Persistent Tinnitus and Hearing Loss: Seeking Expert Advice

Persistent high-frequency tinnitus in the left ear with bilateral hearing issues?

Hello Doctor, I suddenly noticed a decline in my hearing at the beginning of this year.
I often have to ask others to repeat themselves or speak louder.
In mid-July, I experienced sudden tinnitus in my left ear, a feeling of fullness, and further hearing impairment, making it seem like there is a barrier when others speak.
Since July 21, I have undergone four hearing tests (on July 21 at an ENT clinic, July 29 at a hearing aid store, and on August 4 and September 5 at two major hospitals in Taipei).
The results showed that my left ear hearing is approximately 45 dB and my right ear around 55 dB.
At the first major hospital, a CT scan was performed, and the doctor suspected otosclerosis of the ossicles.
Later, at the second major hospital, the doctor believed that the first and second ossicles were fused together.
Both doctors mentioned two treatment options: 1.
Wearing a hearing aid, which is not necessary unless my daily life is significantly affected, and they also mentioned that hearing aids should be worn regularly to be effective; 2.
Surgery, which is not essential, and if I wish to proceed, I can return to discuss it with them.
I also inquired with the doctor at the second major hospital about why I often hear a heartbeat sound in my left ear.
The doctor explained that it is due to the proximity of the venous blood vessels to the thin bone in the left ear.
Regarding the tinnitus, both doctors indicated that it could be related to the ossicular issue, with the first doctor suggesting that I should get used to it, while the second doctor emphasized the importance of adequate sleep and prescribed medication to improve blood circulation and aid sleep for me to try for 14 days.
I feel that the impact of my hearing loss and tinnitus is quite significant, as my job often requires communication and interaction with others.
However, both doctors believe that wearing a hearing aid is sufficient.
The doctor from the first major hospital mentioned that hearing aids should be worn consistently to be meaningful, but they might not adapt well in different environments.
In contrast, the doctor from the second major hospital suggested wearing them only when needed.
It seems that neither doctor is particularly inclined to recommend surgery, and I am unsure why.
The diagnoses and recommendations from both doctors differ slightly, leaving me confused about what choice to make.
Therefore, I would like to seek your opinion and advice, or if you could share from an otolaryngological perspective why the doctors might be hesitant to recommend surgery.
Thank you, Doctor.

Huang, 30~39 year old female. Ask Date: 2022/09/11

Dr. Zheng Jueyi reply Otolaryngology

In general, if there are issues with the ossicles that cause daily life disturbances, it is advisable to consider wearing hearing aids for assistance.
As for surgical options, ossicular surgery carries risks, including potential damage to the inner ear, which may result in worse hearing postoperatively than preoperatively.
Therefore, regarding the necessity of surgery for improvement, physicians may adopt a more conservative approach.
Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology at Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2022/09/11

More Info

Hello,
Thank you for sharing your concerns regarding your hearing loss and persistent tinnitus. It sounds like you have been through a thorough evaluation process, and I understand how confusing it can be when different specialists provide varying opinions on your condition. Let’s break down the situation and explore your options.

Firstly, it’s important to recognize that hearing loss and tinnitus can be interconnected, and both can significantly impact your quality of life, especially in a work environment that requires effective communication. The fact that you have experienced a noticeable decline in your hearing, along with the onset of tinnitus, suggests that there may be an underlying issue that needs to be addressed.

From your description, it appears that you have undergone multiple hearing tests, and the results indicate moderate hearing loss in both ears, with your left ear being slightly worse. The CT scan revealing potential issues with the ossicles (the tiny bones in the middle ear) could indeed be a contributing factor to both your hearing loss and the perception of tinnitus. Ossicular chain dysfunction can lead to conductive hearing loss, which may explain why sounds seem muffled or as if they are coming through a barrier.

Regarding the differing opinions from the specialists, it is not uncommon for medical professionals to have varying approaches to treatment based on their experiences and the specifics of your case. The recommendation to consider hearing aids is a common first step in managing hearing loss, especially if it is not severely impacting your daily life. Hearing aids can help amplify sounds and improve communication, but they do require an adjustment period, particularly in different environments.

As for the surgical options, it is essential to understand that surgery is typically considered when there is a clear and significant benefit that outweighs the risks involved. Surgeons may be cautious about recommending surgery if they believe that the potential outcomes may not justify the risks or if there are non-invasive options available that could provide relief. Additionally, surgery on the middle ear can be complex, and the success rates can vary based on the specific condition being treated.

In terms of managing your tinnitus, the advice from the specialists to focus on lifestyle factors such as sleep and stress management is crucial. Tinnitus can often be exacerbated by stress and fatigue, so ensuring you have a good sleep routine and managing stress levels can help mitigate its impact. The medications prescribed to improve blood circulation and aid sleep may also contribute positively to your overall well-being.

Given the complexity of your situation, it may be beneficial to seek a third opinion from an otologist or a neurotologist, specialists who focus specifically on ear disorders. They can provide a more comprehensive evaluation and may offer additional insights into your condition. Additionally, consider discussing the possibility of a trial period with hearing aids to see if they improve your communication abilities before making any decisions about surgery.

In summary, while the path forward may seem uncertain, there are options available to you. It’s essential to weigh the benefits and risks of each approach and to choose a course of action that aligns with your lifestyle and communication needs. Remember, you are not alone in this journey, and seeking further opinions can help clarify your options.
Best wishes for your health and well-being.

Similar Q&A

Understanding Persistent Tinnitus: Causes and Next Steps for Relief

Hello Doctor, I started experiencing bilateral alternating tinnitus about a week ago, with sounds resembling buzzing or a "E" sound and pressure sounds. Sometimes it lasts all day, while other times it comes and goes, affecting either one ear or both ears alternately. I...

Dr. Zheng Jueyi reply Otolaryngology
Hello, if the appearance and hearing examination in the otolaryngology department are normal, common tinnitus is often related to issues such as stress, emotions, or migraines. It is recommended to start by improving stress and sleep, or to seek assistance from a psychiatrist.

Understanding Persistent Tinnitus: Causes and Solutions for Better Sleep

I have been experiencing continuous tinnitus, described as the sound of insects and birds, for the past two months. Could this be related to aging and degeneration? It has been a constant source of distress for me, often preventing me from sleeping. Could you please provide some ...

Dr. Ye Dawei reply Otolaryngology
Dear Sir/Madam, Please visit the outpatient clinic for examination. Inner Ear Tinnitus As the name suggests, inner ear tinnitus is caused by lesions in the inner ear. The most well-known conditions associated with this are Meniere's disease and the increasingly comm...

Persistent Tinnitus: When to See a Neurologist for Help

I have been experiencing a constant cicada-like sound in my ear for over two weeks. I have seen an otolaryngologist, but it hasn't helped. I'm unsure about what further medical examinations to pursue. Should I first consult a neurologist? Can you recommend a specialist ...

Dr. Lin Zijing reply Neurology
It is recommended to avoid: noise, using headphones, and explosive sounds in daily life. You may visit an otolaryngologist to check for hearing loss and a neurologist for brainstem auditory evoked potential testing.

Seeking Help for Persistent Tinnitus: What to Do Next?

Hello, doctor. About 20 days ago, I started experiencing persistent ringing in both ears in quieter environments. Sometimes, I even hear a sharp, high-pitched sound similar to a bicycle brake squeaking. This is particularly noticeable when I lie on my side at night. The day after...

Dr. Zheng Jueyi reply Otolaryngology
Hello, if all tests are normal and the medications have not improved your condition, it is recommended to return for a follow-up appointment with your physician to discuss whether there are other medications or treatments that may provide improvement. Wishing you safety and healt...