Hearing Issues: Insights on Ear Discomfort and Treatment Options

Hearing consultation

Hello Dr.
Chi,
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, as if they were muffled.

Over the past two months, I have consulted several doctors.
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) 4.
Depyretin 500mg (Acetaminophen, Scanol) (twice daily).

Due to a lack of improvement and scheduling conflicts, I consulted a second doctor who suggested steroid treatment and prescribed Prednisolone 5mg (two tablets twice daily for the first 7 days, then one tablet twice daily for the next 3 days) and methylcobalamin (Ch3-B12) (twice daily).
Upon follow-up, the doctor advised against continuing steroids and switched me to Betahistine mesylate 12mg (two tablets twice daily) for a month, while continuing methylcobalamin.
After finishing the medication, during my next visit, the doctor indicated that he could only prescribe the same medications with no other options available.

Feeling disheartened, I sought opinions from different hospitals.
The third doctor also mentioned that he could only prescribe similar medications but suggested that the ear fullness and imbalance might be related to Eustachian tube issues, so he prescribed Allegra 60mg (twice daily) for me to try.
I felt a slight improvement in ear fullness (though it still fluctuated), but the imbalance between the left and right sound channels persisted.

My hearing tests at different hospitals showed a decline at 8000Hz in my right ear, with results varying from 10 dB to 25-30 dB.
I also underwent 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 sounds quieter, especially when the sound source is from the left) 3.
Tinnitus in my right ear started about a month later (intermittent).

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 options to try?
2.
Is the imbalance between my ears related to the 8000Hz hearing loss? (I found that 8000Hz is a very high frequency, which I rarely 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 hearing loss in the future, or is it likely to age more quickly?
I apologize for the many questions and the lengthy description.
Thank you for your assistance!

K, 30~39 year old female. Ask Date: 2023/03/16

Dr. Ji Zhaoyun reply Otolaryngology

Hello, based on your description, it is most likely that the sudden hearing nerve damage is caused by noise exposure.
However, we cannot rule out the following causes: 1) Eustachian tube dysfunction: This can occur not only during activities like flying, climbing, or diving, but also when forcefully blowing the nose or bending over.
2) Sudden sensorineural hearing loss.
3) Otitis media: a) Acute otitis media: Often occurs alongside upper respiratory infections (colds) and sinusitis, and in severe cases, the ear may discharge fluid or pus.
b) Chronic otitis media with acute exacerbation: This usually occurs when there is a pre-existing perforation in the eardrum, which can become inflamed due to unclean water or improper ear cleaning.
All of the above conditions can be appropriately treated with medication through medical consultation.
If the sudden hearing nerve damage has persisted for more than two months and standard treatments have been administered, there are other medical options to consider, such as hyperbaric oxygen therapy, acupuncture, intratympanic injections, and tinnitus masking hearing aids.
However, the actual treatment options should be discussed with a healthcare provider.
It is advisable to bring your previous examination reports for the physician's reference.
Wishing you peace and good health.
Ministry of Health and Welfare Taichung Hospital.

Reply Date: 2023/03/16

More Info

Hello! Thank you for sharing your detailed experience regarding your ear discomfort and hearing issues. It sounds like you’ve been through quite a journey with your symptoms, and I appreciate your thoroughness in describing your situation. Let’s break down your questions and concerns systematically.

1. Understanding Your Symptoms
Based on your description, your symptoms seem to align with a few potential conditions. The sensation of fullness or pressure in the ear, along with the perception of muffled hearing, could indicate Eustachian tube dysfunction. This condition occurs when the tube that connects the middle ear to the back of the nose fails to open properly, leading to a feeling of pressure and imbalance in hearing. The fact that you experienced these symptoms after exposure to loud music suggests that noise exposure could have contributed to your current situation, possibly leading to temporary threshold shifts in hearing.

Additionally, the fluctuation in your symptoms, such as the intermittent ear ringing (tinnitus), could also be related to noise-induced hearing loss, particularly since you noted a decline in high-frequency hearing (8000 Hz). This frequency is often affected by exposure to loud sounds, and it’s not uncommon for individuals who have experienced such exposure to notice changes in their hearing.

2. Treatment Directions
In terms of treatment, since you have already tried several medications, including steroids and antihistamines, it may be beneficial to explore other avenues. If Eustachian tube dysfunction is suspected, treatments may include nasal decongestants, nasal corticosteroids, or even techniques to equalize ear pressure (like the Valsalva maneuver). If noise-induced hearing loss is confirmed, while there is no specific medication to reverse the damage, hearing aids or sound therapy might be beneficial in managing your symptoms.

3. Left vs. Right Ear Imbalance
The imbalance you’re experiencing between your ears could indeed be related to the high-frequency hearing loss in your right ear. High-frequency sounds are crucial for understanding speech, especially consonants, and if one ear is less sensitive to these frequencies, it can create a perception of imbalance. This is particularly noticeable when sounds come from the left side, as your right ear may not pick them up as well.

4. Variability in Hearing Tests
Regarding the variability in your hearing test results (10 dB vs. 30 dB), it’s important to note that slight variations can occur due to several factors, including the testing environment, the equipment used, and even your physical state on the day of testing. However, significant discrepancies should be investigated further, as they may indicate a need for more consistent testing conditions or a more thorough evaluation.

5. Future Hearing Health
As for your concern about future hearing loss or aging, individuals who have experienced noise-induced hearing loss may be at a higher risk for further deterioration, especially if they continue to expose themselves to loud environments. It’s essential to protect your ears in the future by using earplugs in loud settings and avoiding prolonged exposure to high volumes.

Conclusion
In summary, your symptoms could be attributed to Eustachian tube dysfunction and potential noise-induced hearing loss. It’s advisable to continue working closely with an ear, nose, and throat (ENT) specialist who can provide tailored treatment options based on your specific situation. Regular follow-ups and hearing assessments will be crucial in monitoring your condition and making necessary adjustments to your management plan.
If you have further questions or need clarification on any points, please feel free to ask. Your hearing health is important, and it’s great that you’re taking proactive steps to address these issues.

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Hello, the issues you mentioned could be due to: 1) Eustachian tube dysfunction: This is the most common cause and can occur not only during flying, climbing, or diving, but also when forcefully blowing your nose or bending over. 2) Sudden sensorineural hearing loss (commonly ref...

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