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Hearing test showed diminished hearing. Suggested MRI scan. Should I be worried?

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ENT Specialist
Practicing since : 1991
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I have what I thought was wax in my right ear. Saw an ENT physician at Shands University of Fl yesterday. He gave me a hearing test and it showed diminished hearing in the right ear. He does not see any wax in the ear, he did see skin, which is suppose to be there. He is sending me for an MRI of the brain to check for a tumor(?) and to demonstrated the sinuses. After the MRI I will be seen by a Dr. XXXXXXX O'Malley at UF who specializes in ears. Should I be concerned as the appointment is not until the end of August.

Thanks for your time and as a retired nurse (we nurses know just enough to expect the worse)
Posted Sun, 25 Aug 2013 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Sumit Bhatti 37 minutes later
Hi,

Thank you for your query.

1. A lot depends upon the actual ear drum findings and the hearing test.

2. If the ear drum is intact and there is a conductive hearing loss, then there is no cause for worry. Here sinusitis and nasal problems may be causing Tympanometry (Impedance Audiometry)?

3. If the 'skin' being referred to is a suspected 'cholesteatoma', then the MRI may be done. This should hen include a screening HRCT Temporal Bones and delayed diffusion (45 minutes post contrast) MRI Scan.

4. If you can upload clear, clean endoscopic images of your ear drums and hearing tests reports (audiograms), I will be able to guide you better. The MRI will help settle any doubts, though on direct examination of the ears under a microscope, an ENT Specialist should be able to confidently decide whether it is necessary or not.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Hearing test showed diminished hearing. Suggested MRI scan. Should I be worried? 1 hour later
Thank you Dr. Bhatti,

I did have an Audiometry to include the Tympanometry. Unfortunately I am not able to download the report. What I can tell you is that on the Tympanometry it was entirely normal on the left side, on the right side it was a straight (sort of) line. The audiologist did tell me that there was significant hearing loss on the right.

Thanks again for your help and time. XXXXXXX Rosenberg
 
 
Answered by Dr. Sumit Bhatti 17 minutes later
Hi,

Thank you for writing back.

1. A straight (sort of) line on a Tympanometry is a Type 'B' graph which indicates the presence of fluid behind the right ear drum. A Type 'A' steeple shaped graph centered around 0 (zero) pressure is normal as it must be on your left side. Ther are also other graph variants in Type 'A' and 'C", but not in Type 'B'.

2. Assuming that the ear drum is normal, this will be an XXXXXXX (Serous Otitis Media) or OME (Otitis Media with Effusion) which is usually seen after a cold. A trial of medication including anti-allergic decongestant, mucolytic medication and steam inhalation may be tried first before any MRI Scan. OTC Decongestant nasal drops such as Otrivin (0.1% Xylometazoline) may help. It is easy to repeat Audiometry.

3. Since it is on one side, it is advisable to check the inner (nasopharyngeal) end of the Eustachian Tube.

4. A Myringotomy and Grommet insertion may be useful for persistent cases. In the unlikely event of a 'cholesteatoma' being detected (the ear drum is usually abnormal and the ear discharge, bone destruction is characteristic), ear surgery is the only choice.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Hearing test showed diminished hearing. Suggested MRI scan. Should I be worried? 2 hours later
I understand that a cholesteatoma is a benign tumor. Do you concur?

Thanks again, your explanations are excellent.
XXXXXXX
 
 
Answered by Dr. Sumit Bhatti 1 hour later
Hi,

Thank you for writing back.

1. A cholesteatoma is an ingrowing of the skin of the ear drum. It is benign, not a tumor but behaves like a tumor due to the confined spaces of the middle ear and mastoid air cells. It is destructive as it expands.

2. It is also known as 'skin in the wrong place'. Anywhere on the surface of the body, it would be just a harmless epidermoid cyst.

I must emphasize that a cholesteatoma is extremely slow growing and a very treatable problem. Treatment is done to avoid its vast array of possible complications.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Hearing test showed diminished hearing. Suggested MRI scan. Should I be worried? 51 minutes later
Thank you Dr. Bhatti, Being a nurse (retired) as I stated earlier makes me nuts when something happens to me or my family and friends. You have reassured me and given me peace of mind.

Thanks again and keep of the good work! XXXXXXX
 
 
Answered by Dr. Sumit Bhatti 25 minutes later
Hi,

Thank you for writing back.

I sincerely hope that this is a simple SOM/OME and that it responds to medication.

You may follow up directly at bit.ly/Dr-Sumit-Bhatti

Wish you a speedy recovery.

Regards.
Above answer was peer-reviewed by
 
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