You are unable to see motion, resulting in difficulty tracking moving objects, their movement appearing similar to movement on a screen with a very slow refresh rate. This causes a −(IE) penalty on all Wisdom (Perception) checks to avoid being surprised and any roll relative to a moving object such as attacking, dodging, and catching.

Real-world Examples

Akinetopsia is extremely rare in real life, caused by brain damage or Alzheimer’s Disease, and very little is known about it due to only one person having ever been studied.

Assistive Options

A cane or service animal can help provide tactile or audible feedback to assist in some situations.

Magical Assistance

The Haste spell or any object that duplicates the effects of the spell can effectively negate the effects of this condition for the duration but does not grant the additional benefits of the spell.

You have a persistent sound (ringing, buzzing, roaring, clicking, hissing) in your ears that makes it difficult to understand talking, especially in the presence of background noise. This sound is audible even in magical silence. This gives a −(IE) on all hearing-related Wisdom (Perception) and Charisma (Persuasion) checks when background noise is present.

Real-world Examples

Tinnitus, Ménière’s Disease, Eustachian Tube Dysfunction, Temporomandibular Joint Disorders, Acoustic Neuroma

Assistive Options

While certain factors cause tinnitus to get worse, such as fatigue, alcohol, and reducing stress, reducing them doesn’t have enough effect to change game mechanics.

You experience chronic pain in your ears, causing ear pain and headaches. Any action that requires concentration (e.g., maintaining a spell) requires a successful DC 10 + (IE) Constitution saving throw per round to maintain concentration. Because you’re used to managing pain, even though this doesn’t reduce the experience of pain, you have a +(IE) bonus to saving throws against psychic damage.

Real-world Examples

Otitis Media, Otitis Externa, Eustachian Tube Dysfunction, Wegener Granulomatosis, Ramsay Hunt Syndrome, Polychondritis

Assistive Options

Applied heat or cold may help, as can sleeping upright in some circumstances. A character with chronic ear pain will likely have determined what works for them. The player and GM should decide what works effectively, and using this method will reduce the IE by 1 for 1d6 hours.

Magical Assistance

Any kind of magical healing, except potions, that relieves at least 1 hp can be applied directly to the ears to reduce pain by 2 IEs for a number of hours equal to the number of hp that would’ve been healed to a maximum of 1 day.

You are hard of hearing, which gives a −(IE) penalty on hearing-related checks but +(IE) on saving throws related to attacks that use sound (e.g., banshee wail). (Note: thunder damage is vibration, not sound, so this does not grant benefits against it.) An IE of Acute indicates that you are completely deaf. If you have multiple traits, you may choose Speech Impediment as one of them.

Real-world Examples

Osteogenesis Imperfecta, Patau Syndrome, Treacher Collins Syndrome, Ménière’s Disease, Trauma

Assistive Options

An ear horn can reduce the IE by 1 for listening to a single target for all but those with Acute deafness, but the horn must be held in place with one hand or equivalent and aimed at the target. You can benefit from learning a sign language, which can be exchanged for any language or proficiency.

You lose your sense of balance and equilibrium and experience a −(IE) penalty on Dexterity (Acrobatics) and Strength (Athletics) checks, requiring a successful DC 10 + (IE) Constitution saving throw while prone to recover from the dizziness. This saving throw can be made once per round at the beginning of your turn. The saving throw can be made while not prone but with disadvantage. A critical failure results in Fainting, leaving you unconscious until you succeed on the Constitution saving throw.

Real-world Examples

Ménière’s Disease, Benign Paroxysmal Positional Vertigo, Labyrinthitis, Anemia, Hypoglycemia, Postural Orthostatic Tachycardia Syndrome

Assistive Options

Usually, the solution is to sit or lie down for a while as noted above.

A substance leaks out of your ears. Roll on the table below for the nature and effects of the substance.

Acid. Acid leaks out of your ears at a rate of (IE) ounces per day. Your ear canal is immune to this acid, but your skin is not, so you have scars on and around your ears and need a way to constantly flush it out or collect it to keep it off your skin. If collected, a flask of 32 ounces equals one use as a weapon.

Blood. Blood drains out of your ears at a rate of (IE)² ounces per day. Because of this blood loss, you need to eat more to compensate, consuming an additional (IE) days’ worth of food per week to avoid exhaustion.

Light. Light (The player and GM can choose the color or select randomly from https://www.random.org/colors/hex.) shines out of your ears equal in radiance to (IE) torches, but because it shines out the side of your head, it doesn’t help you see in darkness. The light is bright enough to spoil Darkvision and functions as a bullseye lantern. You have a −(IE) penalty on all Dexterity (Stealth) checks unless your ears are covered, but sufficient covering to negate the light gives disadvantage on hearing-related Wisdom (Perception) checks.

Pus. A foul-smelling ochre pus flows from your ears at a rate of (IE)² ounces per day. The smell gives you a −(IE) penalty on Dexterity (Stealth) and Charisma (Persuasion) checks. If collected, 32 ounces of the pus can be thrown at a target and cause the same effects to that target as a Stinking Cloud spell.

Smoke. Sulfurous-smelling black smoke streams out of your ears. The smell gives you a −(IE) penalty on Dexterity (Stealth) and Charisma (Persuasion) checks but Advantage on Charisma (Intimidation) checks due to suspicion of fiendish origin. If left 1 ÷ (IE) hours in a room without ventilation, everyone in the room except you must succeed on a Constitution saving throw or be affected as if by a Stinking Cloud spell.

Sweat. Sweat drains out of your ears at a rate of (IE)² × 8 ounces per day. Because of this fluid loss, you need to drink additional water to assist with the loss to avoid Dehydration and exhaustion.

Venom. A toxic substance leaks from your ears at a rate of (IE) ounces per day. You are not immune to this substance, so if not contained somehow, in any situation where you take damage that is not psychic or bludgeoning, you need to succeed on a DC 10 Dexterity saving throw with a −(IE) penalty to avoid getting it in a wound. A creature subjected to this poison must succeed on a DC 11 Constitution saving throw, taking 7 (2d6) poison damage on a failed saving throw, or half as much damage on a successful one.
While referred to here colloquially as venom, this reflects real life examples, where an irritant or contagious liquid is expelled.

Real-world Examples

Swimmer’s Ear, Recurrent Ear Infections, Cholesteatoma, External Otitis

Assistive Options

Depending on the draining substance, a container may be designed to collect or absorb the discharge. Anything that sufficiently covers the ears will likely cause disadvantage on all hearing-related Wisdom (Perception) checks and will need to be emptied periodically. A hard container that plugs the ear completely may cause damage to the ear canal over time, and continuous use requires a successful DC 10 Constitution saving throw for every 7 days of use, or you develop Ear Pain.

Magical Assistance

The Prestidigitation spell can clean the affected area but does not stop the discharge.

You hear sounds at two different pitches at the same time. This gives you a −(IE) penalty on all Charisma (Performance) checks involving music or Wisdom (Perception) checks to recognize a specific voice or Intelligence (Nature) checks to identify an animal by sound. You also have a −(IE) penalty on Constitution saving throws to maintain concentration when you can hear voices or music. Because you’ve learned to navigate the world while hearing cacophonous noises, you have a +(IE) bonus on saving throws against sound-based charm effects such as a harpy’s Luring Song.

Real-world Examples

Sensorineural Hearing Loss

Assistive Options

By covering or plugging one ear, you can eliminate the dissonance of the two tones, but this doesn’t sufficiently correct the sound to affect the penalties.

You have extremely sensitive hearing but cannot filter out loud noises. You have a bonus of +(IE) on Wisdom (Perception) checks that rely on hearing faint sounds but a −(IE) penalty on saving throws against loud noises, and noises as loud as a crowded tavern or city marketplace are unbearable, requiring a successful DC 8 + (IE) Wisdom saving throw (or higher for louder noises) every minute or act as if frightened until away from the noise.

Real-world Examples

Hyperacusis

Assistive Options

A character can wear earplugs or other coverings that eliminate this condition while worn but also eliminate the benefits. Anytime you take damage in combat, unless secured firmly, you must succeed on a DC 5 Dexterity saving throw to keep them from falling out of the ears.

One or both of your ears has a shape that’s unusual for your ancestry. Choose or use the following table to determine the unusual shape and effects. This is a permanent condition.

• Miniature or Missing. You have either no outer ear or a vestigial or embedded ear that causes Hearing Loss. This gives −(IE) on hearing-related Wisdom (Perception) checks but +(IE) on saving throws related to attacks that use sound (e.g., banshee wail). (Note: Thunder Damage is vibration, not sound, so this does not grant benefits against Thunder Damage.)
• Dangling earlobes. Your earlobes hang down (IE × 10) percent of your height. Any attempt to surgically sever them results in a loss of 1 hp per ear and the earlobes growing back (IE) percent per week to full length. They must be secured during combat or cause −(IE) on all melee attack rolls due to swinging around your face.
• Aquatic. Your fin-shaped ears are adapted to hearing underwater, giving you disadvantage on all hearing-related checks above water but advantage on all hearing-related checks when underwater.
• Musoid. Your ears are large and round like those of a mouse but horizontal to your nose and pointing forward. This gives you advantage on hearing-related checks if the source is in front of you but disadvantage on hearing-related checks in any other direction. You also can’t wear hats or helmets that cover the ears.
• Fennec. Your ears are large and pointed like a fennec fox, but point forward. This gives you advantage on hearing-related checks if the source is in front of you but disadvantage on hearing-related checks in any other direction. You also can’t wear hats or helmets that cover the ears.
• Forked. Your ears come to (IE + 1) points, like a saw blade. This makes them sensitive to vibration, giving +(IE) on Wisdom (Perception) checks to sense movement but giving a −(IE) penalty on saving throws against Thunder Damage.

Real-world Examples

Protruding Ears, Constricted Ears, Cryptotia, Microtia, Antonia, Cauliflower Ear, Goldenhar Syndrome

Assistive Options

An external apparatus may be worn over the ear to focus sound for Miniature or Missing ears to assist with ear shape, but these tend to be cosmetically noticeable and cannot be worn while sleeping. They can reduce the Hearing Loss penalty by 1 IE while worn. You can benefit from learning a sign language, which can be exchanged for any language or proficiency.