Aa
SNHL or...?
I have a sensorineural hearing loss in my right ear (totally deaf in left since birth). Until July it was quite manageable with a hearing aid. However in July I went to the mountains on holiday and, in a cable car ascent (2,500 ft in 3 mins) I got what I took to be barotrauma. On returning home after a further 9 days, went straight to my doctor who said, 'probably barotrauma, leave it for 4-6 weeks'. No resolution by 6 weeks (indeed progressive deafness from moderate to profound) , so returned and was referred to a specialist who said, 'pressure tests look normal, but could be barotrauma, but likely to be SNHL...come back in DECEMBER!!'
As you might guess, that did not appeal so I took in a further consultation. This guy said straight away, 'Definitely SNHL, only option is cochlear implant'.
Now here is the problem. I don't doubt the sincerity or urgency - in fact it's rather more reassuring than that of the 'come back at christmas' guy. But from none of them - NONE of them - have I had more than a pure tone audiometry and (from one) an ear pressure test. That's the full list of diagnostic assistance for this from July to October....
Is it possible to be definitive in this way without an ABR test and/or a scan?
As you might guess, that did not appeal so I took in a further consultation. This guy said straight away, 'Definitely SNHL, only option is cochlear implant'.
Now here is the problem. I don't doubt the sincerity or urgency - in fact it's rather more reassuring than that of the 'come back at christmas' guy. But from none of them - NONE of them - have I had more than a pure tone audiometry and (from one) an ear pressure test. That's the full list of diagnostic assistance for this from July to October....
Is it possible to be definitive in this way without an ABR test and/or a scan?
You are dealing with amatures. Sad...
First of all, baratruama can result in SNHL or CNHL. So the descent you described may be related. Sounds to me like you know a fair deal about the ear already, so you do have that advantage.
But this is what I would recommend.
Full battery of tests,
Air/bone pure tone testing with speech CPT 92557 ( that is a standard test and if they use that code and do not due the full procedure... they just commited insurance fraud. Not that a physician would ever do such a thing!
OAE, I would not expect to find much, but I like to use it in order to localize things.... you never know
Tympanometry, pressure check, as you already spoke of.
Ask for a Fistula check... if they stare at you with a blank look.... your a really dealing with amatures.
Why you want a fistula test, is because sometimes baratruam ends up with a slight leak around the round window. When this occurs, you get SNHL sometimes coupled with vertigo. In a lot of cases it spontaneously heals, and may have already.
An ABR, depending on the severity of your current hearing loss could be used in order to help rule out an acoustic tumor.
That said, if you are going to get a Cochlear Implant, an MRI will be done previous for that procedure, and I would not doubt that at that time they can do a MRI specifically for a tumor. They will need to inject you with gadalanium (sp), if they do not, then you just wasted a lot of time and money. Sometimes the techies do not do the injection, (because the docs do not notate it) your insurance is billed, and and the MRI is inconclusive.
Does the ENT tell you this when it happens.... Heck no.... CYA from top to bottom.
Good luck to you.
PS, a good resource is www. audiologyonline.com for ear concerns.
First of all, baratruama can result in SNHL or CNHL. So the descent you described may be related. Sounds to me like you know a fair deal about the ear already, so you do have that advantage.
But this is what I would recommend.
Full battery of tests,
Air/bone pure tone testing with speech CPT 92557 ( that is a standard test and if they use that code and do not due the full procedure... they just commited insurance fraud. Not that a physician would ever do such a thing!
OAE, I would not expect to find much, but I like to use it in order to localize things.... you never know
Tympanometry, pressure check, as you already spoke of.
Ask for a Fistula check... if they stare at you with a blank look.... your a really dealing with amatures.
Why you want a fistula test, is because sometimes baratruam ends up with a slight leak around the round window. When this occurs, you get SNHL sometimes coupled with vertigo. In a lot of cases it spontaneously heals, and may have already.
An ABR, depending on the severity of your current hearing loss could be used in order to help rule out an acoustic tumor.
That said, if you are going to get a Cochlear Implant, an MRI will be done previous for that procedure, and I would not doubt that at that time they can do a MRI specifically for a tumor. They will need to inject you with gadalanium (sp), if they do not, then you just wasted a lot of time and money. Sometimes the techies do not do the injection, (because the docs do not notate it) your insurance is billed, and and the MRI is inconclusive.
Does the ENT tell you this when it happens.... Heck no.... CYA from top to bottom.
Good luck to you.
PS, a good resource is www. audiologyonline.com for ear concerns.
Holy moly, were these ear specialists you saw?? What happened to "sudden hearing loss is a medical emergency"!?
I thought that the standard thing to do for a suspected fistula (if that's what they perhaps had in mind) was to do surgery without waiting if the hearing is unstable (as yours obviously was).
If your first "doctor" was a GP, he or she made a big mistake by not referring you to a specialist right away, especially knowing you already have such significant hearing loss and certainly don't need any more.
They should have done SOMETHING right away, not to mention more diagnostic tests, as W.A.J. pointed out.
By "pressure test" do you mean the fistula test? Although that is supposedly unreliable. My neurotologist didn't bother with it, just did the middle-ear exploration after my sudden hearing loss (which occurred when I sneezed, although it apparently wasn't a fistula after all).
Maybe the specialist thought that after six weeks, it was too late to save your hearing anyway? Who knows. But it sounds like you should have had more aggressive action taken in any case.
Nancy T.
I thought that the standard thing to do for a suspected fistula (if that's what they perhaps had in mind) was to do surgery without waiting if the hearing is unstable (as yours obviously was).
If your first "doctor" was a GP, he or she made a big mistake by not referring you to a specialist right away, especially knowing you already have such significant hearing loss and certainly don't need any more.
They should have done SOMETHING right away, not to mention more diagnostic tests, as W.A.J. pointed out.
By "pressure test" do you mean the fistula test? Although that is supposedly unreliable. My neurotologist didn't bother with it, just did the middle-ear exploration after my sudden hearing loss (which occurred when I sneezed, although it apparently wasn't a fistula after all).
Maybe the specialist thought that after six weeks, it was too late to save your hearing anyway? Who knows. But it sounds like you should have had more aggressive action taken in any case.
Nancy T.
The problem with the fistula test is not strictly about reliability.
The problem with the fistula test is that if the results are doubted then the only option is to explore. If the results are positve for a fistula, then physicians usually want to explore and repair... so either way you look at it the physician will want to perform surgery on the ATM (patient)
The problem with the fistula test is that if the results are doubted then the only option is to explore. If the results are positve for a fistula, then physicians usually want to explore and repair... so either way you look at it the physician will want to perform surgery on the ATM (patient)
God, I'm Going Through Something Similar. Who Makes These Gp's Doctors???
It Makes Me MAD. Especially When You Find Out it Should be Treated Immediately.
How Are we supposed to Know??
They Think Deafness is Fine? Fckers. Hell Just Have an Aid, the Next Patient is a Baby.... Stop Wasting Our Time. Ok... Sorry.
Noticed tonight,
Iv tried Pinching the nose, and opening the Eustachian tubes. I Hear Whooshing in the Right/Good Ear.
But Absolutely NOTHING in Left/Deafened Ear....Also the Ear I Had the stapedectomy 20 years ago. Then there is The Fact Hearing Was Fairly Poor Before and This Bloody Viral illness That Never Got Diagnosed.
Guys, Help Me out, Seeing an Proper ENT Wednesday.
I am Not a Ear, Doctor, I need to know What to ask this ENT so they don't fool me.
1) Can they Determine the Cause? i.e Conductive/Neural....What Tests?
2) Can they tell if Cochlear has been damaged, How?
2) Can they Determine if the Previous Prosthesis is Buggered/ How? Just by looking in the Ear?
3) Can they Put a New One in??
4) A Simple Prelim Audiogram was Totally Flat, isnt SSNHL usually tapered? Graph just Dropped, straight dwn.
5) why dosent this Left Tube not Open, any Significance?
I Had No Pain/Vertigo or Discharge. I was on a plane 2 weeks before it happened, and I had Viral Lymphadenopathy for 3 months...Just Dont Understand what to Believe now.
I want to make sure I don't get screwed again.
It Makes Me MAD. Especially When You Find Out it Should be Treated Immediately.
How Are we supposed to Know??
They Think Deafness is Fine? Fckers. Hell Just Have an Aid, the Next Patient is a Baby.... Stop Wasting Our Time. Ok... Sorry.
Noticed tonight,
Iv tried Pinching the nose, and opening the Eustachian tubes. I Hear Whooshing in the Right/Good Ear.
But Absolutely NOTHING in Left/Deafened Ear....Also the Ear I Had the stapedectomy 20 years ago. Then there is The Fact Hearing Was Fairly Poor Before and This Bloody Viral illness That Never Got Diagnosed.
Guys, Help Me out, Seeing an Proper ENT Wednesday.
I am Not a Ear, Doctor, I need to know What to ask this ENT so they don't fool me.
1) Can they Determine the Cause? i.e Conductive/Neural....What Tests?
2) Can they tell if Cochlear has been damaged, How?
2) Can they Determine if the Previous Prosthesis is Buggered/ How? Just by looking in the Ear?
3) Can they Put a New One in??
4) A Simple Prelim Audiogram was Totally Flat, isnt SSNHL usually tapered? Graph just Dropped, straight dwn.
5) why dosent this Left Tube not Open, any Significance?
I Had No Pain/Vertigo or Discharge. I was on a plane 2 weeks before it happened, and I had Viral Lymphadenopathy for 3 months...Just Dont Understand what to Believe now.
I want to make sure I don't get screwed again.
Good point, W.A.J. Either way, you get surgery.
The additional problem being that two surgeons can look at the same opened-up ear and one can say he sees leakage, and the other can say he doesn't! Lots of controversy about PLF.
When I first saw an ENT (a plain one), who diagnosed my hearing loss, he said he thought my sneezes didn't have anything to do with the hearing loss. WHAT!? You mean it's just a coincidence that I sneezed and at the exact same moment lost my hearing, when I never had ANY hearing problems before? He said that some doctors think you can have a membrane rupture but he didn't believe it (or didn't believe that was the case with me, not sure what he meant exactly). He said it was probably a virus.
When I got a neuro-otologist four months later, he right away suspected a fistula and operated.
Cricketer, I"m sorry you have so much hearing loss... that must stink.
Nancy
The additional problem being that two surgeons can look at the same opened-up ear and one can say he sees leakage, and the other can say he doesn't! Lots of controversy about PLF.
When I first saw an ENT (a plain one), who diagnosed my hearing loss, he said he thought my sneezes didn't have anything to do with the hearing loss. WHAT!? You mean it's just a coincidence that I sneezed and at the exact same moment lost my hearing, when I never had ANY hearing problems before? He said that some doctors think you can have a membrane rupture but he didn't believe it (or didn't believe that was the case with me, not sure what he meant exactly). He said it was probably a virus.
When I got a neuro-otologist four months later, he right away suspected a fistula and operated.
Cricketer, I"m sorry you have so much hearing loss... that must stink.
Nancy
Have an Answer?
You are reading content posted in the Ear, Nose & Throat Community
Think a loved one may be experiencing hearing loss? Here are five warning signs to watch for.
Discover the common causes of and treatments for a sore throat.
Learn about what actually causes your temperature to spike.
Find out which foods you should watch out for.
Family medicine doctor Enoch Choi, MD helps differentiate between the common cold and more threatening (bacterial) infections
Dr. Steven Park reveals 5 reasons why breathing through your nose could change your life
