Question: Short flashback of this ongoing situation : • Temporary Tinnitus (low pitch pulsatile sound in left ear, duration:one night) started in 16th october 2013 after exposing myself to headsets during some long periods of time and most of the times at higher volume, no detectable changes in hearing; • After two days without exposure started to use headsets again for long periods of time, after one week noticed again same temporary tinnitus (duration:one night), left the headsets for a week and a half, detected some small changes in hearing, thought it was due to sensibility; • Went to the doctor and explained the situation, no problem in the outer and middle ear, requested audiometric tests (tonal and vocal audiometry; acoustic reflexes and tympanogram) and also asked for a doppler of the neck veins. He said that it could be a inner ear problem; • 4th November no symptoms remained, just a strange sensitive in the left ear reagrding low pitch freq. So, decided to test the headsets to rule out any possiblity of the problem being related to the use of it. After approximatelly one hour of exposure I turned of the computer off and started hearing the same pulsatile noise, like the other times again in the left ear, did some valsalva manouvres but with no effect, just noticing that for a few seconds the sound also appeared in the other ear. Next day when I awoke up it was gone. Then I was sure this problem was related with the use of the headsets so I stopped using it. Started to notice a strange noise inside my car, thought it was related to something that wasn’t well screwed up. At the same night, I was watching a movie but without heasets at a lower volume and I started to notice again the same pulsatile noise. In the morning again after a few hours of sleep it was gone. But while listening to the radio I started noticing some little distortions in the music, I got scared and started noticing also some distortion while watching tv and the noise of the electrical equipments, dishes and glasses were sounding louder than usual.No tinnitus was observable, but apparently there was a strange sound that was attached to other sounds. • Did the exams and went to the ENT, I told him of the last episode and he looked at my audiogram and said that I had sensorineural hearing loss induced by noise, and the distortions that I was listening since the audiogram didn’t show a big loss, my brain would get use to it.Should get away from noise.I notice that after telling him about my last episode he didn’t take a deep look at my exams and right away gave the diagnostic. I was devasted with this, went home and started to search on net how to read an audiogram and I notice that my audiogram was just normal! The XXXXXXX loss was 10db! • So I decided to go a different ENT (13th November), which passed me the same exams, didn’t talk about the headsets just to avoid any early conclusion. I still had the same symptoms. The exams were all normal and the ENT even said that my hearing was well above average for my age (34 years old) that I should relax and maybe this could be related to a vibroacoustic disease, and we should let time pass by to see how it would go. One important aspect that I notice is that on the acoustic reflex threshold my reflexes were absent in the first and on this exam at the frequency of 4000hz (ips/cont) . • One month later, no major changes, decided to go to another ENT, same tests passed, all came normal, Litlle bit different from the last (worst) but still normal, higher loss 15db. 3 days after, 30th December, started noticing a permanent ringing in my both rings, and I caught a cold so initially I associated with this but later started thinking if it wasn’t caused by the ART tests. Since this time permanent tinnitus never left me. Also notice that distortion was get more noticable as time was passing by . • On the 13th of February I went to a small party with live music, I felt it was a bit loud, neverthless i decided to stay without protection but no close to the amps or the band.It lasted less than a hour and a half. There were also some firecrackers but not too noisy being throwned. 2 days later I noticed that the distortion was getting notice in places where after I wasn’t able to detect. Sound from radio and tv seemed that someone had put more bass in to it. • Two weeks later, without exposing myself to noise, I started noticing same changes in hearing some words, specially those with s’s. Three weeks later went to a new ENT (5th March), this time a ENT specialized in tinnitus, looking for an answer. She prescribed me an esteroid (cortisone) Anti-inflammatory to take between 10 days, just to rule out any type of allergy that could be causing the distortion. No luck, situation was continuing to get worst to a point that I was having difficulty to understand speech in crowed places. • Last week did a new audiogram tonal, vocal and impedance, I was thinking that lots of changes would appear taking into account the symptoms that I used to have and the ones that I have now. Just for my surprise, basically no changes, higher loss 10 db!!! If what I’m feeling was created by noise induced, wasn’t it supposed to be visible in a normal audiogram, specially if I’m detecting changes in the speech frequencies band??????????? • This week received also the MRI that I did last week and everything is also normal. Symptoms at this time 02nd April 2014: Bilateral permanent Tinnitus: Left ear hissing sound and sometimes high pitch. Barely noticeable during the day; Right ear lower intensity hissing sound and spikes of very high pitch (seconds); Sometimes seems like Tinnitus is reactive; No sound hypersensibility; Speech distortion mostly in words with s’s. Then in words with f’s/t’s/sh’s. This words sound raspy, edgy; Sound distortion in fans; ventilators; refrigerators; car engines. Producing a sort of morse code effect; Sometimes it feels like my right ear just closes like when your passing throught different pressure levels; Something that I also notice is that my left ear is more sensitive to very low pitch sounds, since this all started, like I can hear things at lower freqs that earlier I wasn’t able to. I would like to know whats happening, because it looks like am losing my hearing and there's nothing I can do

Good afternoon Dr., I'm sending to you my 1st and 2nd audiogram, tympanogram, and acoustic reflex threshold taken in 08Th and 15th November 2013 respectively. The later that I did last week I don't have already since it's waiting for the report, but from what have seen no changes to report. Neverthless tomorrow I'll have to do more exams like: high freq audiogram; normal audiogram (tonal and speech) and impedance, I'll also make a new one to find out the tone and intensity of my tinnitus. Waiting for your reply,

Hello Dr., Thanks for your quick reply. Regarding your diagnostic of noise induced, which is the most probable cause taking into account my story, I've got a few questions: If in fact this is noise induced, how come some of the symptoms only appear weeks after the exposure? Usually people with this diagnostic experience the symptoms right after the exposure and has time passes by, symptoms seems to stabilize or even improve if they protect themself from noise exposure, which is not my cause as you probably have noticed already. Since November that I don't use my headsets and I'm being very carefull with my hearing, besides that party in february, I've been protecting myself from loud noises and I don't live or work in a noisy environment, How come even without exposure my hearing is getting worse, specially in the speech band? From all the forums I have been throught, people with similar symptoms usually have higher hearing loss at high frequencies than I have. Actually it even seems that my audiogram is quite good. How come? Could TMJ cause this kind of symptoms? Not that I'm feeling pain, but my jaws always did a click noises when I open and close my mouth, and it became more noticeble after I took the punch last year, speciallly when gets cold and I'm chewing. However never seen someone with TMJ complaning of hearing distortion in speech... Tinnitus is not a issue anymore. It's sometimes annoying, but most of the time I can't even notice. My biggest concern is distortion, since its now affecting the speech clarity and almost every sound that I hear as I described in the first post. Seems like sound is mixed up. What could be causing this progressive symptoms in my hearing? Could this be reversible? How can we see if this is a inner hear/hair cell problem?

Good afternoon Dr, There was a question you didn't answer and I know that it’s the most enigmatic but my quest right now is that. How can you explain the fact that my audiometry is just normal, and I'm felling distortion in my speech, when supposedly the speech banana is below my actual hearing threshold? As I said the tinnitus doesn't bother me, just the distortion,. And I say again, I haven't been exposing myself to loud noises or noises above 85 or 90 db, How is my symptoms progressing? Even if the damage is permanent, I'm being carefull and for the last 1 and half month I haven't been for sure exposed to loud noises, how come my situation is getting worst? What you are saying is what I already know, but whats missing is that I can hear all pitches at an average of 5 to 10 db, how can this distortion be affecting my speech descrimination? What I mean by sound distortion is, some sounds trigger another sound, which is always the same. It's like it's adding a metallic tint to them (like morse code). My computer's fans trigger it, noticeable when I make noise with a cellophane bag, when running water, engines. In speech I notice that s’s, f’s, x’s, v’s are more raspy and edgy. I also notice that my whisper is not as high pitch as it used to be. Could this be caused by Tonic Tensor Tympani? Regarding the exams that I did today I'll only have the results next week, however the audiometrist said that all of them (tonal and vocal audiogram, tinnitus tone and intensity finder, Impedance) even the High frequency audiogram (8Khz to 16Khz) were all normal. I really need an explanation to the symptoms, because it doesn't make sense to say that I have sensorineural hearing loss caused by noise induced when the audiograms don't show that?!! Or the audiograms don't mean nothing?

Hello Dr., I hope you have already received my latest audiograms. Were made with one week separation between them. The exams that I did today were with the same technician and equipment done in the 15th Novenber of 2013 that I already sent you before (in case if you want to compare). About my tinnitus type and sound it was not conclusive, however, I found out that it sound like rain or an old tv on (15000/16000hz) and probably at low intensity (10 to 20db). I even believe that my tinnitus is a reactive type...because it seems that reacts to certain frequencies. Yesterday I did the Evoked Response Audiometry exam. I'll have the result in the next week. What's the difference between the ERA and BERA exam? Because I did the ERA exam which they said it was the same. However they didn't test me at all frequencies neither they test me to my lowest hearing threshold. Matter a fact, the exam was very noisy with stimulus always with high intensities, reaching 100db. The technician said that the goal of this exam was not to find my hearing threshold but to see if there are any differences between ears and also to analize if the waves and latency are within normal range, and the only frequencies tested were between 2000 and 4000 hz. The technician also said the waves and latency seemed to be at normal range however I need to wait for the report. Was this the exam that you were talking about? Also did blood tests, I'll have the resullts next week. Regarding the symptoms, basically the same , I notice that is getting hard to understand speech as sounds seems to get more distorted, and sometimes more high pitched, more over when I'm listening to some words. Sometimes I even feel pain in my left ear due to the high pitch sounds of some words when listening to TV and radio!

Good morning Dr. Still waiting for the exams results, neverthless I thought it would be important also to say that prior to start noticing permanent tinnitus in my ears in last December, I caught a cold and right before my symptoms of speech distortion got evident I also caught a cold where my throat got sore and a lot of yellowish expectoration was coming out. Do you thing that the colds or flus could aggravate the symptoms? Regarding the possibility of CAPD, do you think the head trauma that I had last year could cause that? About the symptoms, remain the same, can't really say if they are worst or not, however, the better description I can find for the speech distortion is that I hear the s/f/x/v/j/c/z/ch/sh like they lost their high definition (being the "s" more low defintion), are not clear anymore.

Good Afternoon Dr. I have just sent you the exams. What do you think about the Exams results? The symptoms remain the same.

Hello Dr. Can you tell me which are the blood samples that are somehow a little bit deviated? Can you tell me also from which ear I have some slight delay on wave 5? Is it possible to improve or get totally better from CAPD?