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Suggest treatment for hearing loss and tinnitus

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Posted on Mon, 18 May 2015
Question: Last July I suffered from hearing loss in my left ear, followed by tinnitus. No dizziness or balance disorders. Audiogram revealed 65db moderate to severe mixed hearing loss. MRI was clear. I underwent oral steroids treatment after 1 week of onset but to no avail. Since last two months I am on Hydergine 4.5mg x 2, Gingko Biloba 120mg x 2 and Centrum multivitamins. Hearing in the right ear is perfect.

Recently I started feeling mild tinnitus in my right ear (though I am not 100% sure about the origin of this tinnitus) together with some feeling of occasional fullness. Also while I am trying to wake up in the morning I feel as if I become totally deaf for a split second, before the hearing gets "switched on" upon opening my eyes.

I do have long-standing sinus issues and one of my nostrils remains semi-blocked most of the time.

I am extremely worried and stressed. Despite hearing loss in my left ear, I have been leading a normal life as my right ear is perfect. However with these latest changes, I am concerned that I might wake up one day with hearing loss in the right ear.
doctor
Answered by Dr. Sumit Bhatti (4 hours later)
Brief Answer:
Audiograms (PTA and I/A). Plain Sinus CT, Medications.

Detailed Answer:
Hi,

Thank you for your query.

1. Upload any previous audiograms (PTA: Pure Tone Audiograms). A mixed hearing loss has two components, Conductive Hearing Loss (CHL) and Sensori-Neural Hearing Loss (SNHL).

2. The quantum of these two types of hearing loss give a clue to the underlying pathology. It is good to hear that the MRI is normal.

3. Steroids (especially high dose intravenous) and the above medication help in reversing SNHL, though there is always the possibility of spontaneous recovery. SNHL may also not respond to any known treatment but may improve with Transtympanic Steroids and HBOT (HyperBaric Oxygen Therapy). This works best within 3 months of the hearing loss.

4. The Conductive (CHL) hearing loss if large can be reversed by treatment. This can reduce the amount of hearing loss and allow the speech frequencies to be heard.

5. Yes, the right ear is now the precious ear (the better ear) and hence any doubt of a developing hearing loss must be treated immediately.

6. Get an Impedance Audiogram (Tympanogram) done and upload the result. If this is abnormal, get a plain Sinus CT Scan done pre and post decongestion with nasal decogestant drops. Treatment of the chronic sinusitis and any hypertrophy of the nasal turbinates will help avoid any conductive hearing loss. Medication including steroid nasal sprays, anti-allergic medications steam inhalation and saline nasal douching (washes) will also be worth a trial.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Follow up: Dr. Sumit Bhatti (10 minutes later)
Thanks Doc. My latest audiogram and tympanogram is attached. Please advise.
doctor
Answered by Dr. Sumit Bhatti (1 hour later)
Brief Answer:
Looks like a stable hearing loss at present.

Detailed Answer:
Hi,

Thank you for writing back.

1. You have a large conductive (CHL) component in the left ear which can be corrected. The SNHL may be permanent now after a year.

2. Your Tympanogram is normal 'A' type on both sides, normal middle ear pressures, with a lower middle ear volume on the right. This does not suggest any active problem with the middle ear ventilation (secondary to the chronic sinusitis).

3. Next should be an eardrum examination and if this is normal, the chances of a hearing loss developing in the right ear is low.

4. if these episodes of ear fullness persist, get repeated follow up tests. An HRCT (High Resolution CT) Scan and an MRI Temporal bones will be a better option than an Exploratory Tympanotomy. The scans must be on a multi-slice CT Scan machine and a 3 Tesla MRI machine at a center which specializes in temporal bone scans.

5. Upload the ear drum examination images (endoscopic) if possible and the Scan images for further treatment options.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Sumit Bhatti (14 hours later)
OK i will do the CT scan and upload the reports for you to view. You said I have a large CHL component in the left ear. Can this be corrected via medicine or will require surgery. Also, approximately how many db of hearing loss can be recovered through treatment.
doctor
Answered by Dr. Sumit Bhatti (1 hour later)
Brief Answer:
Most of the CHL can be corrected.

Detailed Answer:
Hi,

Thank you for writing back.

1. The current limit (cochlear reserve or SNHL component) of the left ear is the upper limit for normal hearing even if the surgical treatment corrects the entire CHL component. In practical terms, most of the CHL can be corrected.

2. A hearing aid can increase amplification to overcome the SNHL component of the left ear . However, using a hearing aid is difficult as the right ear is normal. Hence no active treatment with regular follow up is an option.

3. A Bone Anchored Hearing Aid (BAHA) fitted in the skull on the left side is an option if you decide not to operate the left ear. You can take a trial with a softband BAHA device.

4. Get the Sinus CT, CT+MRI of the Temporal bones done only at a center of excellence.

5. At present it is difficult for anyone to answer whether the right ear can have a similar fate.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Pradeep Vitta
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Follow up: Dr. Sumit Bhatti (32 hours later)
Please see attached an MRI that i did last August. Is it still relevant or does it need to be repeated. Also, how urgent are the MRI and CT scans? Can they wait one week? The reason i ask because i live in Bahrain where these tests will cost $1,000. If i get these tests done in XXXXXXX next week they will cost $200. Meanwhile Im still feeling considerableear pressure, although taking anti histamines and nasal spray. Yesterday my nose was completely blocked but got opened up after I took nasal spray.
doctor
Answered by Dr. Sumit Bhatti (1 hour later)
Brief Answer:
The Scans are not urgent.

Detailed Answer:
Hi,

Thank you for writing back.

1. Yes, the scans can be done next week. There is no reason to hurry.

2. The report you have attached shows a normal MRI with a maxillary retention cyst/ polyp without nay mention of it's size. Small cysts / polyps do not require treatment.

3. You can manage by taking these medications regularly. Continuous use is require for optimal effect. They are safe for long term use.

4. You can follow up with the reports (later) directly at bit.ly/Dr-Sumit-Bhatti

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

Answered : 2662 Questions

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Suggest treatment for hearing loss and tinnitus

Brief Answer: Audiograms (PTA and I/A). Plain Sinus CT, Medications. Detailed Answer: Hi, Thank you for your query. 1. Upload any previous audiograms (PTA: Pure Tone Audiograms). A mixed hearing loss has two components, Conductive Hearing Loss (CHL) and Sensori-Neural Hearing Loss (SNHL). 2. The quantum of these two types of hearing loss give a clue to the underlying pathology. It is good to hear that the MRI is normal. 3. Steroids (especially high dose intravenous) and the above medication help in reversing SNHL, though there is always the possibility of spontaneous recovery. SNHL may also not respond to any known treatment but may improve with Transtympanic Steroids and HBOT (HyperBaric Oxygen Therapy). This works best within 3 months of the hearing loss. 4. The Conductive (CHL) hearing loss if large can be reversed by treatment. This can reduce the amount of hearing loss and allow the speech frequencies to be heard. 5. Yes, the right ear is now the precious ear (the better ear) and hence any doubt of a developing hearing loss must be treated immediately. 6. Get an Impedance Audiogram (Tympanogram) done and upload the result. If this is abnormal, get a plain Sinus CT Scan done pre and post decongestion with nasal decogestant drops. Treatment of the chronic sinusitis and any hypertrophy of the nasal turbinates will help avoid any conductive hearing loss. Medication including steroid nasal sprays, anti-allergic medications steam inhalation and saline nasal douching (washes) will also be worth a trial. I hope that I have answered your query. If you have any more questions I will be available to answer them. Regards.