What causes clogged ears, hyperacusis, and tinnitus?

Hello doctor,

I have a clogged feeling in both ears, hyperacusis, and tinnitus 18 months after noise exposure. The initial event involved noise from a machine that lasted 20 minutes and immediately after that, I had severe pain in both ears, muffled hearing, tinnitus, headaches, dizziness, and a clogged or blocked sensation in both ears. Some symptoms have improved, but the clogged sensation has not resolved, and the hyperacusis and a tendency to find some sound are very irritating (even if not loud) has persisted. Is there anything I can do? I initially took Prednisolone for two weeks at 60 mg, and Betahistidine for about a month. I started the Prednisolone five days after the noise exposure. It did not seem to help. I have had several audiograms, and they do not show any dramatic hearing loss, for my age group (40s). I read that other medications might help such as medications that improve blood flow, like calcium channel blockers or Pentoxifylline, etc. Medications that affect the neurotransmitters, like Clonazepam, Baclofen, TCAs, etc., and medications that would help reduce any endolymphatic hydrops like Dyazide and other diuretics. Recently, I have been using a corticosteroid nasal spray in case eustachian tube issues are contributing to the problem. I tried various sound therapies, like listening to pink noise, but it did not help much. Hyperbaric oxygen therapy is too expensive where I live, and probably would not help now, as it is 18 months since the event. I have attached some hearing tests, and I am wondering if there are any other tests I should do to try to pinpoint the problem. How about ABR, electrocochleography, Dpoae, and high-frequency audiogram? Please take a look at the tests that I attached, and let me know your suggestions. I also attached pictures of the ear canal, in case you see any issues.

Hello doctor,

Thanks for your detailed reply. I did some blood tests for fatigue, about two months ago, but they only tested a few parameters. They checked my thyroid, metabolic panel, complete blood count, and HbA1C, cholesterol, and triglycerides. All these tests came back within the normal range, though LDL was a little elevated. It was 5.5 as far as I recall. But they have not checked my hearing issue thoroughly. The initial event that triggered the entire issue, was an MRI scan of my back. They told me the scan would be loud, and gave me headphones with attenuation of 14 decibels. They did not provide in-ear earplugs. It was so loud, that I was almost about to stop the scan but assumed (wrongly) that they knew what they were doing, and that the noise would not exceed the safety limits. However, once I finished the scan and took the earmuffs off, I had intense pain in both ears, felt like my ears were blocked, my hearing was muffled, and my balance was affected. Later that evening I noticed the hyperacusis, and tinnitus, and woke up with a headache and discomfort from the ringing in my ears, after just four hours. Now 18 months later, there has been some improvement, but I still experience many of the symptoms. They improve with quiet but are aggravated again by sound. I contacted the hospital twice by email and letter, and they just ignored my letters. Anyway, thanks for the suggestion about the schwannoma and meningoma. I will try to get those tested in the future and will try to get tests for vasculitis and the other things you mentioned. I also had reflux seven years ago, and maybe that irritates the eustachian tube too. However, the nasal corticosteroid spray has not helped much. They said I probably have LPR and gave me Nexium twice a day for a few months. I am not on it now. I have modified my diet and cut down on things like coffee, tea, fizzy drinks, and fried foods. Sleep on an incline and do not eat for three hours before bed. But wake with a terrible dry mouth with a bitter taste(so bad, I sometimes have to get up three or four times during the night to wash my teeth, and rinse my mouth). And I awake with eyes burning and irritated. I do not get any heartburn though, since removing trigger foods like coffee. The PPIs did not help much. I also tried Famotidine before bed, Gaviscon Advanced, etc. The main symptom initially was hoarseness. I assume these symptoms are from GERD or LPR, but maybe it could be something else. I will try to get more tests, but will I have to move somewhere else as here it is atrocious.

Thank you doctor for the reply,

I will try taking Gaviscon advance three times a day. In the past, I had only been using it after my final meal, and when I did not see results after a night or two, I would switch to something else. This led to me taking it only about twice a week at night. However, as you mentioned, the results might take weeks to become apparent. So, I will follow your advice and continue using it for a full eight weeks. I also have a history of left vocal cord paralysis from a few years ago. I could not move the cord, making it very difficult to speak. An endoscopy confirmed the paralysis. My first nasopharyngoscopy was five years ago, and at that time, they prescribed twice-daily PPIs for three months to address hoarseness.

After experiencing the paralysis, I underwent a CT scan, which did not detect any tumors or abnormalities. Paralysis in some cases can be related to tumors near the left recurrent laryngeal nerve, but in my case, this was not the cause. Fortunately, the paralysis gradually improved after about four months. My ongoing issue with hoarseness may also be attributed to the vocal folds not approximating correctly. I have not had a follow-up larynx endoscopy in several years. Recently, I experienced chest pain, leading to another CT scan and gastroscopy. The results showed evidence of reflux, and as a result, I was prescribed PPIs and sucralfate. My doctor also recommended adopting a lower acid diet.

I have become more mindful of my diet and have been trying to identify foods that trigger stomach discomfort. Coffee, in particular, is a significant trigger for stomach pain. I have switched to herbal teas instead of standard black tea, as I found that excessive black tea consumption also irritated my stomach and caused dryness in my mouth, possibly due to its high tannin content. I quit alcohol 13 months ago. I used to consume two beers once or twice a week, but it would occasionally make me feel tired. Wine used to cause stomach pain, so I switched to low-alcohol beers. However, despite quitting alcohol, I still wake up feeling unwell every day, with a terribly dry, bitter mouth, and burning, irritated eyes.

I appreciate your recommendations, and I am considering undergoing some of the tests you mentioned. If Gaviscon does not provide relief, I am open to trying other treatments. Some people have suggested using a prokinetic like Domperidone, while others believe that stress could be a contributing factor and recommend Baclofen. I had a basic sleep study conducted, which revealed that I have very mild sleep apnea. I have learned that using a CPAP (continuous positive airway pressure) machine may not only help with sleep apnea but also alleviate reflux symptoms.

Anyway, thanks again for your help.