by Neil Bauman, Ph.D.
A veteran wrote:
My hearing loss and tinnitus is service-connected. I was exposed to constant cannon fire while in the Marine corp. No hearing protection. Marines were expected to tough it out. Now I’m paying for that silly theory with my hearing problems.
I am trying to explain to the VA doctors and audiologists about my severe sensitivity to sound. Some loud sounds hurt my ears really bad. This is causing me to have anxiety and panic attacks secondary to the loud sounds. The VA has said that my problems are psychological so I’m now seeing a psychologist.
I am very depressed because of my inability to hear well, and my tinnitus is extremely loud. I sometimes think that there are mice in my ears scratching to get out. The tinnitus and combined hearing loss is very depressing, but so also is the sensitivity to loud sounds.
Loud sounds cause me to become disoriented and dizzy and I lose my balance. Several times, upon hearing loud sounds, I have fallen. I realize that this is caused by my anxiety reactions and panic reactions to the pain of the loud sounds.
My problem is that I can’t seem to make the VA medical people understand. They just think I have to get over the depression. They think the depression is causing the problem and that when the depression goes away so will the tinnitus and sensitivity to sound.
I also hear phantom sounds, which I know are a part of my hearing loss and tinnitus. But again the VA is saying no. They want to blame it on psychosis? The bottom line is that the depression, anxiety and panic disorder are secondary to my hearing problems.
Fear of sounds is called phonophobia. In your case you perceive the sounds as so loud they hurt. No one wants to be hurt—whether it is loud sounds or anything else.
However, I think that rather than having phonophobia, you have hyperacusis—where you perceive normal sounds as too loud. Hyperacusis is often the result of having your ears damaged by loud noise such as you were exposed to in the Marines.
Living with loud tinnitus day in and day out can lead to depression. Actually, this is sort of a Catch 22 situation. Depression often leads to louder tinnitus—so you want to get your depression under control in order to help control your tinnitus, but on the other hand, loud tinnitus leads to depression, so you want to get your tinnitus under control if at all possible.
You can learn to live and enjoy life even though you have tinnitus and can’t hear much. I don’t hear much at all now, and I’ve had tinnitus day and night for 65 or more years—but I don’t let it affect my happiness. My book, “Take Control of Your Tinnitus—Here’s How” has helped many.
It’s interesting (not nice, but interesting) to note that loud sounds also cause you to lose your balance. I don’t see how it relates to anxiety reactions like your doctors think it does. To me, it seems you have a condition called Tullio’s Phenomenon in which people lose their balance from loud sounds—not from anxiety or panic.
Another name for it is Superior Canal Dehiscence Syndrome. Basically what happens is that you have a hole or thin spot in the bone separating the balance system from the hearing system. Thus when you hear a loud sound, the sound wave travels via the hole to act on the balance system. Since it is a sound signal and not a balance signal it sends false balance information to your brain. This totally confuses your brain and the result is loss of balance.
Some people drop to the floor like they were knocked out. Others have vertigo and some dizziness and imbalance. Sometimes doctors can patch the hole and cure this, but other times not.
If this is what you have, then the psychologist is wrong in trying to treat you for anxiety and panic. Yes, you need to get those under control too, but you also need to have an otologist check you out for things that cause Tullio’s Phenomenon such as Superior Canal Dehiscence Syndrome. You have several ear-related problems and each one needs the proper treatment by the appropriate professional. Blaming it all on you just isn’t going to help!
This sounds very similar to my recently diagnosed Meniere’s disease. I’m wondering why no one has considered this in this man’s case, as stress or anxiety seem to exacerbate symptoms? Just a thought. Thanks for your help & suggestions. 🙂
Hi Melissa:
I don’t think losing your balance because of loud sounds is related to Meniere’s Disease. I know a good number of people with Meniere’s and no one has ever mentioned a connection between Meniere’s and loud sounds.
Regards
Neil
Dr. Neil,
I am also a veteran and suffer from occasional dizziness from loud noises. I have had tympanoplasty on my left ear after an IED blast suffered in Iraq in 2005. My right ear drum was ruptured in the incident as well, but it was decided that it would heal naturally and no surgery was required. Now I am dealing with tinnitus in my right ear, dizziness around acute loud noises (bang, boom, crash and the like) and the occasional benign positional vertigo. Is there a chance that the military doctors missed something in their diagnosis that could have led to my condition? I have been back and they seem to be giving me the cold shoulder.
v/r
Eric
I am going on 36 and have recently had an incident where someone dropped a small medal pizza pan on accident on a hard floor. Which caused a loud ringing or banging. At the exact moment that this occurred it was like I was pushed back but from inside my head and I could not see the whole time that the ringing or banging was happening. I Have not had issues with anxiety or depression. At least not as of late. LOL. I have not had prolonged exposure to extremely loud noises. At least not for many years. Don’t really listen to loud music anymore. However I have been unknowingly exposed to black mold that was growing in my apartment. This can cause hearing and vision problems and also, neurological issues. My son has suffered from an imbalance issue at times where he had extreme dizziness and couldn’t stand. We took him to a specialist and it is not his hearing. I have had fear of this happening to me again. It seems at times (as it did that day) that I am in a chamber of some kind. Where I can hear extremely well. Like super hearing. Just thought I would share to see the comments and suggestions. Thank You All and God Bless. 🙂
I also have a problem when exposed to really loud music….i get sort of disoriented, my knees bend like im gonna fall down and i lose balance..specially when it catches me by surprise..i’ve never been to the army or exposed to super loud noises i live in tx where its just normal sounds nothing out of the ordinary..i guess the man’s depression and his trouble with sound are two different issues. My guess is that the fluids that make our balance right have a connection to our ear drums…im not a doctor but i’ve thought about when people have ear infections, some people lose balance or cant walk straigh..maybe thats also my problem that the fluids (dont know what they’re called) are chimically unequal one side to another cause they meet right at the forehead. So I will see a doctor my problem is not bad or serious but i noticed it last time i went to a concert and almost fell to the floor. Thats when i noticed i had an issue there. Hope my story helps you out and dont always listen to doctors..they blame all problems on one thing you’re going through cuz some are lazy and dont want to go the extra mile to heal their patients..i dont blame them, they live off your illness… 🙂
Hi Jesus:
It sounds like you have Tullio’s Phenomenon or Superior Canal Dehiscence Syndrome or something similar. What happens is that there is a “hole” in the bone that surrounds your balance system and sound vibrations that are supposed to only go to your cochlea are allowed to travel to your vestibular system where they are interpreted, not as sound waves, but as balance signals. These spurious “balance” signals confuse your brain and you lose your balance. In severe cases, a sudden loud sound will cause you to lose your balance so suddenly that you fall to the floor as though you had been poleaxed. You should see an ear specialist and be checked out for the above.
Regards
Neil
Dr. Bauman:
I have been diagnosed with Loud Noise Vertigo. My first experience was 30 years ago & is very predictable to get dizzy after exposing to loud noise. My dizziness occurs after 24/36 hours of sound exposure. Recent hearing test shows a 50% loss in left year. Meclizine had helped in the past but not much any more. What test do you recommend & is ENT doctor the right specialty in my case?
Regards
Paul Gupta
San Diego
Hi Paul:
I’d go to a knowledgeable ENT, or better yet, an otologist if you can find one close to you, and ask to be checked out to be sure you don’t have something like Tullio’s Phenomenon, otherwise called Superior Canal Dehiscence Syndrome. I think that would be the most likely cause of your balance problems. Your doctor may find a different cause, but I’d start there.
Cordially,
Neil
I also had tympanoplasty surgery by a non VA Doctor, approved by the VA, since I live so far away from my primary VA Doctor.
I have had a hole in my right eardrum ever since I was on active duty overseas and was involved in an accident, which resulted in my right eardrum becoming perforated.
This surgery was performed on 12/10/2014.
For the first 7 or 8 months, I had such terrible, extremely painful headaches that seemed to originate from the scar area and inner tissue next to my skull on my right ear.
I also have had non stop, very loud, very high frequency ringing that never has stopped. In fact it seems to be getting worse.
Another problem that I have had all along and continually, is when ever I wake up from sleeping, I always will tip to the right and unless I am holding on to a wall or something, I will fall, always to the right side.
That also seems to be getting worse, because when I first noticed it, it would last up to 5 or 10 minutes at the most before I could stand and not feel as though I am falling. Now that equilibrium problem is lasting longer, and occurs when I must realize my balance when I am physically challenged to need my balance. LIke walking a beam, or tight rope, but just on a flat surface.
I am really starting to be mentally affected by all of this, and half of my right ear and the upper half of my scar tissue is still numb and much without sensitivity.
What should I do?
I have tried to ask the hospital where the surgery was performed, but the already closed the case and refuse to admit that something went wrong.
I am at my wits end, especially with this ringing.
What can I do?
Thank you!
Hi, I have issue with people blasting sound from their phone, it causes dizziness and disorientation. I had went though many rounds of tests and exams to rule out Tullio. My hearing is 100 %, but I was told I am more sensitive at lower db than norm.
In the end I was told there is nothing wrong with my hearing and off I go. Back to square one.
Hi George:
If you don’t have Tullio’s, that eliminates that as a cause of your dizziness, etc. Now you need to figure out what else may be causing it. I know I’ve read something about this, but I can’t quite dig it out of my memory at the moment.
What does your audiogram look like? Is your hearing showing at the 0 dB line all the way across? If you really hear better than normal, then your hearing may show up all above the 0 dB line–at -10 dB or even -20 dB. That would certainly indicate hyperacute hearing.
Cordially,
Neil
Hi Neil ,
I have sensitive to sound all the time and have fluid behind drums and dizzy head … ent claim it is anxiety /tmj my ears constantly ake all the time my blance and hearing test came back perfect
mel
I’m also sound sensitive, when my dog barks or metal clanging. But this come and go. I also have nystagmus sometimes. When I poke my left ear using my finger, my eyes move.
I have sensitive hearing. Saturday night I was very close to the noisy fireworks. It is now Monday, my equilibrium has been off. What is happening to me??? Inf;amation of the nerve????
Hi Jeanette:
Good question. My first thought was that the loud sounds ruptured a membrane allowing sounds to affect your balance system. If so, any louder sounds would affect your balance. You wouldn’t feel “off balance” when it is quiet.
Is your balance off all the time, or just when there is noise around?
Cordially,
Neil
Hi Neil,
I am wondering if you can help me. I have developed hyperacusis after my second child. I also had BPPV and what has now morphed into a chronic dizziness. There are some good days in between but mainly, when I get the sensitive hearing days, my ears feel full and i feel dizzy. Not to thepoint where I am incapacitated, just “off”. I also can notice some aural fullness and low tinnitus.
What would cause this?
In July 1967 a 50 caliber machine gun “cooked” of a round that was very close to my head. I couldn’t hear for a week. Had tinnitus but, MD said there was no damage to ear drums.
I started experiencing in my vision lights and dizziness. when I blew a whistle during track practice I lost my balance and fell backwards. Thinking that was just an accident I blew the whistle again and fell down. Last week I attended a party which had extremely loud music. The next day I fell down dizzy when I tried to stand up. My MD thought I l might of head a mild stroke. I think it was due to hyperacusiis. I am deaf to high frequency sounds.
Hi Bob:
I don’t think either of you is right. What jumps out at me is that you now have a “hole” in your inner ear that shouldn’t be there and lets loud sounds through to your balance system where your brain interprets them as balance signals–and since they are bogus balance signals, your brain gets confused and you lose your balance.
The result is that with a sudden loud sound you drop to the floor like you’ve been polaxed.
You most likely have what is called Tulio’s Phenomenon, typically caused by superior canal dehiscence (a hole in the superior semicircular canal). The doctor you want to go to is an otologist or neuro-otologist and be checked out for this. Sometimes they can patch the “hole” and then you are ok.
In the meantime, block your ears if there is going to be a sudden loud sound so you don’t lose your balance. I.e. block your ears before you blow your whistle for example.
Cordially,
Neil
Two years ago I had SSNHL followed by three steroid injections in inner ear which didn’t help, but I think it caused recruitment. At around 70 db to 75 db sounds explode. I simply can’t tolerate loud traffic , background noise, vacuum cleaner, clothes dryer, etc. I plan to see a hearing aid specialist to see if a custom hearing aid can enhance speech, allow noise up to 70 decibels and block louder. Is this possible?
Hi Mildred:
How soon after the sudden hearing loss did you notice that 75 dB was your limit before sounds “explode” in volume? Within the week, or did it occur much later?
What is your degree of hearing loss by frequency? Is your loss more in the high frequencies or more in the lower frequencies?
Assuming you have recruitment and not loudness hyperacusis, a hearing aid fitter should be able to set the compression and maximum loudness to a level such that your recruitment won’t kick in. They may not want to do this as they’ll think you are limiting the usefulness of the hearing aids–but if they don’t, you won’t wear your hearing aids except in quiet places. You need to find someone what will work with you to find the best solution. It won’t be perfect, but it should help.
For example, when the background noise goes up, or there are certain sounds around me that recruit, I yank my hearing aids off. (In my case, louder sounds don’t recruit if I’m not wearing my hearing aids.)
Cordially,
Neil
I have had high-pitched tinnitus for over 20 years. In my younger years, I was a musician, so I attribute the ringing to that. However, for the past 10 years, whenever I sit in front of hi-fi speakers of any quality, my tinnitus gets worse, my ears become super sensitive to sound, I get moderately dizzy and disoriented, and have difficulty with my balance. This will last for a few days after listening. The last ENT I was seeing did a VEMP test on me and ruled out Superior Canal Dehiscence. However, the most direct cause of symptoms is sitting and listening to high quality hi-fi speakers…I can literally start feeling sick within ten minutes. Any thoughts? Thank you!
Hi Alan:
Your situation is definitely unusual so I can see why your doctors are baffled. I need more information, and that means you probably need to do some experimenting in order to answer my questions.
1. Is this volume-related? If you turn the sound down, does it make any difference compared to the level you’d usually listen to music?
2. Is this frequency-related? Is there a lot of deep bass in the music when this happens? If you listen to totally different kind of music, say violins or other high frequency instruments, does this still happen? Or vice versa?
3. Is this equipment-related? If you listen to exactly the SAME music on another Hi-Fi system do you have exactly the same results? Then, if you listen to exactly the same music on a different kind of system does it not bother you?
4. Any other things that make a difference?
Hopefully, when you get back to me, I may have a good idea of what is going on.
Cordially,
Neil
Hello,
Thank you for your response. It seems to be mainly frequency related. I can listen to lo-fi boomboxes or car stereos, but expensive hi-fi systems that cover wider frequencies make my tinnitus ring louder and bring on vertigo and balance issues for days especially really bright higher frequencies. Certainly volume IS a factor too, but maybe just not as direct. This has been a long-term problem. The first ENT I went to years ago thought it was an abnormal meniere’s presentation. The next ENT diagnosed vestibular migraine. Have tried lots of mediations with no real success. Have been through vestibular rehab and all of the spin tests…etc. I was seen at John’s Hopkin’s and they said that I had “some sort of inner ear disorder”, but they could not pinpoint exactly what. At times over the past 15 years, I have had vertigo/balance problems without having listened to music, it just seemed to come and go almost at random…however, these days, if I stay within my comfort zone with noise/music/sound, I feel pretty good most of the time. I have normal male age 50 slight upper register hearing loss, but overall, despite the loud ringing all the time, my hearing is normal. I should say that I added an additional complication after dental work a few years ago. I developed some problems with TMJ after having a tooth pulled. My bite went off and I developed a problem with clenching that has at times very much exacerbated my inner ear problems. I am being treated for that with a Gelb orthotic. It has helped somewhat. But the sensitivity to sound still exists. I do not feel that TMJ is the cause for my problems, just an agitation to the issue that already existed. I have been a challenging case to ENTs and neurologists for many years. LOL!
Just a bit more to add… I mentioned previously, that I was a musician in my younger years. In high school through early college, I was a drummer in several rock bands…no ear plugs were used back in the 80’s! After that, I worked with electronics to create music at home. I have thought at times through this process that the exposure to the loud music/sounds damaged my ears. I certainly cannot tolerate being in a room for five minutes with a drum set these days. One other possible suspect was in 1998 I was hospitalized with pneumonia. My lung ended up having to be drained after the intravenous antibiotics did not clear it up. I have thought at times that I was given ototoxic antibiotics that lead to my inner ear problems. The vertigo/balance problems began about a year after this Frequent loud music and/or antibiotic otoxicity have been my prevailing theories over the years. Obviously, there is no way to prove them. And, the ENTs I saw over the years always told me that loud music cannot cause damage to the ear that can lead to vertigo and/or balance problems.
Hi Alan:
When I hear a person has balance problems due to loud sounds, I immediately think of Superior Canal Dehiscence as the likely cause. Since your doctors have ruled that out, obviously you have to look for another cause.
Interesting that two of your doctors have suspected a form of Meniere’s as the cause. Coupled together with the fact that your TMJ problems make it worse, my next thought is that your upper cervical spine is not in proper alignment.
Have you ever had any neck/head trauma–maybe in your high school or college days? Or ever been in a motor vehicle accident? If yes, then I’d say very likely you need to see a special kind of chiropractor called an upper cervical spine chiropractor. When the top two vertebrae (C1 and C2) are out of proper alignment (and it doesn’t have to be very much), this can “pinch” your vestibulo-cochlear nerve and cause all sorts of balance and hearing problems–depending on exactly which nerve fibers are affected. This can give rise to full-blown Meniere’s disease, or sub-forms of it such as vestibular hydrops or cochlear hydrops.
Read my article on the subject at https://hearinglosshelp.com/blog/atlas-adjustments-alleviate-menieres-disease/ . Then find yourself a good upper cervical chiropractor and see what he finds out. That may be you basic problem.
It is possible that drugs in the past may have damaged your vestibular system, and certainly the loud music you exposed your ears to caused some hearing damage (you may have a considerable degree of hidden hearing loss) that you are not aware of.
But from everything you have said so far, if I were in your shoes, I’d head to an upper cervical spine chiropractor as my first step. It’s all laid out in the above article link.
Cordially,
Neil
Thank you. Last night was a perfect example of my problems. I had been without stereo speakers for about three weeks, and so any music listening had been done in my car or on a very small boombox-style unit in the bedroom. Generally speaking, I felt mostly fine during this time. I always have tinnitus, but it was not overly loud or intrusive. Yesterday evening, a new pair of bookshelf speakers arrived. I hooked them up and listened to about six songs at low to moderate volume on them. They sounded wonderful! I totally enjoyed listening to them and was feeling that perhaps they were small enough that they did not aggravate my ear condition. No such luck! immediately upon turning everything off, I could already hear that my tinnitus was significantly louder…always a bad sign. While sleeping throughout the night, I noted a slight rocking sensation as if I was sleeping in a hammock outside blowing in the wind, ears were ringing very loudly (louder than my white noise fan that I sleep with every night), and my balance was off moderately. This morning, the ears are still ringing very loudly and I still feel a bit off. Not horribly, but notable. This is basically what happens every time I try to listen to decent stereo speakers or am exposed to loud or vibrant frequencies.
Hi Alan:
I think your problem is basically (as you said previously) related to frequency. The high quality sound systems provide more power in the very low and very high frequencies–and obviously, you are sensitive to one or both seeing as you listened to the music at low to moderate levels, yet the same levels on car speakers doesn’t affect you.
I’ll address my thoughts on how to deal with it in my next comment.
Cordially,
Neil
In my research I have come across Vestibular Hyperacusis. The symptoms and causes seem to match mine. What do you think? If I did have this issue, what would the treatment be?
In response to your question about neck trauma, I have not had any accidents or any neck issues that may have caused an injury. At times, I have had some neck pain related to TMJ, but that is muscular. I have had MRI scans done by neurologists of my spine and they said it was normal. However, my TMJ dentist, who is a neuromuscular dentist, has mentioned the C1 and C2 issue that you talked about as being a possible issue for me.
Hi Alan:
Yes, you have vestibular hyperacusis. As I mentioned way back, the most likely cause is called Tullio’s phenomenon or Super Canal Dehiscence Syndrome. You had been tested for this in one balance clinic and supposedly didn’t have this. It wouldn’t hurt to go to a different clinic for a second opinion. The first clinic may have missed it because your symptoms seem to be out of the normal range.
The other cause is as I pointed out and your neuromuscular dentist has confirmed, that if your C1 and C2 vertebrae are out of proper alignment, it could be “pinching” your vestibular nerve just enough to cause your symptoms. So I still recommend you head for a good upper cervical spine chiropractor and see whether your C1 and C2 ar in proper alignment.
Those are two main causes of vestibular hyperacusis. So that is where to begin. Once you have taken care of this, and if they don’t reveal anything, then it is time to look further afield such as the possibility of some drug has caused this.
Cordially,
Neil