternocleidomastoid alone.

My guess is that pressure on the sternocleidomastoid (SCM) muscle (due to tightness, inflammation, spasm, etc.) inhibits full function of the Eustachian tube.

Glad that you are getting auditory tests.

 

[ChiggyT]

Thanks @CC_16 and @bobthebuilder. Have either of you had experience with Nortriptyline? The only reason I don't think it's the meds is because my neuropathy has kicked up again, I'm getting similar symptoms as I was before, hence the reason to increase my dose to 40 mg. Whilst it's true the tinnitus kicked off when I increased my dose, it was also accompanied by the crackling in ears and the stiff neck/shoulders. If you have any experience with the meds please let me know as any advice there is helpful! The tinnitus is only in left ear and is pretty constant.

@Greg Sacramento, thanks for your thoughts above. The ENT said there doesn't seem to be fluid in my ears (he checked with a tuning fork), but do you think the Sternocleidomastoid muscle tightness can be caused by nerve issues?

 

[Greg Sacramento]

Sternocleidomastoid muscle tightness can be caused by nerve issues?

An impairment or injury to the spinal accessory nerve can cause weakness or paralysis to the SCM. This can cause atrophy (shrinking) in the affected sternocleidomastoid and may cause difficulty in turning the head and bending the neck. Treatment for this involves strengthening exercises for the SCM muscle.

I knew of one who had pressure placed to the vagus nerve caused from inflammation of a sternocleidomastoid, but this would present as head pressure - headache.

The sternocleidomastoid muscle's nerve supply consists of the accessory nerve (also known as cranial nerve XI) and the second and third cervical nerves (C2 and C3).

Other likely nerve disturbance from sternocleidomastoid tightness are the facial nerve and trigeminal nerve.

Really need to see a neck MRI, but when you said "if it tilt and hold my head to the left for 10 seconds and repeat on the right, I get some very temporary release" - I thought of sternocleidomastoid.

A pitched nerve is also possible, but indication of C spine cause would be seen on a simple neck X -ray and MRI neck may show the actual pitched nerve. A pitched nerve (SCM association) would be at C2 - C3.

Let's see what your head MRI shows.

 

[ChiggyT]

Thanks again @Greg Sacramento, your help is really appreciated.

I don't have my MRI for another two weeks unfortunately so will have to wait and see.

The fact that previous MRIs showed nothing doesn't give me high hopes, but we'll see.

Over the past 48 hours I've also now developed vibrations in the right foot (I believe this is Pallesthesia?) and my right arm is very tingly, cold, and I think my grip is weakening...

 

[Greg Sacramento]

Over the past 48 hours I've also now developed vibrations in the right foot (I believe this is Pallesthesia?) and my right arm is very tingly, cold, and I think my grip is weakening...

With much of what you previously mentioned and the above, could you be having a body's stress response that sends hormones and blood flow to different parts of the body by way of muscles and nerves in anticipation of fight or flight. Pallesthesia can happen in response to stress. If so, try calming down through breathing exercises. By doing this, all may just improve. Try taking some time-out and do some relaxing stuff. Lay on a couch, alleviate your legs a little and watch some TV or listen to some soft low volume music.

 

[ChiggyT]

Thanks @Greg Sacramento, there's definitely some stress involved in all of this (but it's not the reason for it). I am mapping a plan of action:

1. Try acupuncture tomorrow.
2. Neck stretches to loosen and strengthen the SCM. Rotate each side for ten seconds, and tilt each side for ten seconds.
3. Warm compress on the neck.
4. Jaw stretches, touching the tongue onto the roof of my mouth and opening/closing, as well as pushing my lower jaw out and inwards. This pushing in and out seems to impact my tinnitus and increase the volume.

Re: Nortriptyline, really keen to hear if anyone has had personal experiences with it?

 

[ZFire]

Nortriptyline, really keen to hear if anyone has had personal experiences with it?

I'm still on Nortriptyline (50mg). It's been very helpful for treating my migraines along with anxiety issues and depressive thoughts. No effects on tinnitus and maybe a tiny bit of relief on hyperacusis.

I believe @glynis also took Nortriptyline and it eliminated the head tinnitus she had. @GBB's taken it with no ill effects on tinnitus... same thing with @Rockman and @SmallRonnie.

 

[CC_16]

How is your nerve pain? Is it very intense?

 

[ChiggyT]

@ZFire, thanks for the above. It's been a week now since I've been on 40 mg of Nortriptyline. The nerve issues still seem to be peaking through, I've been getting pins and needles and vibrations in my right foot, and burning up my right leg, and numbness down my right arm. Perhaps it takes a while to kick in but I am concerned about my ever increasing dosage of the drug.

@CC_16, the pain has been at bay for some time up till February. I started running again which kicked off the issues again, and had to steadily increase me dosage to 20 mg daily, then 20 mg/40 mg on alternative days, now 40 mg daily.

@glynis, @GBB, @Rockman, @SmallRonnie, any perspectives from yourselves? Appreciate any further insights.

 

[Greg Sacramento]

It's been a week now since I've been on 40 mg of Nortriptyline

Too much - as this can cause:

Burning, numbness, prickling, "pin and needle" or tingling feelings, numbness of the feet, legs, arms, hands, and around mouth. Pain or discomfort in the arms, jaw, back or neck.

 

[ChiggyT]

Too much - as this can cause:

Burning, numbness, prickling, "pin and needle" or tingling feelings, numbness of the feet, legs, arms, hands, and around mouth. Pain or discomfort in the arms, jaw, back or neck.

Ironically these are the reasons why I am taking it! I was on Amitriptyline before but it made be far too groggy and feel like a zombie.

Think I should pare back?

 

[ZFire]

Now that you and @Greg Sacramento mention it, I do get random occurrences of the pins and needles in my feet...

 

[bobthebuilder]

Re: Nortriptyline, really keen to hear if anyone has had personal experiences with it?

I took Amitriptyline (another TCA) for 5 days before it triggered my tinnitus back in 2015. I had some headaches and whiplash injury prior to that, but it was the medication that triggered it. I know Amitriptyline is not Nortriptyline but it is very similar within the class of tricyclic antidepressants. There is a published case report with the exact same mechanism of onset from amitriptyline (e.g. case study 1 and case study 2) and also many similar posts on the forum (e.g. most recently this post).

I have also tried Nortriptyline + Topamax recently as part of this study and as the dose got higher, my tinnitus got way worse. It could've been the Topamax but given my prior experience with Amitriptyline, I strongly suspect it was the Nortriptyline that made my tinnitus worse. Thankfully after I stopped, the tinnitus returned to baseline.

Of course, there are others for whom it has no effect or makes the tinnitus better, everyone's clearly different. But I'd be careful with it - maybe try tapering off the Nortriptyline a bit and see if the tinnitus gets any better.

 

[Greg Sacramento]

@ChiggyT, I still think that peripheral neuropathy caused:

I was out for a run when suddenly my right hip, knee, and foot gave in. Over a week or two it was fine, but then suddenly I started experiencing pain in my right foot. The pain started travelling to my left foot, and all the way up my leg. I then started experiencing burning/numbness/pins & needles in my right leg. I thought this was sciatica but the burning/numbness/pins & needles/pain then spread up my spine, into my arms & hands, and sometimes numbness in my face as well.

You don't smoke, so cause is hard to say - blood clot / injury to a leg artery is possible. Over time blood flow can slow to other leg, then spine.

Burning, numbness, prickling, "pin and needle" or tingling feelings, numbness of the feet, legs, arms, hands, and around mouth. Pain or discomfort in the arms, jaw, back or neck is mentioned in this link for Nortriptyline. In section for Healthcare Professionals, notice the mention of peripheral neuropathy and pallesthesia.

Nortriptyline Side Effects

I have periperal neuropathy with severe tingling feelings in feet and legs. It has moved up to my spine. My cause is the death of a leg artery and this causes blood clots. I can not take Nortriptyline as it made my condition worse. It also made my neck, jaw, face, arms and hands come into play. I had mentioned all this several times on this site. I agree with what @bobthebuilder has said.

 

[ChiggyT]

Hi all - apologies for the radio silence, I wanted to provide an update after a few days...

Since Monday afternoon, my tinnitus seems to have calmed down, in terms of volume and pitch. I am well aware that tinnitus fluctuates a lot in the early days, but I have narrowed the reasons of this decrease down to:

• Increased vitamin intake. Since last Saturday I have been taking Vit B1, B6, and B12 supplements, alongside turmeric and magnesium. I don't think this is the reason given the short gap between me starting them and the drop in volume (Saturday to Monday).
• Neck and jaw exercises. I have been stretching my neck and my jaw to help losen the SCM muscle as advised by @Greg Sacramento. Don't think it's this either as I started this on Monday.
• Habituation. It could be this although hard to say given then the relatively short time I've had tinnitus (c. 2 months). I have been using the app Oto to do mindfulness exercises (thoroughly recommend this app for this and for noise cover).
• Nortriptyline. Monday marked day 6 of 40 mg of Nortriptyline. I think it might be because of this, especially since the groggyness of the drug has kicked in and some of my neuropathic conditions have lessened. The ear crackling whilst swallowing remains which is not solved via Nortriptyline, so further evidence the reduction in tinnitus could be due to the drug.

My tinnitus definitely gets worse if I bend over or stimulate movements in my jaw e.g., push my lower jaw out. Not sure what this means exactly, but I believe it that it is indeed somatic. I tend to only really hear it at night when going to bed and at random times in the day instead of constant. The high-pitched buzz seems to have dissipated a little, leaving just the underlying lower hum.

I have been getting tremendous pain in my lower right jaw but this may be due to excess clenching rather than TMJ (as my tinnitus is in my left ear). My dentist seems to confirm this (and also confirmed I have receding gums...). Both my left and right pinky fingers have slowly been loosing motor functions and holding a pen and writing is proving more difficult.

It also gets worse when I get up quickly or oddly, when I stretch. More oddly, I seen to be producing a lot more ear wax since this all started...

I went to the gym today and did some leg exercises and my lower back hurt and got itchy, which I know now from experience is a tell-tale symptom of neuropathy. I do think given my injury started in my foot and worked it's way up that everything stems from issues in my lower back (again as suggested by @Greg Sacramento).

Audiology exam next Friday along with the MRI, follow-up consultation week after, neurologist appointment after that. So we'll see how things go...

Any thoughts on any of the above is welcome as always. This thread has helped me greatly so far, so many thanks for all contributors.

 

[ChiggyT]

Update: I was wrong; it's definitely the neck exercises that is helping so far.

On Friday & Saturday of last week, I didn't do any exercises and the high-pitched tinnitus in the left ear came right back. By Saturday evening it was a 7 or 8/10. I continued with neck exercises of (1) looking left/right for 5 seconds at a time and (2) tilting my head to the side and slight back for 30 seconds each side, and the high-pitched noise subsided. So, @Greg Sacramento, it certainly seems to be related to SCM muscles you mentioned above. Any idea what this means for a diagnosis?

What's more, the crackling in the ears when I swallow has slightly subsided. It's definitely not there when I swallow to drink. My hypothesis is my SCM and other neck muscles are working less as the they are lubricated... but really, I'm unsure why....

Peripheral neuropathy remains. My jaw pain has gone up several notches and the bottom left & right of my mouth is becoming slightly swollen. I have a metallic taste in my mouth, but no blood. Not sure if the nerve/SCM muscles are causing this?

 

[Greg Sacramento]

@ChiggyT, a few exams done in your home would be helpful for neck (SCM and other neck muscles) and results should also be helpful to note how much involvement the jaw has. It does to some extent - jaw pressure to joints, teeth and nerves.

Movement of jaw with tinnitus may be too basic alone - as many can have a tinnitus increase or decrease with jaw movement - jaw joints, muscles, associated nerves and nerves to other pathways. Opening and closing mouth can also be too basic as a stand alone judgement for the same reasons.

May need an ultrasound for legs, arteries and feet - injury? The connection of this problem to upper body may be posture.

1. Look in a wall mirror, a bathroom mirror for shoulder height - stand straight, but let gravity have control. See if you notice a difference in shoulder height between right and left.

Next - in the mirror, note if one side on your neck is shorter than the other side.

Next - in the mirror, notice if one side of your neck is straighter (less curve) than the other side.

2. Use a ribbon mearsuring tape to measure leg height. Research - how to measure leg height - videos are also available. Easy methods below - you will need assistance.

How to Measure Leg Length: Men's Guide - Tall Paul

Chiggy, excellent explanation of your influences.

More discussion will be needed after doing home exams.

 

[ChiggyT]

Thanks @Greg Sacramento, I'll try this tonight after I get home.

I may have figured out why my gums are receding: lack of saliva (I have been getting an extraordinarily dry mouth). Because of my general neuropathy, I've been reading up on different nerves in the body and how damage/compression/anything otherwise affects those nerves. I read the vagus nerve influences the mouth and jaw, so irritation of this nerve could be causing a lack of saliva. I understand it also affects your heart, and my resting rate is 88 bpm... On the other hand, it could be the Nortriptyline. Will drop down to 30 mg and see...

 

[Greg Sacramento]

On the other hand, it could be the Nortriptyline. Will drop down to 30 mg and see.

I would.

gums are receding: lack of saliva

With tinnitus: Medications and Nortriptyline is one. Dehydration. Grinding or clenching teeth and bacteria on a mouthguard can cause severe receding gums and tooth eruption.

 

[ChiggyT]

Apologies @Greg Sacramento, got home late from work yesterday so didn't get a chance to do the above.

Both shoulders are pretty even in curve and the shoulders are both pretty even. My outseam is about 98cm and inseam is 86cm. Hopefully this helps...

I have moved to 30 mg Nortriptyline, will report over next few days.

EDIT:

Having looked again, properly, this morning, the right neck seems "shorter." Tinnitus is in the left ear though...

 

[bobthebuilder]

@ChiggyT, have you seen this post re: Nortriptyline?

Don't want to beat a dead horse but I strongly suspect Nortriptyline is behind your tinnitus, especially given that it is somatic. Excess serotonin in the DCN causes somatic and auditory nerve input signals to get mixed up, causing tinnitus.