I've experienced a +P 9mm round fired indoors. It induced immediate physical pain. Not debilitating, but very uncomfortable. It began to subside shortly afterward but took most of a day to be entirely rid of it. Ringing lasted for maybe two days. Now, some years later, I notice no lasting effects. As I age, who knows, maybe it will resurface.
Related story... My first time to a NHRA drag race wasn't too long ago. A rain delay caused the top fuel cars to be the very first races of the day. As a first timer I didn't know what to expect and I wasn't eased into it by the normal way things are run by starting with relatively calmer engines and progressively going up from there. So like an idiot I was standing at the fence, no ear protection, hands at my sides, when the first two 8000hp cars roared form zero to three hundred three seconds. Again, immediate physical pain. I probably had time to stick my fingers in my ears, but didn't/couldn't, as I was in a state of shock induced by what I had just witnessed. I don't recall any ringing, but my ears hurt for most of the day again.