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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Can SNHL cause fluctuations in hearing loss?

Answered by
Dr.
Dr. Suresh Heijebu

General & Family Physician

Practicing since :2010

Answered : 3579 Questions

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Posted on Thu, 2 Aug 2018 in Ear, Nose and Throat Problems
Question: What could be infected between a healthy ear and the brain causing conductive hearing loss but fooling the Rinne/Webber and audiology tests into a false SNHL misdiagnosis?

hello

If someone is diagnosed with SNHL is it possible for their hearing loss to fluctuate sometimes hearing better sometimes worse?
doctor
Answered by Dr. Suresh Heijebu 40 minutes later
Brief Answer:
Pure tone Audiometry is more reliable test to diagnose SNHL

Detailed Answer:
Hello Sir,

I can certainly understand your concern.

I have worked through your attached query in detail..

Early stages of SNHL can cause fluctuations in severity and hence could be misjudged by standard Rinne's and Weber's test (tuning fork tests).

It's advisable to consider a pure tone Audiometry for precise diagnosis of SNHL and to estimate it's severity.

Diseases of the inner ear are usually responsible for causing SNHL. Not only Infection, but trauma, inflammation, degeneration are all other causes of inner ear dysfunction leading to SNHL. Direct involvement of the brain in SNHL is quite unlikely.

Are you satisfied with my consultation? Is there anything else left to be discussed?

Please post your further queries if any
Thank you

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Suresh Heijebu 13 minutes later
I had sudden hearing loss in my right ear. After Tests ENT told me I had SNHL and would never hear again. After taking an antibiotic my hearing returned 100%.

This happened 4 different times. Every time different ENT's told me it was SNHL not conductive hearing loss. I had my personal doctor prescribe antibiotics and the hearing returned. All the ENT's refused to admit negligence.

What was going on?
doctor
Answered by Dr. Suresh Heijebu 9 minutes later
Brief Answer:
Further tests are required

Detailed Answer:
Hello Sir

I can certainly understand your concern

Infection seems to be the predominant cause of hearing loss in your case.

Infection is known to cause mixed pattern of hearing loss depending on its site ( external ear, middle ear or inner ear)

To identify the location of Infection and to assess the type of hearing loss accurately, I'd advise you to take up HRCT (High-resolution CT scan) of the temporal bone and Pure tone Audiometry (PTA) respectively.

Further management if any is largely based on test results.

Thank you


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Suresh Heijebu 8 minutes later
Would an MRI accomplish the same thing as a HRCT

What if the auditory nerve is infected? Would an ENT be able to see this by examination?

I believe this issue unvolves direct involvement of the brain. In 2007 I survived bacterial meningitis. Then in 2014 my hearing suffered. I have been battling a misdiagnosed infection somewhere in my ear or head, for 3yrs now, that has become resilient to most antibiotics. But it still is dramatically affected by antibiotic treatments yet always survives and grows until I hit it again with another antibiotic. then it retreats and begins to rebound after a few months.
doctor
Answered by Dr. Suresh Heijebu 3 hours later
Brief Answer:
Possible post Infection ( bacterial meningitis) sequale. Require diagnostic

Detailed Answer:
Hello Sir

I can certainly understand your concern

In presence of past history of bacterial meningitis, the involvement of brain is very certain.

As per my knowledge the possibility of Infection of the inner ear and sequale to bacterial meningitis is responsible for hearing Deficiency in your case.

Auditory nerve is a component of inner ear and hence it's malfunctioning along with Cochlear damage can be objectively picked by PTA. It's dysfunction if any can be readily identified by an expert ENT surgeon.

As of now I consider this as a post meningitis sequale.

HRCT OF TEMPORAL BONE yields more information than MRI of whole brain because it gives information of both internal ear structures as well as surrounding area of temporal lobe of brain.

PTA is extremely important as stated earlier to determine further course of action.

If you are focussing on recurrence of Infection, it's important consider a detailed Neurological assessment in person determining the need for CSF ( cerebrospinal fluid ) examination to identify any active Infection.

Above answer was peer-reviewed by : Dr. Nagamani Ng
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