by Brian Tomasik
First published: 13 Jul. 2017; last update: 13 Jul. 2017

Summary

This piece describes my history with an extremely mild case of tinnitus and my experiences seeing doctors about it.

History

As a very young child (mostly before I can remember), I had ear infections. I'm not sure what they were caused by. I remember being given ear drops, probably to soften wax, around age ~7, though I don't recall why.

Throughout my life I've generally avoided loud noises. For instance, I never played music too loud like some teenagers do. I may have had some abnormal levels of noise exposure when helping out with house construction (both my own houses and Habitat for Humanity houses), but these occasions weren't extremely frequent. In summer 2002, when I was sick at home with esophagitis, I read, among other things, a book about noise pollution and hearing loss.

Once during college I went to the campus health clinic for a checkup. The one thing they flagged to me was that my hearing was worse than expected. They referred me to an Ear, Nose, and Throat (ENT) doctor. At the visit with him, he found that I had lots of earwax and cleaned it out. I think he used pressurized water, but I don't remember with certainty. I do remember that the process was mildly painful, and I wondered whether I should worry about long-term ear damage from the water pressure. The procedure took several minutes, and afterward, I observed a marked improvement in my hearing. A friend who had a similar procedure done told me that after his treatment, he could (figuratively) "hear ants walking on the sidewalk".

Earwax in 2014

Ever since I started college, I've kept earmuffs at my bed in case I want to block out noises at night. This is very helpful when living with other people, or when there are loud street noises outside. A downside of earmuffs is that they prevent air circulation, which can leave one's ears more prone to wax buildup. In 2014, I found this problem to be particularly acute. On some mornings I woke up with an ear that was wet from being filled with wax. A possible aggravating factor for this problem may have been that my earmuffs were old and had past ear gunk on the soft inside part. I got new earmuffs in 2014, which may have improved the situation a bit. I think scratching wax out of my upper ears with my finger may also contribute to wetness overnight.

In summer 2014, my hearing had become noticeably worse, probably due to the frequent wax buildup. The summer humidity probably didn't help. Around this time, I also learned that using Q-tips is actually bad for one's ears, so I stopped using them.

Eventually, my hearing improved a bit, perhaps as humidity waned in the fall?

Tinnitus in 2015

In Nov. 2015, I went to my high-school 10-year reunion. Unfortunately, it was in a very loud nightclub, which made it hard to hear other people talking. The noise also made my ears hurt a bit. I don't think I had ever been to a nightclub before (at least not for very long), and I intend to avoid them in the future.

After the event, I became curious how bad nightclub noise is for one's hearing and looked it up online. Some articles I read mentioned tinnitus, "the club disease", which I hadn't known about before.

Later that month, at night when there were no other sounds, I noticed a soft, high-pitched ringing in my ears. It was a constant high-note tone. I don't know when it started. I suspect that it had been present for years, and on the rare occasions when I noticed it, I probably assumed that it just "the sound of silence" that one's ears naturally make, in a similar way as you can "see" weird colors moving around when you close your eyes (which we might call "the color of darkness"). It's also possible that the noise started more recently. I can't remember.

The noise was never bothersome, and I often couldn't hear it unless my environment was perfectly silent. But given that tinnitus is often correlated with hearing loss, I worried whether the tinnitus indicated a deeper problem.

Seeing doctors

I waited a few months, and the tinnitus continued. It was stronger in my right ear than my left, and I noticed that my hearing was also worse in my right ear, since when I switched a single earbud from my left ear to my right, I couldn't hear the sound as well.

I figured it was time to consult professional advice. I began by asking a doctor on justanswer.com, since this allows one to cheaply get answers to medical questions with a time delay of minutes rather than the time delay of weeks or, often, months for in-person doctors. The doctor I called said my ears were probably fine, given that I'm young and am not exposed to loud noises. But he agreed it would be best to see someone in person just in case.

I called some audiologists, but most of them told me I needed to get a referral from my primary-care physician (PCP). I hadn't set up a PCP yet, and doing so took a while. Eventually, a few months later, I went to my PCP and talked about my situation. My PCP observed earwax buildup and tried irrigating my ears (much more gently than the ENT I saw during college had done). That removed some earwax, but more remained. So I was also told to use Debrox drops for about a week to soften the wax and then come back for another visit.

I still had some tinnitus after the first visit. So at the second visit, my PCP irrigated my ears again and got more wax out. She also referred me to an ENT to check my hearing. I did a quick hearing test at the PCP's office, which was fine, but I still went to the ENT about a month later.

ENT visit

Interestingly, 1-2 weeks after the second PCP visit, my tinnitus had become inaudible. Maybe the second irrigation cleaning had done the trick. But I still went to the ENT appointment just to ask their thoughts on the history of the situation and to get a more comprehensive hearing test.

Upon arriving at the ENT doctor's office, I had to fill out paperwork because I was a first-time patient. Ordinarily this involves a few sheets of paper, but at this office, I filled out something on the order of ~20 sheets of paper, including a tinnitus questionnaire, two different medical-history questionnaires, and various statements requiring my signature. It seemed like overkill for what would probably be a one-time visit.

ENT doctor

Eventually I got to see the doctor. He was a man, which is generally a slightly bad sign because male doctors on average seem to be less gentle. That proved to be the case here. The doctor listened to me briefly explain my situation in about 40 seconds, after which he seemed to get impatient and immediately started looking in my ears.

He had a camera hooked up to a TV screen on the wall. He saw that a lot of earwax remained and began using an instrument to remove it. Unfortunately, rather than an ear irrigator, he used a metal(?) thing to scrape away wax. In principle this doesn't seem so bad, but in the process of scraping, he often seemed to dig into my ear tissue, which was astonishingly painful. The pain was enhanced by my concern that he might be doing damage. (I think Julia Galef once remarked on a Rationally Speaking episode that pain can feel worse when one worries one is injured, rather than when one knows the pain doesn't indicate any actual tissue damage. I agree.)

The first time the doctor poked my ear sharply, I winced and made a noise, as a way to tell him that he probably had poked too far. However, as the removal continued, I kept getting poked, which made me think this was a normal part of the process (or that he was a bad doctor). So I soon stopped signaling the pain and put up with it. Cleaning out both ears took 5-10 minutes.

Painfulness

The pain was quite intense. It was probably the most intense pain I had felt in a few years and may have been the worst bout of pain lasting more than a few seconds that I had felt since my esophagitis days in 2002 (although the peaks of nausea I had occasionally experienced since 2002 had also been pretty bad in a slightly different way). I didn't cry out or tear up, but my fight-or-flight response was triggered, and by the end, I found myself quivering a bit due to stress hormones.

I thought to myself that this experience might be comparable to a warm-up exercise for someone torturing a person strapped to a chair (though I wasn't strapped down). The pain was surely far less bad than full-blown torture; indeed, I checked at the end that my ears weren't bleeding, so the doctor probably didn't even pierce skin. But the pain was beyond what we ordinarily experience in everyday life.

Thinking about magnitudes of pain and tradeoffs among types of pain is part of my "day job", so I found this experience enlightening. My ear pain wasn't unbearable in the sense that I would have done anything to make it stop. (Indeed, I voluntarily stayed in the doctor's chair the whole time.) But it was bad enough that I would probably experience the pains of ordinary life (hunger, tiredness, itches, etc.) for an extra ~6 months rather than redo the ear procedure.

It looks like some other people agree that earwax removal with an instrument is pretty painful. This person apparently had a worse experience than I did:

Not sure what the ENT did removing my ear wax, but I was screaming in excruciating pain. Like having a tooth pulled w/o Novocaine! I didn't even go in with ear trouble. He wanted to do the other ear and I said no way!!! He insisted and it hurt like a mother too. Never experienced this in my life (59) didn't seem right!!!

This person had bleeding, which I didn't have:

If, however, your doctor was like mine and uses a plastic extraction device to scrape hard wax that is deep within the canal, that will hurt more than anything and will cause bleeding to the point of having to keep a cotton ball in your ear.

Hearing test

After the ear scraping, I waited for a few minutes for an ear test. The test involved clicking a button when I heard noises of various volumes and pitches. The noises seemed to occur fairly regularly, so I wondered whether some people cheat by just guessing when the noises are supposed to happen. However, this cheating approach wouldn't work for the next part of the test, which involved speaking back words that the experimenter said at various volumes through earphones.

The last part of the test involved putting an instrument into my ear that measured the ear's reactions to sounds, without any effort on my part.

After the test, the computer printed some results, and they were given to my ENT doctor. A few minutes later, he came back in and said that my hearing was good, although I had a "4k notch", which is a sign of mild hearing damage. I don't know what would have caused that.

I asked whether my tinnitus was due to earwax, and the doctor said probably not because that's not typical. (Some web pages say tinnitus can be caused by earwax, but I don't have statistics on what fraction of tinnitus cases are so caused.) He just said that I was fine and should use ear protection.

Aftermath

Since my tinnitus had basically gone away after my second PCP visit, I figured it would really be gone after the ENT visit, since even more wax was removed there. However, to my surprise, my tinnitus was louder after the ENT visit than before. It remains as strong as ever many months later. I don't know why. However, like always, I don't mind it, and I often go weeks at a time without even noticing it.

In any case, I don't plan to go back to that ENT doctor, because apart from the pain, I worry whether aggressive wax removal could damage my ears. My tinnitus doesn't cause me any problems, and as long as the ENT doesn't think it's a reason for concern, it's fine for the foreseeable future.

Ear shower covers and air conditioning

One of the main reasons my ears were so wax-filled in the past was that they always got waxy when I showered. In early 2016, I found a solution to this problem: "Disposable Clear Shower Water Ear Protector Cover". These almost always keep my ears completely dry in the shower, and when they do occasionally leak a bit around the edges, it's rarely a cause for concern.

Wax buildup at night due to my earmuffs is worst in the summer on account of humidity. Air conditioning helps reduce this problem. (Lowering humidity also has the benefit of limiting populations of dust mites.)