Potential triggers to increased Tinnitus intensity

April 2, 2015 7:04 AM

I have a friend who suffers from tinnitus which is variable in intensity and am looking for triggers or insight into the pattern. There is a rough pattern to the intensity of the train wheel-like screeching – generally, he has 3 days when it’s bearable and then 2 when it is unbearable. I’m not looking for coping or masking strategies but trying to understand what could be causing the rise in intensity.

However sometimes it has been up to 6 bearable or unbearable days in a row. The intense period usually comes on in the morning, between when he wakes up and when he is on the way to work (between 6.30am and 8.00am) and grows from regular background intensity to strong over about a half-hour period. On the last day of aggressive intensity it starts to reduce and after sleeping it’s back to the calmer period.
Two things that increase the likelihood of an intense period is lack of sleep and doing sport (jogging or even going walking). Blood pressure and alcohol consumption have no effect on intensity. It does not seem to be stress related (similar pattern when on vacation). Keeping his mind off it (doing activities) and a period when he took anti-depressants seems either to reduce intensity or just help him ignore/cope with it. He has been to lots of doctors, physiotherapists, osteopaths, hypnotists, dentists (jaw), ENT specialists and but to no avail - all these were in Belgium. He has also tried cutting out carbs and glutene (and is trying a low salt diet at the moment).

It may have initially been triggered by a plane flight in a turboprop (first time he had taken a plane in many years) or a period of high stress 15 days after taking the plane. This was about three years ago. At that time, most days were intense, with only intermittent respite, however now he is in a rough 3 “OK”, 2 “Bad” pattern.

I’m not looking for coping or masking strategies. But does anyone have any ideas for potential triggers or methods to help him remain at the lower intensity of the sound? It seems that there must be some identifiable factor that produces such a pattern. Any ideas would be much appreciated.

posted by guy72277 to Health & Fitness (14 answers total)

Hmm, triggered by a flight makes me wonder about air pressure. Has he tried to map this intensity to changes in temperature or barometric pressure? Is it better or worse at higher or lower altitudes, or completely underwater?
posted by Andrhia at 7:39 AM on April 2, 2015

I have mild tinnitus. At first it was annoying and a constant distraction, but over time I've learned to ignore it -- and I gather the brain learns how to filter it out to a certain extent as well. Sometimes, I'll get an acute 'attack' where a louder tone, distinct from the usual background tone, fades in, maintains for a few seconds, and then fades out. This is pretty much random, and it seems quite commonly reported in tinnitus havers. Apart from that, things that make the normal tone 'louder' are usually either: situations where I'm deprived of ambient white noise -- e.g. being in a very quiet room, or being blocked up with a cold; situations that increase my mental/physical stress, like lack of sleep, or worry; situations that (I presume?) increase my blood pressure, like excercise or drinking caffeine; and situations that hamper my habitual ability to ignore and not think about the tone, like answering Ask questions about tinnitus. :P
posted by Drexen at 7:54 AM on April 2, 2015 [1 favorite]

Not an answer to your question, but your friend might find this article interesting.
posted by tizzie at 7:55 AM on April 2, 2015 [1 favorite]

I'm an ENT doc in the US. Here's a long list of questions to get everyone's juices flowing:

Is it in one ear or both? Equal?
Has he had an MRI? How about a CT angiogram (aka CTA)?
Did he have a head injury within 6 mos of the tinnitus starting?
Is he on any medications?
Does it seem to correlate with hydration (either more or less water)?
Does he have any hearing loss/vertigo and does it seem to change?
Does "popping" his ears (blowing out against a pinched nose) make it better or worse?
Is he able to pop his ears with this method regardless of its effect on the tinnitus?
Does it ever completely go away?
posted by robstercraw at 8:20 AM on April 2, 2015

I have mild tinnitus that occasionally flares up to I HATE THIS levels. These are the things that set me off

- sinus/dental issues
- caffeine intake
- salt intake (big one for me)
- barometric pressure (snowstorms bring it on sometimes)
- some medicines are "ototoxic" make sure he's avoiding them
- water in my ears from swimming/showering
- sometimes driving or keeping my head in a still position for a long time

I got more traction with it when I realized that (for me, and many others) tinnitus is as much of an anxiety issue as a hearing/sound issue. So when I get a flare up I treat it more like a panic attack (drop stressors way down, take ativan or something similar, have a drink, take a shower where I can't hear it) and that is helpful.
posted by jessamyn at 8:41 AM on April 2, 2015

Some common medicines cite tinnitus as a side effect. Pepto bismol is one, for example. A relative of mine has reacted to a single dose with several days of worsened tinnitus and can no longer take it. It is listed as one of the adverse side effects for this product, so they might want to think about what is in their medicine cabinet that they might take frequently
posted by Rapunzel1111 at 8:43 AM on April 2, 2015

Seconding that the general level of stress an anxiety is a factor.

My tinnitus is triggered by some antibiotics, e.g. Cipro.
posted by SemiSalt at 9:04 AM on April 2, 2015

I haven't seen this in the e-cig forums--and this is probably not an issue for your friend, but for the sake of someone stumbling across this question in the future--smoking e-cigarettes really brings up the noise level of my tinnitus.
posted by thebrokedown at 9:13 AM on April 2, 2015

I have a mild, barely noticeable case of tinnitus that I forget about for weeks on end, unless I have too much coffee. Then, watch out. I gave up coffee for about 2 months and the ringing went away completely. But the lure of the morning cuppa joe was too strong. Just when I thought I was out, it pulled me back in. So maybe ask him to try going without an AM stimulant. HMMV.
posted by the webmistress at 10:47 AM on April 2, 2015

My tinnitus is always there, but it flares up after loud sounds. After teaching piano each night, it flares up (because pianos can be loud), and if my kids yell or scream, then I feel my eardrum "flutter," I lose hearing for a brief moment, and then the tinnitus comes back hard core for several hours.
posted by TinWhistle at 12:36 PM on April 2, 2015

My partner's tinnitus flares with aspirin use and also after exposure to loud-ish sound. Things like concerts are obvious, but he also gets flare-ups after longer car trips or environments where there is a constant loud-ish drone noise (like a plane trip). Now we keep earplugs in the car for trips that involve the highway and that seems to help. Also, if he notices a flare coming, he can prevent it from getting to maximum bad by wearing earplugs for a couple of days. The origin of his tinnitus is damage from loud noise/music.
posted by quince at 2:40 PM on April 2, 2015

Nthing loud sounds. Road construction with a huge hunk of concrete dropped right next to me set off the most lengthy bout of loud tinnitus I have ever had.

I also notice the tone and intensity change with sinus congestion caused by atmospheric pressure.

My ears seem to generate sound on their own, since I have always had tinnitus and have very acute hearing. Some folks ears generate sound internally.
posted by effluvia at 8:35 PM on April 2, 2015

I have fairly severe tinnitus related to (lifelong) sensorineural hearing loss. It's mostly a constant annoying background, but a couple times a week it can get very distracting and make it hard to concentrate on anything. It sounds like your friend it experiencing something worse than this. I have never been able to establish any direct cause-effect patterns. It does seem like I'm more prone to severe episodes when I am over-tired or quite stressed, but it's not consistent enough for this to feel like something I can control.
posted by amusebuche at 11:51 PM on April 5, 2015

Response by poster: Thanks to all of you for your answers. It's definitely given him some new avenues to explore.
posted by guy72277 at 11:44 PM on April 21, 2015