My Very Mild Tinnitus

By Brian Tomasik

First published: . Last nontrivial update: .

Summary

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

Contents

History

I'm told that I had several ear infections around 1 to 2 years of age. I was given amoxicillin for them.

I remember being given ear drops around age ~7, though I don't recall why.

Throughout my life I've generally avoided too much loud noise. 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.

As a teenager and young adult, I tended to pick out the "gunk" (dry, dead skin and wax) in my ears with my fingers, because doing so felt satisfying. At the doctor's office, I was sometimes told I had infected external ears, and in retrospect I suppose this was probably due to my picking gunk out. At the time I didn't care much about this issue, assuming it was harmless.

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 and swimmer's ear 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 swimmer's ear. Mayo Clinic Staff (2016):

Swimmer's ear is an infection in the outer ear canal, which runs from your eardrum to the outside of your head. It's often brought on by water that remains in your ear after swimming, creating a moist environment that aids bacterial growth.

Putting fingers, cotton swabs or other objects in your ears also can lead to swimmer's ear by damaging the thin layer of skin lining your ear canal.

In 2014, I found this problem to be particularly acute. On some mornings I woke up with an ear that was wet, presumably from infection? 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 also noticed that scratching wax out of my upper ears with my finger may have contributed to the problem.

In summer 2014, my hearing had become noticeably worse. 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 in 2016

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 take out wax. In principle this doesn't seem so bad, but in the process of scraping, it felt subjectively like he sometimes dug 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.

Based on Yahoo! Answers (2008), it looks like some other people agree that earwax removal with an instrument can be painful. One person on that thread 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!!!

Another person on Yahoo! Answers (2008) 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.

allnamesfckintaken (2017) extols earwax removal, noting that the process is "painless and quick". In the comments, someone describes his/her own experience getting earwax removed by an ENT using "a special expensive microscope and suction":

It started out ok, but as he started to get deeper in, it started to HURT. I have a decent pain tolerance, but this shit felt like he was scraping my brain. It fucking hurt. I couldn't help myself, my body reacted by jolting away. I know he's got this thing in there and I'm fighting as hard as I can to not jolt but my body is saying fuck this MOVE.

He gets one ear done and starts in on the 2nd and I couldn't make it through. I'm sweating and cussing pretty loudly at this point. Probably scaring some other patients thinking I'm being tortured in the next room.

Hearing test

After the earwax removal, 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. In retrospect, I should have asked whether the tinnitus might be due to swimmer's ear, rather than just earwax, but I didn't really diagnose my problem as swimmer's ear until later.

After the ENT visit

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 remained as strong as ever during the rest of 2016. That said, I didn't mind it, and I could go weeks at a time without noticing it.

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. I'll be careful before letting an ENT doctor perform a similar procedure again.

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 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.)

Revisiting the problem in 2018

Toward the end of 2017, I noticed that hearing in my right ear had gotten substantially worse. When I moved an earbud from my left ear to my right ear, the volume seemed to drop at least 10 times. When I used earbuds to listen to videos, the right ear was basically useless, and I only bothered putting an earbud in it to give the right earbud somewhere to go, rather than because I could hear much in that ear. My right ear was the same ear that had shown more hearing loss and tinnitus in 2016.

My guess is that the resurgence of hearing loss in my right ear was contributed to by occasional swimmer's ear brought on by humidity and wearing earmuffs at night. In 2018, I realized that I should take the situation more seriously in case there was a chance of permanent ear damage due to the continued problem, and I began learning more about swimmer's ear.

I noticed empirically that there tended to be a correlation between cleaning gunk out of my ears with my fingers and getting swimmer's ear the following night. This relationship was confirmed by what I read about swimmer's ear online. For example, Mayo Clinic Staff (2016) says: "scratching inside your ear with a finger, or wearing headphones or hearing aids can cause small breaks in the skin that allow bacteria to grow." So I resolved to try to stop putting my fingers in my ears at all going forward, other than to gently feel them or remove earwax chunks almost ready to fall out. The classic saying "don’t put anything in your ears that’s smaller than your elbow" seems correct. (And of course, I wouldn't put your elbow in your ear either with any amount of pressure, to avoid damaging things.)

One night in April 2018, even after resolving not to pick gunk out of my ears, I scraped some gunk out without really thinking about what I was doing. Right on schedule, that night I had the first instance of swimmer's ear in several weeks, contributed to by wearing earmuffs at night during humidity that preceded some rain.

I tried putting a silica gel desiccant in my earmuffs to reduce humidity, and while this seemed to maybe help a bit, it did very little or nothing to help on a particularly humid night. So instead, I ordered a dehumidifier to use in my room during months when it's too cool to have my air conditioner on. I think the dehumidifier helps a bit, though the air inside my earmuffs still becomes somewhat wet on humid nights.

I unfortunately can't stop wearing earmuffs altogether, because sometimes when I'm sleeping there's bothersome noise. One reason for this is that my waking hours move around such that I sometimes sleep during the day. However, as of April 2018, I was able to reduce my earmuff use, both by tolerating some increased risk of being woken up by noises and by occasionally using other noise sources to block out soft sounds. And a few weeks after doing this, I found that I could hear slightly more in my right ear, though it sounds were still very muted. It's possible that the onset of spring weather also played some role, since my ears were less dry and flaky as the air became more humid.

Historically I've avoided earplugs because I'm nervous about putting things far enough into my ears to block sound. And an ENT doctor confirmed to me that earplugs would tend to just push wax into my ears.

ENT visit in 2018

Since I wanted to confirm that there wasn't a risk of permanent hearing damage from wax and swimmer's ear in my right ear, I agreed to see an ENT again, although I specifically asked my PCP to refer me to a different ENT this time, given my unpleasant experience with the previous ENT.

Before my ENT appointment, I asked on the site JustAnswer the following question: "Two years ago I went to an ENT doctor, who removed my earwax. The process was extremely painful. It felt subjectively as if the doctor was digging into my ear, although there was no blood. I was wondering if this degree of pain is normal and if there's a chance that poorly done earwax removal can cause lasting damage to one's ears." Within a few minutes, an ENT doctor on JustAnswer replied. He said that some people's ears are more sensitive, so that earwax removal is painful for some people. He also recommended using Debrox drops for a week or two before the ENT visit to soften the wax and make it easier to remove. I ended up using Debrox two days before and on the day of my visit.

At the ENT office, I was seen mostly by an assistant. He did a quick test with a tuning fork placed at a few different locations by my ears. Then he looked inside and said he would remove earwax. Fortunately, the removal process was vastly less painful than the last time. I only experienced about 3 total seconds of the strong pain that I had felt for much longer periods at the previous ENT. Some possible reasons why this earwax cleaning was much less painful:

I asked the 2018 ENT if I had a punctured eardrum, and he said no. I also asked if my past swimmer's ear might cause permanent damage, and he said in 99% of cases, it's just a temporary infection that clears up.

What about my tinnitus? Could the earwax have caused that? I was told that tinnitus is caused by other things, although earwax can sometimes make it louder by blocking out background noises. Oddly, I was told I had more earwax in my left ear, even though the tinnitus and hearing loss were stronger in my right ear. (Earwax removal also took longer from the right ear. Is it possible the ENT assistant just mixed up left vs. right, or meant "his left" rather than "my left"?) To further investigate the tinnitus, and because my previous hearing test found a 4K notch, we scheduled a new hearing test.

After the earwax removal, I could hear much better in my right ear, almost as well as I could hear in my left ear (as measured by swapping a single earbud between left and right ears). One or two nights after the procedure, I felt like my tinnitus was barely audible even in complete silence, although a few nights later, it seemed a bit louder again.

Hearing test in 2018

A few weeks after I saw the ENT for earwax removal in 2018, I did a hearing test. I don't know the formal name for the person who administers this test, so I'll call him/her a "specialist".

The specialist began by asking about my history.

The specialist inspected my ears and noted that my eardrums were in perfect shape. Next was a test that measured something or other for which I just sat still. The remaining tests were in a soundproof booth. The specialist said that sometimes those tests are done using headphones, but in my case, the specialist stuck little microphones into my ears, they way you would stick earplugs into your ears. I listened for a series of three beeps, pressing a button as soon as I heard them. Different beep triplets had different volumes and pitches. I did this first without and then with a metal thing on my head. I also listened to words of varying volumes and tried to repeat them back.

The specialist said that three beeps were used instead of one beep because sometimes people with tinnitus have trouble distinguishing a single beep from their tinnitus background noise. I can't remember if my 2016 hearing test also used three beeps or only one beep.

At the end of the test, I was told that I had perfect hearing. But why did my 2016 hearing test find a 4K notch? The specialist wasn't sure, but maybe the previous hearing test had faulty equipment. I suggested another possibility: the previous hearing test was done right after earwax removal, whereas this one was done a few weeks following earwax removal. The specialist agreed this was also a possible explanation. A third possibility that I'm inventing while writing this is that maybe the 2016 hearing test only used one beep instead of three, making the beeps harder to distinguish from tinnitus noise?

If my hearing was perfect, why do I have tinnitus? The specialist said that sometimes noise exposure can cause tinnitus before it causes hearing loss. Maybe farm and construction noise in my past caused it. Another possibility is genetics. (Note to self: Googling {tinnitus without hearing loss} is a way to explore this further.)

I mentioned that I use iPod-style earbuds to listen to things, both on my iPod and on my computer. However, I keep the volume relatively low, about as loud as a typical conversation. The specialist mentioned that in addition to intensity, the duration of listening to sounds of this sort can also cause hearing loss.

Even though it wasn't strictly relevant, I took the opportunity to ask the specialist whether painful earwax removal by an ENT has a risk of causing hearing damage. The specialist said that was rare because ENTs know what they're doing.

The specialist suggested a follow-up test in 2 years to monitor the situation.

Follow-up to the hearing test

A few days after the hearing test, I saw my ENT to discuss the results. He told me that my hearing was great—as good as the hearing of most kids.

Because of my tinnitus, he suggested scheduling a follow-up hearing test in a year to see if things change.

Updates from 2019

Following the ear exam in 2018, my ears situation remained roughly constant for the rest of 2018 and into 2019. In fact, I think the amount of gunk and infection in my ears actually lessened, perhaps based on the following changes in behavior that I tried.

In the past I had tried to avoid getting shower water in my ears, and I sometimes wore ear shower covers, as mentioned earlier in this article. I did this with the aim of reducing wax buildup. However, in late 2018, I instead decided to try allowing water into my ears and then scrubbing out my outer ears (which are technically called the auricles) with a towel afterward, to preemptively remove the flakes/gunk that tend to build up there.

To help with this gunk removal, I decided to try adding a bit of Head & Shoulders shampoo to my ears, in case this would help remove the ear gunk. I already used Head & Shoulders on my face to treat seborrheic dermatitis, and I wondered if that skin condition might be responsible for the ear flakes too. While I don't have any hard data, it does seem like using Head & Shoulders in the ears helps keep the ear flakes away.

After trying this for several months, I decided to look up whether anyone else does this. I found the blog post Anders (2015-2019), which says: "To use an anti-dandruff shampoo or conditioner for seborrheic dermatitis in your ears, simply apply a pea-sized amount to the ear. Once applied, leave it on for 3-5 minutes and rinse off with water." Note: That blog post also mentions honey as a possible treatment. I discourage using honey because of the harm that bees may suffer during its production (PETA 2010-2016).

Another change that I think improved my ears situation was that I was more strict about not using earbuds within ~2 hours after showering, in order to give my ears the opportunity to fully dry out. One time in Jun 2019 I didn't follow this rule, putting in earbuds about 20 minutes after showering. The next day I found a little bit of slimy, crusty stuff in my ears, which I assume was due to using earbuds too soon.