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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for loss of hearing

Answered by
Dr.
Dr. Sumit Bhatti

ENT Specialist

Practicing since :1991

Answered : 2561 Questions

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Posted on Thu, 21 Aug 2014 in Ear, Nose and Throat Problems
Question: I recently lost 50% of my hearing over 3 months ago. No trauma. No Pain, No Inflammation. No Infection. I lost it several days after going lobster hunting 3 feet under water for several hours. When I do the Val Salva maneuver, a good portion of my hearing returns but just for a few minutes. I have popping in my ears thru out the day. I feels like there are water baloons over my ears. So where I used to listen to TV and radio on 15, I not listen at 30. I am wearing BTE devices to assist with my hearing loss. I have done audiograms, etc. So 300 to 2500hz at 40db, 2500 to 6000hz at 90+db. I am needing to know the following in laymen's terms (I am not a Doctor):
1 - What happen to my hearing
2 - Will my hearing ever return
3 - What can I do now to return my hearing to normal
doctor
Answered by Dr. Sumit Bhatti 26 minutes later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for your query.

1. Kindly upload the following:
a. A Pure Tone Audiogram (PTA) graph.
b. A Tympanogram (Impedance Audiogram).
c. A plain CT PNS (Para Nasal Sinuses).

2. If these is normal, then medication will help. If these are abnormal, a simple Myringotomy with grommet insertion will help.

3. The description of your audiogram suggests that you have moderate (lower frequencies) to severe (higher frequencies) mixed hearing loss.

4. There is a possibility that you are a candidate for a Baha (Bone Anchored Hearing Aid). However, I need to see the actual graph.

If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 1 hour later
I have many many questions. Don't want to second guess anything you say.
What is Grommet?
What is a Baha?
Did water do this damage to my ears?
If not, what cause me to have such a hearing loss w/o any trauma?
Will my hearing return?
Do I need to stay away from water, pools, lakes, oceans?
A PTA Graph and Tympanogram were performed.
I know what the audiogram shows.
I don't know why a little water would do such damage.
How do you explain my ears feel like there are water balloons over them?

I dont know what to do or understand what has happen and my ENT has told me nothing just ETD and nerve sensory damage or something near to this.
Please remember I am not medically trained.
doctor
Answered by Dr. Sumit Bhatti 2 hours later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. A grommet is a small ventilation tube placed in the ear drum.

2. Baha is a short form for Bone Anchored Hearing Aid. It enables sounds to be conducted through the skull bones directly into the inner ear, bypassing the conductive mechanism of the middle ear.

3. If your ear drums are intact, water has not caused direct damage. Indirectly, frequent colds and sinusitis may lead to ETD.

4. ETD may cause such hearing loss without trauma. I believe part of your high frequency hearing loss is age related.

5. Any sensorineural hearing loss is likely to be permanent. Any conductive hearing loss component may be corrected with hearing aids or surgical correction.

6. You need to stay away from water to avoid worsening of the hearing loss.

7. You cannot describe an audiogram easily. Upload the image.

8. Long standing fluid in the ears thickens like glue. Repeated infections damage the inner ear. Normal middle ear fluid secretion increases in ETD.

9. The muffled feeling will correspond with the Tympanogram. Thinned out eardrums may be hypermobile, giving the feeling of water balloons over the ears.

If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 14 hours later
Thinned out eardrums...What does this mean? My eardrums are thin?

may be hypermobile...What does this mean?

Long standing fluid in the ears thickens like glue....I believe this to be a problem. I have very bad sinusitis.

Any sensorineural hearing loss is likely to be permanent...they wrote me up as having this.

Normal middle ear fluid secretion increases in ETD....What does this mean? Are you saying that I should have a damp Q-Tip when placed ion the ear canal?

mage was uploaded yesterday. Still waiting your reply.
As a Patient, the questions I am seeking are:

What can I do to get my hearing back?
What lifestyle changes do I need to make (I am a scuba diver)?
Is this a permanent loss?
Which is more critical or conducive to my loss - the ETD or the sensory loss?
doctor
Answered by Dr. Sumit Bhatti 31 hours later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. Thinned out hypermobile eardrums are usually seen after ear drum perforations that heal on their own. The ear drum is thin, transparent and moves with a greater compliance than a normal eardrum. This may be seen on direct examination or on the Tympanogram.

2. Any sudden sensorineural hearing loss (SSNHL) is likely to be permanent unless treated within 4-6 weeks (with a ~50% sucess rate). Gradual sensorineural hearing loss is difficult to treat, hence becomes permanent.

3. Normal middle ear fluid secretion increases in ETD behind the intact eardrum. Hence a Q-Tip placed in the ear canal will not get damp.

4. The image had not been uploaded. Please try again.

5. To get your hearing back get your sinusitis treated.

6. As a scuba diver, you are prone to sinusitis, swimmer's ear, barotrauma and vertigo.

7. Whether this is a permanent loss depends upon the factors mentioned above.

8. The sensorineural hearing loss (SNHL) is more critical than the conducive hearing loss (CHL).

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 : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Sumit Bhatti 17 hours later
6. As a scuba diver, you are prone to sinusitis, swimmer's ear, barotrauma and vertigo.
Does this mean I need to STOP diving completely?
Does this mean I should not even water ski?
Does this mean I can but I need to put wax or other to protect my ears?
If so, why? I have been diving & skiing for 20 years w no issues.
My recent dive at 3 feet has caused the issues we are discussing.
If I dont and continue to dive and ski what are my risks (since
I have gone so many years w/o any issues)?

5. To get your hearing back get your sinusitis treated.
I have had a Rhino-Plasty & a Septo-Plasty. What treatment are you
recommending now?

3. Normal middle ear fluid secretion increases in ETD behind the intact eardrum. Hence a Q-Tip placed in the ear canal will not get damp.
So the damp Q-tip from the canal is from something else?
What? Residue on Q-Tip is clear, not waxy.

2. Any sudden sensorineural hearing loss (SSNHL) is likely to be permanent unless treated within 4-6 weeks (with a ~50% sucess rate).
So its permanent. But what caused this? Since I dive much, I am not
accepting that a little water (3' under) cause this damage. So what did?

1. Thinned out hypermobile eardrums....
Please speak in laymen's terms. What is this and what does this mean?
doctor
Answered by Dr. Sumit Bhatti 30 hours later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. There is a deterioration in your hearing in 2014 as compared to your PTA from 2013.

2. Your most recent PTA done in 2014 shows a pure sensorineural hearing loss (SNHL). There seems to be no component of a conductive hearing loss (CHL) as expected from a flat (Type 'B') Tympanometry graph with no gradient. This would ideally have shown a mixed hearing loss (with both SNHL & CHL). This can mean any of the following:
a. There was a poor ear canal seal with loss of pressure during the Impedance test. Or there is a small perforation in the eardrum.
b. The middle ear fluid is negligible or had dried up ,as no air volume is seen in the middle ear, usually as a small peak or gradient.
c. The PTA needs to be repeated.

3. SCUBA diving in shallow water should not cause a problem unless it is causing swimmer's ear or if you have a small pinpoint eardrum perforation (hence the damp q-tip). In this case, you have to stop for a while and reassess. Water skiing would be worth avoiding. Ear plugs may work in shallow water, but are also known to increase bacterial and fungal counts in the ear canal.

4. Rhinoplasty and Septoplasty do not directly treat the sinuses. Get a plain CT PNS (Para Nasal Sinuses) done and upload the images.

5. The higher frequency SNHL is partly due to Presbyacusis (age related hearing loss). The deterioration must be investigated further, especially since you have poor speech discrimination in your PTA report.

6. A thinned out eardrum usually lacks a middle fibrous layer and appears transparent (as opposed to a translucent three layered normal eardrum). It is lax and tends to move in and out much more than a normal eardrum. This would however, give rise to a very tall or open ended graph on the Tympanogram. Hence an endoscopic image of the ear drums is requested. This can be arranged easily by your ENT specialist.

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 : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 42 hours later
Sorry.

I left a couple things out...
I had a very high fever when I was 13 years old, which caused the high pitch hairs in the cochlea to lay down thus causing my high pitch hearing loss. This is separate from the subject now. After the Lobster dive, the chart of my audiogram shifted about 20db across the board so where I was hearing at 20db at 500hz, I now am hearing at 40db at 500hz, etc, etc.

The biggest question today is....
What is causing the popping in my ears?
My ears pop about 100+ times a day. And in several occurrences they pop many times in one occurrence. When the Val Salva is performed, I hear much better for a min or so.

So you got my hearing test results?

CT PNS - Is this a Cat Scan?
doctor
Answered by Dr. Sumit Bhatti 7 hours later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. Yes, the childhood illness may have caused the initial damage to the cochlea.If it was meningitis, there is a possibility that you have a partially ossified cochlea. This can be confirmed on a CT Scan of the Temporal Bones.

2. You must repeat the PTA fr the reasons mentioned above and in the previous answers.

3. The popping is a sign that the ETD is decreasing. Unless the popping sound is a myoclonus (rapid muscle spasms). or due to an eardrum perforation.

4. CT PNS is a Cat Scan of the nasal Sinuses (Sinus CT Scan).

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 : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 14 hours later
Good news. My hearing ability has returned somewhat. I can now hear enough to talk to people on the phone and without a device and hear them. This was not the case for the last 3 months.

Could this and the constant popping a sign that my hearing could be returning some?

a flat (Type 'B') Tympanometry graph with no gradient....What is this. Please speak in laymen's terms.
doctor
Answered by Dr. Sumit Bhatti 6 hours later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. That is good to hear from you.

2. This means that you had a component of CHL (Conductive Hearing Loss) that has improved.

3. A flat (Type 'B') Tympanometry graph with no gradient slope indicates that there is no air in the middle ear cavity. The normal middle ear space behind the ear drum contains air. This air containing space communicates with the back of the nose via the Eustachian Tube. This fluid interferes with sound transmission and leads to a CHL.

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 : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 2 hours later
3. A flat (Type 'B') Tympanometry graph with no gradient slope indicates that there is no air in the middle ear cavity. The normal middle ear space behind the ear drum contains air. This air containing space communicates with the back of the nose via the Eustachian Tube. This fluid interferes with sound transmission and leads to a CHL.

If not air then what? Fluid? GLue?

What does flat mean? Like a straight horizontal line?
doctor
Answered by Dr. Sumit Bhatti 12 minutes later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. Normal mucoid middle ear secretions build up as they can no longer drain into the nose via the blocked Eustachian Tube.

2. The amount of secretion increase as the oxygen is reabsorbed by the body.

3. Over time, this fluid dries up to form a thick glue like consistency. At this stage, medication alone cannot help drain the collection in the middle ear space.

4. Yes, the Tympanometry graph is almost flat as in a horizontal line parallel to the x axis.

If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 5 hours later
Please explain #4 in laymen's terms. I am not a doctor. Its flat. So what does that mean?
doctor
Answered by Dr. Sumit Bhatti 16 hours later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. A normal Tympanogram is known as type 'A' , it looks like an inverted V and has a peak centered around zero pressure. This means that as the pressure is increased in the external ear canal by the Typanometry probe on the outside of the drum, that exact pressure is equalized in the middle ear on the other side of an intact ear drum via the Eustachian tube.

2. A type 'B' Tympanogram is a horizontal line without a peak.

3. For all practical purposes, this type 'B' Tympanogram is what you have and it is which is consistent with middle ear pathology, such as fluid or infection behind the ear drum. This is also possible when there is a hole in the ear drum in which case the build-up in the pressure is not possible.

If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 42 hours later
I have been using a warm saline solution sprayed up to nose. Will this help to open my Eustachian tubes?

My hearing fluctuates. Today it is very bad. Yesterday it was very very good.
How can this be?
doctor
Answered by Dr. Sumit Bhatti 16 hours later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. Steam inhalation is more likely to help.

2. Warm saline is fine to use, however the strength of the solution should be perfect. What saline solution do you use?

3. It is usually the conductive hearing loss (CHL) component that fluctuates depending on the ETD (Eustachian Tube Dysfunction) and the fluid build-up.

4. Sensorineural hearing loss (SNHL) can also fluctuate rarely, as in Meniere's Disease. In this condition there is also severe vertigo.

If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 2 days later
No Vertigo, no disease.

You write....
3. It is usually the conductive hearing loss (CHL) component that fluctuates depending on the ETD (Eustachian Tube Dysfunction) and the fluid build-up.

Then this would explain my hearing ability fluctuates daily. Today very bad. A 4 on a scale of 1 to 5. Yesterday a 3. But on Sat was a 1. Nasal cavities were clear and low pollen in the air.

But this also supports that if I can keep my ears clear, I will be able to hear better so I am taking more decongestants so I can hear better.
doctor
Answered by Dr. Sumit Bhatti 6 hours later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. Decongestants are fine in the short term. They are contraindicated in the presence of hypertension, heart problems, glaucoma, thyroid problems, diabetes and enlarged prostate. There is also rebound congestion when the effect of the decongestants wears off.

2. It is better to rely on steam regular inhalation and steroid nasal sprays along with intermittent anti allergy medication.

3. These will help you keep your ears in better health.

If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 41 hours later
I am using Netti-Pot(warm saline solution) every morning and sometimes in the evening, and steroid nasal sprays. I will use anti allergy medication more often.

Hearing is very bad today. Allergies are bad. Heavy nasal congestion. Can hear very little.

This daily change in allergy conditions altering my ability to hear so much is hard for me to understand.

Can you explain this in terms I can understand once more before I close this question?
doctor
Answered by Dr. Sumit Bhatti 17 hours later
Brief Answer:
As below:

Detailed Answer:
Hi,

Thank you for writing back.

1. The Eustachian tube is one of the main mechanisms by which middle ear pressure (behind an intact ear drum) is equalized with atmospheric pressure (or the pressure in the external ear canal underwater).

2. Congestion at the nasal end of the Eustachian Tube causes ETD. This affects the middle ear pressure and drainage of normal secretions from the ear and mastoid air cells into the nose. This reduces the sound conduction efficiency of the middle ear. The middle ear conducts sound from the ear drum vibrations to the inner ear. Hence the hearing level decreases. On better days, the conductive hearing loss improves.

3. This is a very complex mechanism, also depending on yet some unexplained theories of middle ear aeration. These include the mastoid air cell system, levels of different gasses in the middle ear, presence or absence of infection, duration of the ETD, nasal and sinus problems, allergy and so on.

4. Continue with the above line of treatment and you should see improvement in a few weeks. You may follow up in a month's time.

If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sumit Bhatti 29 hours later
Thank you
doctor
Answered by Dr. Sumit Bhatti 8 hours later
Brief Answer:
Thank You.

Detailed Answer:
Hi,

Thank you. I, too, have to reply to close this discussion.

Wishing you good health.

Regards.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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