Muffled hearing and ringing in the ears

“I woke up with extreme nausea, the room was spinning, my eyes were extremely sensitive to light. I didn’t think much of it at the time, I had thought maybe I was coming down with a virus or that I was extremely dehydrated. A couple days after that I started to get migraines severe enough to end up in the ER… My symptoms were vertigo, dizziness, rapid heart rate, nausea, ringing in the ears and muffled hearing at times…I had also… (traveled) and once the plane was airborne the ringing started in my right ear again.”

Read more: Muffled hearing and ringing in the ears

Ringing in just one ear, a feeling of muffled hearing in one ear, and room-spinning vertigo are all classic symptoms of Meniere’s disease.  It is easy to diagnose once it has become severe because there will be permanent hearing loss in the affected ear on audiogram and balance function in that ear may show a decline in responses to caloric (warm and cold water) testing.  However, it is much harder to be certain of the diagnosis in early cases. 

In the early years during a spell, your hearing will be decreased.  The simplest way to test this is to rub your fingers next to each ear; the hearing will be muffled on the bad side. Or put an earbud up to each ear in sequence and listen for a change in tone or muffling of the sound. 

If the hearing loss during a spell is noticeable you will likely also be able to hear a low rumbling or roaring sound, like the sound you hear when holding a conch seashell over your ear.  This can get quite loud, meaning the hearing loss is worsening.  It can also be faint in the early stages.  The hearing loss and the tinnitus are two sides of the same coin. 

At first there is no permanent hearing loss, so if you have an audiogram it may look normal.  During a spell, though, there will be hearing loss, usually in the low tones.  After the spell resolves the hearing may return to normal.  Because of the vertigo, it may be hard to get in for testing while having a spell.  Talk to a local audiologist about getting permission to come in quickly when a spell happens and have someone else drive you. 

Barometric pressure changes, like what happens when flying, can change pressure in the inner ear and set off a spell.  A barometer can be helpful in warning of an impending attack.  Very low pressure (like a storm) followed by high pressure can be a trigger.

Headaches, especially migraines, frequently accompany Meniere’s disease.  There are several underlying conditions that cause migraine, so a workup by a neurologist is best.  The combination of headache and Meniere’s disease is frequently caused by an anatomic abnormality in the ear (endolymphatic hydrops) along with sleep apnea or any other cause of increased stroke or heart attack risks.  These include smoking of any kind, high blood pressure, autoimmune diseases and diseases of the vascular system. 

The cornerstone of diagnosis is to see a neurotologist (ENT specializing in the inner ear) and have a complete workup including VNG, audiogram, and any other tests they may recommend.