by Neil Bauman, Ph.D.
© November, 2021
You probably know that listening to louder music via earbuds can damage your ears. This is because the sound is trapped in your ear canals and focused on your eardrums. If you have the volume turned up too high, the end result can be hearing loss and mind-rending tinnitus. You can prevent this by keeping the volume down to a safe level—the level at which you typically listen to people speaking.
However, what you almost certainly don’t know is that just wearing earbuds, even if the sound is set at a low level or turned off can wreck your ears—as hard as that is to believe!
Even more scary is that this damage can occur in a moment of time. It doesn’t need minutes or hours or days or weeks or months or years of abusing your ears with loud sounds for this to develop. All you need to do is accidentally, yet vigorously, yank your earbuds out of your ears.
This happened to “Tim”. Here’s his story. “Tim” put his earbuds on and started listening to his favorite music. What he didn’t realize was that the volume on his cell phone was cranked way up. The sudden, blaring sound caused him to reflexively rip the earbuds out of his ears. The next day he felt intense pain on the right side of his head. He had the sensation of fluid oozing deep inside his ear. A few weeks later, he experienced a deep pressure sensation. His once-sharp vision became blurry. He continued to feel fluid oozing. Looking back on his experience, he lamented, “it was the worst several months of my life.”
“Dave” had a somewhat similar experience. He explained, “I accidentally yanked the earbud out of my left ear when my hand snagged the earbud cord. Ouch! I heard a pop; I felt a deep stinging pain; and, then I felt a fluid-oozing sensation from deep in my ear to the back of my throat.
I was off-balance when I got up the next morning. It felt like half my body was falling. When I’d swallow, my left ear crackled, crunched, and squelched. I felt intense pain on the left side of my head. I felt a stabbing pain in my left ear when I (or others) spoke. It felt like someone was blowing a balloon up inside my left ear, filling and stuffing it. The nausea I began experiencing was extreme. The hearing in my left ear would sound muffled when this happened. And to top it off, I had high-pitched ringing and whistles inside my ears. I felt really out of it.
“Henry’s” story began innocently enough when he was vigorously exercising while wearing a Virtual Reality headset. He had just started his 20th session using the FIT XR app with his virtual reality headset. He explained, “The FIT XR software had recently added a new style of high-intensity training in which you move your hands from left to right to hit a virtual ball.”
He was wearing his wired earbuds with sound isolation rubber domes, because, as he explained, “You can’t use wireless earbuds with my VR headset because of audio/video latency issues.”
The virtual trainer avatar challenged him to reach his maximum. He relates, “I was reaching to smash another virtual sphere and moved my arm in such a way that I accidentally snagged the earbud cord and inadvertently jerked the earbuds out of my ears.”
That’s when “Henry’s” troubles began. He explained, “I immediately had a sensation of pressure in both of my ears and ear pain. Day 3, I felt liquid draining deep inside my ears. By Day 11 I felt dizzy and lightheaded. On Day 12, I began to hear high-frequency tinnitus for the first time. I can say that these weeks have been the worst of my life.”
Unfortunately, after four weeks of rest and six weeks after the incident “Henry” sees little improvement. One of his problems was getting a proper diagnosis of his condition. He couldn’t find a doctor knowledgeable with his symptoms.
What happened to “Tim”, “Dave” and “Henry” was that they all experienced acoustic shock as they yanked their earbuds out of their ears. In addition to the acoustic shock, something far more serious happened. They developed perilymphatic fistulae. (More about this later.)
Two Styles of Earbuds—Be Safe, Not Sorry
Before we continue, realize that there are two basic styles of earbuds—those that fit “loosely” in the ear canal and thus do not completely seal it, and those that fit “tightly” and thus completely seal the ear canal.
In contrast, the style of earbuds that completely seal your ear canals basically have rubber domes at their tips. These earbuds typically sit deep in the ear canal and the rubber domes completely seal the ear canal thus preventing any air or sound leaking in or out. Some examples of this style of earbuds are shown on the right.
While both earbud styles can give you great sound, the tightly-sealed earbuds can be very dangerous to your ears unless they have a sufficiently-large air vent built in to allow air to get in/out (but I’m not aware of any that do).
The earbuds on the right are the style of earbuds that caused all the problems that “Tim”, “Dave” and “Henry” experienced.
If you wear wireless (bluetooth) earbuds, the chances of accidentally yanking your earbuds out of your ears when you exercise is pretty slim since there are no cords to get snagged. Thus, they are a much safer alternative to wired earbuds with their dangling cords—especially if you are wearing the domed style of earbuds shown on the right.
There may be reasons why you can’t or don’t want to use wireless earbuds. For example, bluetooth doesn’t have the dynamic range or frequency coverage needed for certain uses such as for some tinnitus treatments. Furthermore, the audio delay caused by bluetooth currently is still too much for people using certain Virtual Reality (VR) applications.
Therefore, to sum it up, do not use wired earbuds with rubber isolation domes. They can be dangerous to your ears in any situation where you need to swing your arms or move in such a manner that the cords might get snagged on anything. This is especially true when using Virtual Reality headsets for fitness activities where you make vigorous, sudden movements. In such situations, and if you are using wired earbuds, it is prudent to wear earbuds that don’t form a tight seal in your ear canals. If the unthinkable happens and you accidentally snag an earbud cord, you’ll be glad you weren’t wearing sealed-dome earbuds.
How Sealed-Dome Earbuds Can Devastate Your Ears
If you have earbuds that tightly seal your ear canals (similar to the examples shown on the right), two principal kinds of damage can result if you accidentally yank them out of your ears. First, the acoustic shock you receive can result in tinnitus, hearing loss and ear pain. Second, you can rip a hole in your oval window and thus cause your ear to leak.
You Can Give Yourself Tinnitus and Hearing Loss.
Once earbuds have formed a tight seal, yanking them out of your ears can cause acoustic shock. Although this happens in an instant, here’s what occurs (in slow-motion so to speak). As you begin to yank (or even pull too fast) on the earbud cord, you create an increasingly-strong vacuum in the space between your earbud and your eardrum. This is because the tight seal prevents outside air from rushing in and neutralizing the vacuum behind the earbud. This vacuum sucks your eardrum out. The tighter the seal, the further out it sucks your eardrum before the seal finally “breaks” and air rushes in.
Note: All that stretching of your eardrum and associated ligaments can give you instant, stabbing ear pain. This ear pain typically fades away in a few days as the stretched tissue “heals”.
When the seal finally breaks and air rushes in to fill the vacuum, your eardrum (just like a tightly-stretched elastic band) suddenly snaps back. This sudden, large movement of the eardrum has the same effect on your ears as if you just experienced a loud explosion. Your eardrum snaps inward “hitting” the hammer (malleus), the first of the three tiny bones in your middle ear. The hammer “hits” the anvil (incus) and in turn, the anvil “hits” the stirrup (stapes). The footplate of the stirrup, attached to the oval window membrane by a ligament, raps on the oval window with excessive force pushing it in further than normal. This causes damage to the fragile components in your cochlea (inner ear).
The structures we are talking about are minuscule. For example, the footplate of the stirrup (stapes) is less than 3 mm long and less than 1 mm wide. The oval window is a tiny connective tissue membrane that separates the middle ear from the inner ear. It ranges in size from 1.26 mm to 2.4 mm according to one study. The rim of the stapes footplate is attached to the oval window by the annular ligament that looks like an extremely-tiny, sticky, rubber washer. As you can imagine, these structures are fragile and subject to damage from “rough” usage.
Thus, the result of jerking sealed-dome earbuds out of your ears is often threefold—instant pain, developing tinnitus and hearing loss. (Typically your ear feels muffled—what audiologists call a temporary threshold shift [i.e., temporary hearing loss]).
Hopefully, in a few minutes to a few hours, the tinnitus fades away and your hearing returns. However, this doesn’t always happen. You may be left with some degree of permanent hearing loss, and since tinnitus almost always accompanies hearing loss, you typically have some degree of permanent tinnitus.
You Can Cause Your Ears to Leak (Perilymphatic Fistula)
The above symptoms are bad enough, but the second kind of damage caused by ear trauma, although less common, is far more serious, nasty and insidious. As you saw above, when you forcefully yank an earbud out of your ear, the vacuum created by the sealed earbud pulls your eardrum outwards which, in turn, pulls on the three tiny middle ear bones. If the force is too violent and the vacuum is too strong, the stirrup, as it is yanked away, may rip the delicate oval window membrane, causing perilymph from your inner ear to leak out—a perilymphatic fistula—that results in some nasty things happening.
Not only can you experience hearing loss, tinnitus and ear pain, but also you can experience vertigo where your world spins around causing you to lose your balance and the resulting nausea leads to you puking your guts out. A perilymphatic fistula is an extremely serious condition and incompatible with a normal life. It can be vestibular ‘hell on earth’.
Furthermore, when the oval window ruptures, it allows the perilymph from your inner ear, and afterwards the cerebrospinal fluid (CSF) that bathes your brain, to enter your middle ear where it oozes down your Eustachian tube into the back of your throat and from there to your stomach.
As the perilymph leaks out, it is replaced by cerebrospinal fluid via the tiny cochlear aqueduct. This leaking cerebrospinal fluid lowers the CSF pressure in your brain and spinal cord. When your CSF level drops even slightly, you begin to get “low-pressure” headaches. The headache intensities vary, and can be debilitating.
As Dr. Aaron DeShaw explains,
What few people know, or consider, is that your inner ears are connected by the cochlear aqueduct to the CFS-filled subarachnoid space that surrounds your brain. If the oval window or round window of the inner ear is perforated due to trauma, then perilymph escapes, driven by the hydrostatic pressure of cerebrospinal fluid. The escaping perilymph is replaced by CSF entering the cochlea through the cochlear aqueduct. In this condition a longitudinal flow will exist between the cochlear aqueduct and the site of the perforation. The chemical composition of perilymph will be disturbed because the perilymph will continually be “washed out” and replaced by CSF.
Diagnosing these low-pressure headaches can be difficult. And to make matters even worse, if you have a perilymphatic fistula, doctors typically either totally miss it, or misdiagnose your problems as something else entirely, so you can needlessly suffer for years before someone discovers the truth and diagnoses you correctly and then treats you properly.
Not only that, according to Dr. DeShaw, once the oval or round window ruptures, healing takes a long time and during that time even just swallowing, straining, coughing or sneezing can cause a re-rupture, forcing the process to start all over again. He explains:
Healing of the inner ear membrane [oval or round window] occurs one cell at a time. If it is re-ruptured by new trauma you start over again. Once it heals over at one cell thin, the connective tissue starts to move in. This is vastly different from other parts of the body where collagen comes in early after an injury. This means that collagen fibers do not lay down for approximately eight weeks of uninterrupted healing. Once the connective tissue starts to lay down, it does not fully rehab for 12–18 months.
Imagine, all of this needless anguish just because you accidentally yanked your tightly-sealed earbuds out of your ears. How much better to either use wireless earbuds so there are no cords to accidentally yank on, or wear “loose-fitting” earbuds so if they ever get yanked out—air quickly flows around them and into your ear canals to prevent strong suction from being created that can then damage your ears.