Hearing Loss: Insights and Treatment Options

Hearing consultation

Hello Dr.
Lee,
I attended a music performance at the end of December last year (12/24), and since my position was very close to the speakers, I felt discomfort in my ears afterward: 1.
My right ear (the speaker was in front of my right side) felt stuffy and dull, similar to the sensation of pressure adjustment during an airplane takeoff.
2.
Sounds in my right ear seemed quieter and somewhat muffled.
Over the past two months, I have consulted several doctors.
The first doctor prescribed the following medications: 1.
Beesix 50mg (Vitamin B6, Pyridoxine HCl) (once daily) 2.
Euclidan tab 50mg (Nicametate) (once daily) 3.
Folic acid 5mg (once daily) 4.
Depyretin tab 500mg (Acetaminophen, Scanol) (twice daily, morning and evening).

Since there was no improvement and I couldn't align my schedule for follow-up, I consulted a second doctor, who suggested corticosteroids and prescribed Prednisolone 5mg (2 tablets twice daily for the first 7 days, then 1 tablet twice daily for the next 3 days) and methylcobalamin (Ch3-B12) (twice daily).
During the follow-up, the doctor advised me to stop taking corticosteroids and switched me to Betahistine mesylate 12mg (2 tablets twice daily) for a month, while continuing with methylcobalamin.
After finishing the medication, I returned for a follow-up, and the doctor mentioned that he could only continue prescribing the same medications, with no other options available.
Feeling disheartened, 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 in hearing might be related to eustachian tube issues.
He prescribed Allegra 60mg (twice daily) for me to try, which seemed to slightly improve the ear fullness (though it still fluctuates), but the imbalance in sound perception remains.
My hearing tests at different hospitals consistently showed a decline at 8000Hz in my right ear, with results varying from 10 dB to 25-30 dB.
I have also undergone tympanometry and otoacoustic emissions (OAE), both of which were normal.
However, since the third doctor recorded a 30 dB loss, he arranged for an auditory brainstem response (AABR) test, which also returned normal results.
Currently, my main symptoms are: 1.
A feeling of fullness and tightness in my right ear (which fluctuates) 2.
An imbalance in sound perception between my ears (the right ear seems quieter, especially when the sound source is on the left side) 3.
Tinnitus in my right ear started about a month ago (intermittent).
I have a few questions I would like to ask 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 options to try?
2.
Is the imbalance in sound perception between my ears related to the 8000Hz hearing loss? (Since I found that 8000Hz is a very high frequency, which I don't often encounter in daily life.)
3.
Is it reasonable to have different results of 10 dB and 30 dB from different hospitals?
4.
Will my right ear be more susceptible to future hearing loss or aging?
I apologize for the many questions and the lengthy description.
Thank you for your assistance, Dr.
Lee!

K, 30~39 year old female. Ask Date: 2023/03/13

Dr. Li Jiaxuan reply Otolaryngology

A difference of 10 decibels and 30 decibels is not considered a normal range of error.
Sometimes, hearing can decline due to poor Eustachian tube function.
Eustachian tube dysfunction can lead to abnormal ear pressure, and prolonged abnormal ear pressure can cause premature degeneration of the auditory nerve.
In a minority of cases, degeneration of the auditory nerve may not result in a significant decline in hearing but can lead to tinnitus.
Wishing you peace and safety.

Reply Date: 2023/03/13

More Info

Hearing loss and tinnitus can be distressing conditions that significantly impact a person's quality of life. Based on your detailed description of symptoms and medical history, it appears you may be experiencing a combination of noise-induced hearing loss and possibly eustachian tube dysfunction. Let’s address your questions one by one.

1. Possible Diagnosis and Treatment Direction: Your symptoms, particularly the feeling of fullness in the right ear, reduced hearing, and subsequent tinnitus, suggest that you may be dealing with noise-induced hearing loss, especially given your proximity to loud speakers during the concert. This type of hearing loss can sometimes be temporary, but it can also lead to permanent changes in hearing if not addressed. Treatment options may include corticosteroids, which you have already tried, and other medications aimed at improving blood flow to the inner ear. If your symptoms persist, you might consider consulting an audiologist for further evaluation and possibly hearing aids or sound therapy to help manage tinnitus.

2. Balance and Hearing Loss Connection: The imbalance you feel between your ears could indeed be related to the 8000 Hz hearing loss. High-frequency hearing loss can affect how you perceive sounds, particularly in environments with background noise. This frequency range is crucial for understanding speech and detecting certain sounds. The sensation of imbalance could also be linked to eustachian tube dysfunction, where the pressure in your ears is not equalized properly, leading to discomfort and altered hearing perception.

3. Variability in Hearing Test Results: The variability in your hearing test results (10 dB vs. 30 dB) is concerning. While some variability can occur due to testing conditions, a difference of this magnitude may indicate that the hearing loss is fluctuating or that there are inconsistencies in the testing methods or equipment used. It would be advisable to have a comprehensive audiological evaluation at a facility that specializes in hearing disorders to obtain a more accurate assessment.

4. Future Hearing Loss Risk: Regarding the risk of future hearing loss, once you have experienced noise-induced hearing loss, you may be more susceptible to further damage, especially if you continue to expose your ears to loud sounds without protection. Age-related hearing loss (presbycusis) is also a natural process that occurs over time, but maintaining ear health through protective measures, such as using earplugs in loud environments, can help mitigate this risk.

In conclusion, it is essential to continue seeking medical advice and possibly consider a multidisciplinary approach involving an audiologist, an ENT specialist, and perhaps a neurologist if your symptoms persist or worsen. Regular follow-ups and monitoring of your hearing will be crucial in managing your condition effectively. Additionally, lifestyle changes, such as avoiding loud noises and managing stress, can also play a significant role in your overall ear health.

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