Dr. Shyam Kalyan. N
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have a normal MRI and a normal tympanogram. Am I losing hearing based on both the test results?
Hello,
Welcome to icliniq.com.
No, you are not (attachment removed to protect patient identity). But I would like to see the graph of pure tone audiogram to pick out if there is any early hearing loss. Kindly upload the graph of your hearing test.
Patient's Query
Hello doctor,
Please note as you can notice I have noise-induced hearing loss in my left ear, which I have managed to maintain at the same level for the past four years with the use of protective earplugs. This is after years of loud music exposure without being careful or using any protection. This year's test result is because after four years I accidentally (and stupidly) went to an event without my earplugs that also, unfortunately, was very loud. I noticed immediately that my left ear has got worse and it was confirmed via the hearing test. I will make sure I never forget my protective earplugs again. My right ear does all the work anyway and I see this slight dip in the right ear in this test even though the ranges are in the normal hearing range. It has made me slightly fearful, is this a cause of concern? Or just make sure to never forget my earplugs again. Should I keep it at the same level as it is now?
Hello,
Welcome back to icliniq.com.
I went through both audiometry reports. The one five years back seems worse than this year when you compare it to the left ear. I say because the nerve conduction seems better in that ear currently than during the last one. But this variation can be due to the doctor variation or audiometer calibration difference. But on top of the nerve-related loss (which most probably is noise-induced), there is a good conductive component. Have you been having any other symptoms with the left ear? Like block, muffling sound, fullness, wax, ear discharge, pain, giddiness, nose block, throat pain, etc.? These symptoms can point to a conductive problem which will have to be ascertained by visiting an ENT. The ENT will check the inside of the ear using an endoscope or otoscope and make sure everything is fine. I am saying this because a conductive component of hearing loss can be treated. So if you have felt any such symptoms do let us know. When we talk of the right ear, which is hearing within normal limits and is your only performing ear, there seems to be a slight dip in 4000 Hz which indicates a noise-induced hearing loss. Such a dip is not present in the previous report. While you have had only a single extreme exposure, I would say it is more of an acoustic trauma than noise-induced hearing loss. Acoustic trauma is more of an acute episode and with rest and precautions, the nerve fibers should get back in shape. While this is not always true, we can expect some improvement with regard to that dip. When you repeat the audiogram after two months we can ascertain whether there has been any improvement. Precautions, you seem to know. Some even use active noise isolators which remove sounds higher than certain intensities while increasing sounds of lower intensities. It is prudent to install a decibel meter on your laptop (device) and keep looking into it once in a while during your performances. If dB increases beyond certain intensities you can reduce the volume or increase your level in the plug. Have a healthy diet. Smoking can accentuate hearing loss. Alcohol can subdue your responses to loud sounds and you may not feel like reducing the volume. Marijuana and acid can be equally dangerous while thinking from a noise point of view. I suggest you start with good neurotropic vitamins taken twice daily for two weeks and thereafter once daily for a couple of months. I just want to rule out any drum or middle ear-related problem that can cause a conductive component of your hearing loss. Always get your hearing tests done from the best place as results vary from place to place. Do revert back to me with details. Ultimately the hearing sensitivity in your right ear is within normal limits. So not to worry about it much. Till 25 dB it is normal. It is unlikely that in noise-induced hearing loss, one ear gets more affected than the other. Unless you do something that can cause a differential output of sound to each ear.
I hope this has helped you. Thank you.
Patient's Query
Hello doctor,
I have uploaded it again with the correct naming so you can double-check if possible, please. The recent one is in black and white. The 4k dip is in the older one (which I assume could have been me not paying attention to that frequency properly during the test - hence why this dip is not there in the recent one). Sorry for my late response to you. My main concern that I want you to reassure me of is my right ear, as you can see in my right ear some frequencies are still the same as they were 10 years back, but there is a tiny dip of +5 / +10 compared to it. Is this a cause for concern even if the recent audiogram of the right ear is still in the normal hearing range? Well let me give you my full history, maybe that will advise you further. This all started back in 13 years back when I was listening to very loud music with my headphones – which I did not even perceive as loud back then. It is crazy now that I think how loud it was. I damaged my left ear one night because I could feel my left ear hurt, literally like something stinging inside (hair cells or auditory nerve, not sure which). That is when very quiet tinnitus started in my left ear. I was only 17. Note that it was only my left ear that had the painful experience during that night. I went to an ENT he cleaned my ears, did not give me any hearing test, and treated it like it was some form of ear infection with a nasal spray and some pills. The tinnitus remained, obviously I had no idea I was suffering from hearing loss at the time because my right ear was still totally fine and made up for any loss I had in my left for a very long time, and I never noticed any hearing loss overall anyway. After another 1-2 misdiagnoses and no hearing tests, I finally have an ENT that does a hearing test on me after he asked me to do an MRI (which came back normal) and he tells me I have hearing loss in my left ear, the tinnitus was not as loud as it is now, and neither was the damage. Because I was not given the diagnosis of hearing loss because of loud noise I continued to play loud music without protection for longer than I should have. I decided to continue, being careful, listening to music at sensible volumes, and always wearing earplugs at events when attending or DJ’ing, and I got totally used to the tinnitus and I could not notice any new symptoms. I was not even concerned about my ears at all, the entire situation has stabilized. It took me two days to notice when I was talking loudly, my left ear perceived the noise a bit differently, like a little squeak, the blocked sensation, etc as well. I went to the ENT weeks after this event, he did the tympanogram (normal – attached) and concluded that my left ear got worse. He looked at my nose and then my ears with an otoscope also. Said it was normal. Doctor, please note I have never had any ear infections, no discharge, no blocked nose, no hurting throat. Occasionally I would get vertigo but even that my brain got used to it and it never occurs properly. I have had two MRIs done 10 years back, both normal (one for this and one for a different matter altogether). I do not care for my left ear because it is a bit of a lose cause for me now, it seems that even if I wear ear protection, there is a chance it could get worse, it is just a matter of trying to limit it as much as possible. I will continue to look after my ears as best I could but I do not plan to quit my music career, only if my right ear would ever reach moderate hearing loss. I am trying my best for that not to happen with extra care now and to make sure I never forget my earplugs ever again. I have attached my latest tympanogram and another test I had when I was there nine years back, that might indicate something for you (if at all?). Do you think I have hair cell loss or is it auditory nerve damage? Can you tell from what I have provided you? Maybe this was the result of the loud event exposure that I told you about, I do not know. Anyway, I do not plan to quit unless my right ear reaches moderate hearing loss. That's when it is too much of a scare for me and I will have to quit for my own hearing sake in my right ear. I will try my best if it does not reach that stage and never forget my earplugs again. Also, I occasionally smoke marijuana, how does it have a negative effect? Actually no, at 4k both are at the same at 15 in both. I think you are confused with 6k. 10 years back 6k shows 20 yet recently it shows 10. I do not know why that is, I believe maybe I was not paying attention properly during the test during that frequency. Please can you re-evaluate everything I uploaded for you originally and the new files I sent?
Hello,
Welcome back to icliniq.com.
I am sure about what I told you. I checked. Summarily your right ear is hearing within normal and whatever dip you see cannot lead to any conclusion. Since you are in this profession you are advised to regularly have PTA every six months and review with me. Please upload your tympanometry reports.
I hope this ha helped you. Thank you.
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Otolaryngology (E.N.T)
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