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.
Those earbuds that fit “loosely” (some examples are shown on the left) are made of hard plastic and don’t have rubber domes. Thus they don’t seal your ear canals.
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.
Can you get secondary Hydrops from acoustic shock.. fullness and echoish ringing in quiet place
Hi Adam:
I wouldn’t call it secondary hydrops at all. Two of the side effects of acoustic shock you may experience are indeed that feeling of fullness in your ears and ringing in your ears (tinnitus).
Cordially,
Neil
Thank you i was on prednisone when i had acoustic shock i didnt even think it was loud then 2 minutes later the ring started ive always had a mild tinnitus in the one ear now both has multiple tones low hum that amplifies and the other has a litle reactive cricket to low sounds the that seems my old electrical tinnitus makes it flutuate to is pulses the right ear has a wine glass ring that goes with the fan on low .. the hum is worse it buids up and amplifies in quiet . Im 35 days into this acoustic traumaor the prednisone did it not sure made it 4 on prednisone doctor told me stop it caused anxiety and panic Didn’t taper
Thank you for this info. It’s very helpful. I have recently been using silicone earbuds to block out noise while I sleep (such as the Loop Quiet, and off-brands like it), and I had been wondering if the tight seal that even the smaller ear tips provide might be damaging in some way, and it led me to this page. I’ll be very careful with removal from now on. Thank you again.
I recently ruptured my eardrum, and I swear this is the most painful two weeks of my life and going. I don’t know for how long I can take it. I’m desperately looking for answers, my symptoms are just horrible (severe migraines, vertigo, trouble falling asleep and many more). The ENTs told me just to take painkillers, it is not helping at all. They didn’t prescribe for me any antibiotics because there is no infection but Lord, I’m in pain, I can’t live a normal life. So, I read through this article briefly, are my symptoms what is called: “perilymphatic fistulae”? If so, is there cure for it, what medication do I have to take? Please, please I need answers.
Hi Nancy:
How did you rupture your eardrum? What happened to cause this?
I fail to see how migraines, vertigo, etc. is related to this, so something more is going on. I need to know the full story in order to have a hope of helping you.
You may have a perilymphatic fistulae, but I don’t see a connection to a ruptured eardrum. They would be two different conditions with different treatments. That is why I need you to tell me more so I can understand what you have going on.
Cordially,
Neil
Dear Dr Neil,
Thank you for getting back to me, the past few days I felt helpless and hopeless. So, my story begins like this, as far I can remember like two weeks ago I was cleaning my right ear with a Q-tips as regular but then I saw a tiny blood stain on it, but there was no pop or pain. Few days forward I started to experience dizziness and headaches. I went to the hospital and they examined it with an otoscope and they told me my eardrum is ruptured, and I should avoid water from getting into it and just take pain medicine for the headaches. Few days after I started feeling better and hopeful that I am making progress with my recovery. But, I didn’t know that I should also avoid earbuds, so at some point I was using my earbuds then after few hours I started feeling dizzy again. That’s when my symptoms all came back and worser, I went to the hospital again and they checked the ear again and they said now the hole is larger, so I guessed a second rupture. The symptoms that I have, mostly at night I get the headaches and sometimes it felt like migraines, I can’t even differentiate because of how tense the pain is . Mostly at the back and middle part of my head, and I also get tinnitus from time to time but not leakages. I remembered when I was young I also ruptured my eardrum but I didn’t experience any of the symptoms, only pus leaking and ear pain.
PS: this is the strangest and headaches or maybe it is migraines that I have ever experienced. One thing I have noticed is, it is not consistent like sometimes during the day I feel better, I will even go for a walk (short walk because it is cold outside)just to relieve the stress. Some days I feel sick like I am getting a fever, my neck hurts and I get a little confused I don’t know if it is the stress or just my symptoms. I have no medical record of any severe condition nor my family but I also wonder if it could be something.
I lost almost complete hearing from the right ear; so, when I shut my left ear, I won’t hear any low noises or sounds, but I can hear louder ones, albeit muffled and unclear. Additionally I accidentally blew my nose and I felt air coming from that ear. Now that I remembered, I also have never fully regained hearing in the same right ear that I have ruptured when I was young. I am currently 24 years old.
Hi Nancy:
How are things going with your ears now? I was too busy to answer my emails so am trying to get caught up now.
Since your eardrum was ruptured years ago, do you know whether it healed up in the meantime, or was there always a hole in it ever since then? Sometimes they never heal and in that case, you never want to use Q-tips or get water in your ears.
Why do you say you should avoid earbuds? If you keep the volume at a reasonable level, I don’t see what the problem is–unless you have an ear infection.
I’m wondering if you have a viral infection that the hospital never found. If the virus got into the vestibular (balance) part of your inner ear, that could account for the dizziness and balance problems you experienced. And it maybe also could account for the headaches and migraines. This doesn’t sound like the typical (bacterial) middle ear infection like you had years ago.
Cordially,
Neil
Dear Dr. Neil,
I recently visited the ENT and my doctor suggested that surgery may be the only way to see some improvement. He also highlighted that the hole in my eardrum will not heal on its own, possibly due to damaged cells or the eardrum never fully healed since I last ruptured it when I was young. However, my symptoms had stopped for a while but now they have returned and the headaches are worse. There is no sign of any infection, I never let water get into it. But, I don’t why I keep getting this weird symptoms, making everyday life really difficult, the headaches, fatigue and I get so stressed about it.
Hi Nancy:
Since there is no infection, having the surgery to close the hole in your eardrum may have nothing to do with your headaches, etc., especially since they go away and then come back, but it could be a good idea anyway.
As concerning your headaches and vertigo, one thought I have is that your neck is “tight” and thus your vertebrae are not properly aligned. This can affect both certain nerves and blood vessels.
What I’d do if it were me is to go to an upper cervical spine chiropractor and make sure all your cervical vertebrae are properly aligned. This might account for both the headaches and balance problems.
You want to go to an upper cervical chiropractor, NOT a conventional one. These guys are very gentle and do NOT crack your neck, but gently push the vertebrae into proper alignment.
You can find the one nearest you by going to https://www.upcspine.com/ and clicking on the “Practitioners” button.
The ones that take precision Xrays can tell whether you vertebrae are even slightly out of alignment. When I went to one, he said I was out a total of just 3 degrees–but that was enough to cause periodic vertigo episodes. I had two treatments and since then (7 or 8 years now) I’ve never had another episode of vertigo. You might find you have a similar experience.
Cordially,
Neil
Dear Dr Neil,
Thank you for the info, I recently went to another doctor and she diagnosed me with tension headaches. Similar to what you highlighted, she suggested I should see a physiotherapist for the tight muscles around my neck or get a botox injection. I will check the chiropractor as well, hopefully I will be able to get some relief. PS: I don’t have vertigo any more just the headaches which definitely came from muscle tightening due to stress. I did worried a lot about my ear, never experienced some of the symptoms that’s why I freaked out.
Hi Nancy:
I’d second that about physiotherapy, but even better to have both chiropractic and physiotherapy. However, I sure wouldn’t take Botox. I have had too many people contacting me and telling me how it wrecked their ears. I think the risk is just too high to take it.
You also need to calm yourself down. Freaking out and being anxious is just counterproductive.
Cordially,
Neil
I’ve been using earbuds with rubber noise cancelation at night while I sleep and started to hear crackling in my right ear during the day as if there is water in my ear. I stopped using the earbuds because I thought I was getting an ear infection although I have no pain or itching. Just the crackling every so often. I put a little bit of Bactine on a qtip and put in my ear very gently today and there was a point where I could touch a specific spot and I heard that crackling again directly corresponding to the movement of my qtip. Am I touching inner ear parts that have gotten sucked out without my knowing it and what can be done if so?
Hi Regina:
It’ not a good idea to block your ears with earbuds as your brain needs to hear sounds in order to keep the volume you perceive sounds at normal levels. When you block out sound for long periods like when you sleep at night, you run the risk of developing loudness hyperacusis. Then, all or most sounds seem too loud.
Explain more about this crackling sound. If you have a cold and your middle ears and/or Eustachian tubes get clogged up, when you yawn or swallow, the air exchange makes crackling sounds as the air pushes through the “gunk” there.
If this is not the case, explain more about when and how often you hear these sounds and what triggers them if you know. Is “crackling sounds” the best description of them or is there some other ways of describing what they sound like?
Cordially,
Neil
The best way I can describe it would be to say it’s like a recording of sheets flapping in the wind (with the microphone picking up on the wind rushing over it). Maybe less about the sheets and more about the wind on mic. Either way I googled “sound of sheets flapping in the wind” and clicked the first video which is a link to a Facebook vid that shows mauve sheets blowing. That’s the sound. Now lay a recording of a record player over it with the crackling as the vinyl turns under its needle. I googled “crackle of a record player” clicked videos and chose the second link which is YouTube “old vinyl record crackle on loop…” That’s similar to the crackle. When I yawn, the 2 sounds together are what I hear. I’ve always heard the initial short crackle as things open up but it’s one short crackle and then progresses to the wind over mic sound for the duration of the yawn. That’s been my whole life and never freaked me out. Ever since this thing started, it’s the two sounds laid over each other for length of yawn every time, then crackles as things settle and I close my mouth. And then a crackle or two sometimes within the few minutes after a yawn. When I use a qtip now, if I poke it into the canal staying close to the top and gently swab and I mean very gently it sounds like I’m plucking a taut string. I know how odd that sounds. Anytime I yawn or do anything that changes pressure in my ears is when I hear the first description, and if I happen to hiccup with my mouth closed it causes pressure change and I hear the 2 sounds. Any time I use a qtip the string sound has me thinking I’m touching some inner ear part directly, so I back out and try not to do it again. I don’t associate it with any of the colds I’ve had over the last few months (maybe two) but I could be wrong. I can’t be sure but I think the problem started before the either cold occurred. And has persisted to date which is why I thought to check back here. I do have allergies to some tree pollen which I’m starting to get now off and on, but it usually causes itchy eyes and throat and a dry random cough not fluids or congestion. Thank you so much for taking the time with me.
Hi Regina:
When you yawn or swallow, your Eustachian tube momentarily opens to allow air exchange between the back of your throat and middle ear. If your Eustachian tube stays open longer than normal you may be hearing your breath sounds as a sort of wind noise. I wonder if that is what you are experiencing.
The crackling sound is the sound of your Eustachian tube opening–sort of like the way your lips make a sound when you are kissing. More crackling sounds typically indicate that you have gunk in your Eustachian tubes and the air is pushing through them making a path that open in front of the air and closes behind it.
The “twang” sound you get when touching a part of your ear canal with a q-tip is probably a tinnitus sound generated by a somatosensory nerve there when you touch it. It sends a “sensation” signal to the base of your brain where it is routed through to your auditory circuits and thus your brain interprets it as a sound, not a tactile sensation.
Do these explanations make sense to you?
Cordially,
Neil
Dear Dr. Neil,
I won’t be doing the Botox injection, I felt like that would be just too much. However, I started seeing a chiropractor for upper cervical issues. He took X-rays of my neck, spine, and jaw (sometimes at night I found myself clenching my teeth really hard). He concluded that my neck is straight when there should be some curvature present. He explained that this lack of curvature perhaps resulted in a potential miscommunication in my nervous system, which may be causing the headaches and pain I have been experiencing.
So far, I have undergone two adjustments and exercises with him, which have significantly reduced my headaches. However, I still have persistent neck pain and digestive issues, and my arms also hurt.” I was thinking if I should take nerve blockers, because the chiropractor said I will have to do at least 24 sessions of adjustments. That seems a lot to me.
Nancy
Hi Nancy:
That’s great that you have reduced your headaches. Shows that you are on the right track with this chiropractor. It takes time to get everything adjusted correctly and holding the proper positions. Doing 24 treatments may seem like a lot, but that is how many it may take. I’d suggest going for 10 or 12 and then re-evaluate how you are doing. Then you can decide whether to continue on, or if you have reached a point of no further improvements.
I’m not a fan of taking nerve blockers or other drugs. I believe chiropractic and massage therapy would be a better course of action with no worries about drug side effects. Massage therapy can relax your muscles, etc. Why not also give it a try?
Cordially,
Neil