Hearing Issues: Symptoms, Treatments, and Concerns

Hearing issues?

Dear Dr.
Cheng,
I am the patient who consulted you previously regarding discomfort in my right ear after being too close to the speakers during a music performance at the end of December.
Currently, my main symptoms are: 1.
A feeling of fullness and tightness in my right ear (which fluctuates), 2.
A sensation of imbalance between my ears (the right ear seems quieter, especially when sound comes from the left side), and 3.
Approximately one month later, I began experiencing intermittent tinnitus in my right ear.
I underwent a hearing test, which showed a decline at 8000Hz in my right ear over the past two months.
I have seen several doctors since then.

Initially, the first doctor prescribed the following medications: 1.
Beesix 50mg (Vitamin B6, Pyridoxine HCl) (once daily), 2.
Euclidan 50mg (Nicametate) (once daily), 3.
Folic acid 5mg (once daily), and 4.
Depyretin 500mg (Acetaminophen, Scanol) (twice daily).
However, due to a lack of improvement and scheduling conflicts, I consulted a second doctor who recommended corticosteroids and prescribed Prednisolone 5mg (two tablets twice daily for the first seven days, then one tablet twice daily for the next three days) and methylcobalamin (Ch3-B12) (twice daily).
During my follow-up, the doctor advised against continuing corticosteroids and switched me to Betahistine mesylate 12mg (two tablets twice daily) for a month, while I continued taking methylcobalamin.
After finishing this course, I returned for another follow-up, and the doctor mentioned that he could only continue prescribing the same medications, with no other options available.
Feeling discouraged, I sought opinions from different hospitals.
The third doctor also indicated that he could only prescribe similar medications but suggested that the ear fullness and imbalance might be related to Eustachian tube dysfunction.
He prescribed Allegra 60mg (twice daily) for me to try, which seemed to slightly improve the fullness (though it still fluctuates), but the imbalance between my ears persists.
My hearing test results across different hospitals consistently show a decline at 8000Hz in my right ear, with varying degrees of loss reported (10, 25, and 30 decibels).
I have also undergone tympanometry and otoacoustic emissions (OAE) testing, both of which were normal.
However, since the third doctor recorded a 30-decibel loss, he arranged for me to undergo Auditory Brainstem Response (ABR) testing, which has left me concerned about the possibility of other issues.
I have several questions for you:
1.
What do you think is the most likely cause of my symptoms? What treatment direction would you recommend? If it is noise-induced hearing loss, are there really no other medications or treatments to try?
2.
Is the imbalance between my ears related to the 8000Hz hearing loss? (I understand that 8000Hz is a very high frequency and is not commonly encountered in daily life.)
3.
Is it reasonable to have different results of 10 decibels and 30 decibels from different hospitals?
4.
Will my right ear be more susceptible to future hearing loss or age-related changes?
I apologize for the numerous questions and the lengthy description.
Thank you for your assistance!
Best regards.

K, 30~39 year old female. Ask Date: 2023/03/01

Dr. Zheng Jueyi reply Otolaryngology

Hello, common causes may include noise-induced hearing loss.
In terms of medication, corticosteroids, vitamins, blood circulation enhancers, and antihistamines have all been used by clinicians, and there are no other significantly effective medications to recommend.
As for the sensation of imbalance between the left and right ear canals, if no other abnormalities are found upon examination, it can only be speculated to be related to high-frequency hearing loss.
If there are concerns about further hearing damage, it is advisable to avoid prolonged exposure to loud sounds.
Normal aging, however, cannot be avoided.

Reply Date: 2023/03/01

More Info

Hello! Thank you for reaching out with your concerns regarding your hearing issues. It sounds like you've been through quite a journey with your symptoms, and I appreciate the detailed information you've provided. Let's address your questions one by one.

1. Possible Diagnosis and Treatment Direction: Based on your symptoms, including the feeling of fullness in your right ear, the imbalance in sound perception, and the tinnitus (ear ringing), it is possible that you are experiencing noise-induced hearing loss, particularly affecting the high frequencies (8000 Hz). This type of hearing loss can occur after exposure to loud sounds, such as music from speakers, which can damage the hair cells in the cochlea. Treatment options for noise-induced hearing loss are somewhat limited, as the damage to hair cells is often irreversible. However, some patients benefit from hearing aids or sound therapy, which can help manage tinnitus and improve overall hearing. Additionally, cognitive behavioral therapy (CBT) may help you cope with the emotional aspects of tinnitus.

2. Sound Imbalance and Hearing Loss: The imbalance you are experiencing between your ears could indeed be related to the 8000 Hz hearing loss in your right ear. High-frequency sounds are often associated with consonants in speech, which can make understanding speech in noisy environments more challenging. The perception of sound imbalance can also be exacerbated by the brain's processing of auditory information, especially if one ear is not receiving the same level of sound input as the other.

3. Variability in Hearing Test Results: It is not uncommon to see variability in hearing test results across different facilities. Factors such as the calibration of equipment, the testing environment, and even the technician's technique can contribute to differences in the results. A difference of 10 to 30 dB is within a reasonable range of variability, but significant discrepancies should be further investigated, especially if they correlate with your symptoms.

4. Future Hearing Loss Concerns: As for your concern about future hearing loss or age-related changes, individuals who have experienced noise-induced hearing loss may be at a higher risk for further auditory issues. Protecting your ears from loud noises in the future is crucial. Using ear protection in noisy environments and being mindful of volume levels when using headphones or attending concerts can help preserve your hearing. Regular check-ups with an audiologist can also help monitor your hearing health over time.

In conclusion, I recommend continuing with the audiological assessments, including the auditory brainstem response (ABR) test that your doctor has scheduled. This test can provide valuable information about the auditory pathways and help rule out any neurological issues. Additionally, consider discussing with your healthcare provider the possibility of a referral to an audiologist or an ear, nose, and throat (ENT) specialist who specializes in tinnitus and hearing loss for a more tailored treatment plan.

It's understandable to feel concerned about your hearing health, but with the right support and management strategies, many individuals find ways to cope effectively. Don't hesitate to reach out for further assistance or clarification on any of these points. Wishing you the best in your journey toward better hearing health!

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