Patient whose tinnitus worsens with the use of amplification

So I have a patient who came to me with his main complaint being Tinnitus, his wife’s main complaint being he can’t hear well.

After some counseling and conversation, he finally admitted that he has a problem hearing, and decided to try some hearing aids.

They work, in that they help him hear better, but they don’t work in that he claims that when he first puts them on, everything is fine. But after 2 to 3 hours, the level of his tinnitus begins to climb, and according to him, it gets so bad that he can’t hear anything but the roaring tinnitus.

I have been fitting hearing aids for almost 25 years, and this is a first. I have never had anyone who, when fitted with hearing aids, their tinnitus got worse.

Anyone else have any insight into this phenomenon?

I’m not a professional, but I lost hearing in my left ear and had extremely loud tinnitus in that ear. I finally got a hearing aid for that ear because I read it could help tinnitus. At first, the tinnitus got even louder - I described it as roaring. But after a few weeks, the tinnitus got a lot softer. Now, after four years, the only time the tinnitus is really loud is when I’m stressed, have food/drink that triggers it (red wine, chocolate), after being in an extremely noisy restaurant, or when I’m having an audiogram.

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Kaytee…

thanks so much for the reply. If I may ask, were you diagnosed with anything related to the inner ear? Menieres disease or endolymphatic Hydrops? Thanks a lot!

Eric

I have the most difficulty with my left ear. Specific sounds become intolerable, and the response (as explained to me) is called vestibular hyperacusis. In some situations I need to remove myself from the location before a vertigo episode is triggered.
I have had meniere’s for more than 20 years, and have learned the triggers that can bring on an episode of vertigo. Sometimes, the barometric pressure causes an increase in symptoms also. I do use a medication that works when symptoms start to increase, that ‘calms down’ the response of the vestibular system. If that fails, I have a medication that I can use for vertigo/vomiting instead of repeat visits to the ER.
I have aides in both ears, however the left aid functions more to mask the tinnitus and turn down ‘non verbal’ sound.
I am not a doctor, but this is the best description I can offer. I have had hearing aids about 12 years.

I have the same experience of having tinnitus become louder after I use my hearing aids. I am heterozygous for a mutation in a hair cell structural protein, cadherin 23, so I don’t have any fully normal hair cells in my head. But I don’t think that is the problem. I think that the moment my brain picks up stimulation it hasn’t heard without the aids, it turns up the volume centrallyto hear more. What results is more tinnitus. This is just speculation but I hope it’s helpful.

That is correct. The harder the ear works to try to hear, the louder it becomes. With meniere’s disease the hair cells are destroyed.

It appears one option might be cochlear implants, (which bypass the hair cells and send electrical signals to the brain). I have several friends who have cochlear implants. That is a long process of retraining the brain to work with the device, but for those who have lost ability to hear, it is something to consider.

Sorry for the delayed response (got my first grandchild soon after I posted).

I wasn’t diagnosed with anything related to the inner ear, but the medical “care” I’ve received for this has been lacking, to say the least. When it first happened (over a decade ago), my primary doc referred me to an ENT who removed some wax, then held a tuning fork to my ear, asked me if I could hear it. When I said, no, he said I had “nerve damage,” referred me for an MRI to check for “a tumor.” Returned to ENT who said MRI was clear, go see this audiologist. Audiologist did a hearing test and quoted $3,000 for one hearing aid. No insurance for hearing aids, didn’t have $3K to spare, and shortly after became responsible for two parents with dementia, so I just lived with it.

After my parents died (a decade later), I went to a different ENT. That ENT sent me for another MRI (just in case!), had his in-house audiologist do a hearing test, and told me my only option was a CROSS. I didn’t want a CROSS, so I never went back.