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Suggest Treatment For Muffled Hearing While Having Bell's Palsy
Question: Hi, I had my second Stapendectomy January 12 2016 in my right ear after my first one (June 12 2014 ) FELL Out , five days after my second I developed complete Bells Palsy on my right side of my face witch has only recovered 85 percent, (treated with Prednisone) yet my hearing tested over 85 percent normal, on the evening of May 6th i felt a poping sensation, the next morning the 7th i was 100 percent deaf in my right ear, and confirmed on that Friday with hearing test, doctor said i had worst luck he has ever seen and now suffering with SSNHL, He started me on Prednisone again, a week later i requested intratympanic steroid injections, i had my third shot today, also requested to be put on Valacyclovir and took that for 7 days after my first shot. I have constant Tinnitus, Question is has anyone experienced this and if so are there any early signs if your hearing came back, i seem to hear a deep ringing other than the Tinnitus every now and then or am i just suffering from wishful thinking ! needless to say this has been difficult
Brief Answer:
Recovery of hearing is unpredictable.
Detailed Answer:
Hi,
Thank you for your query.
1. Due to the inherent nature of stapes surgery, a small percentage of cases develop a dead ear. Usually the patient is advised against stapes surgery on the second ear, however many patients successfully get this done on the second ear. Assuming that this is the same surgeon, it was not expected.
2. Stapes surgery bypasses the ossicular fixation and the resultant conductive hearing loss for a few years. After that, if the otosclerosis progresses into the cochlea, the patient develops sensorineural hearing loss and has to use hearing aids.
3. A dead ear after a stapes surgery is usually permanent. In SSNHL from unknown causes, there is always the possibility of some spontaneous recovery, however in such a situation, it is unlikely. Upload any audiograms that you have.
4. Your treatment is on the right track. The facial palsy should recover. If not, a second look surgery should be done after high resolution HRCT scanning of the Temporal bones, to check if there is pressure or contact of the prosthesis on an exposed nerve .
5. Tinnitus may be treated later with (Tinnex) Caroverine Injection and Capsules.
6. Rehabilitation includes the option of no treatment.
a. Hearing aids are difficult to use in Single Sided Deafness (SSD) as one ear is normal and the other has profound hearing loss if the condition is permanent. CROS (Contralateral Routing of Signals) hearing aids may help.
b. Bone anchored hearing aids (BAHA) is an option. Traditional BAHA devices use an external Titanium Abutment or Magnetic Implant . These include Cochlear, Oticon and Medtronic (Sophono / Otomag).
7. You may follow up with your reports.
I hope that I have answered your queries. If you have any further questions, I will be available to answer them.
Regards.
Recovery of hearing is unpredictable.
Detailed Answer:
Hi,
Thank you for your query.
1. Due to the inherent nature of stapes surgery, a small percentage of cases develop a dead ear. Usually the patient is advised against stapes surgery on the second ear, however many patients successfully get this done on the second ear. Assuming that this is the same surgeon, it was not expected.
2. Stapes surgery bypasses the ossicular fixation and the resultant conductive hearing loss for a few years. After that, if the otosclerosis progresses into the cochlea, the patient develops sensorineural hearing loss and has to use hearing aids.
3. A dead ear after a stapes surgery is usually permanent. In SSNHL from unknown causes, there is always the possibility of some spontaneous recovery, however in such a situation, it is unlikely. Upload any audiograms that you have.
4. Your treatment is on the right track. The facial palsy should recover. If not, a second look surgery should be done after high resolution HRCT scanning of the Temporal bones, to check if there is pressure or contact of the prosthesis on an exposed nerve .
5. Tinnitus may be treated later with (Tinnex) Caroverine Injection and Capsules.
6. Rehabilitation includes the option of no treatment.
a. Hearing aids are difficult to use in Single Sided Deafness (SSD) as one ear is normal and the other has profound hearing loss if the condition is permanent. CROS (Contralateral Routing of Signals) hearing aids may help.
b. Bone anchored hearing aids (BAHA) is an option. Traditional BAHA devices use an external Titanium Abutment or Magnetic Implant . These include Cochlear, Oticon and Medtronic (Sophono / Otomag).
7. You may follow up with your reports.
I hope that I have answered your queries. If you have any further questions, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Prasad
Thank you for the professional reply, I want to clarify that i had a stapendectomey on the same ear twice, my left ear has almost perfect hearing, the doctor di dthe first stape 2 years ago, then in january this year my hearing had failed and when he did surgery this time he said that the previous stape had fallen out, after the first time i had no side affects and had 85 % hearing after surgery, this time i had the Bells Palsy after 5 days but din not get SSNHL till almost 4 months later, does this still apply to your position that stape recipients tend not to recover and if so why not after the first stape surgery? and why now after the second and is their a coincidence with the Bells Palsy and SSNHL? I had 20% hearing before the second stape , i would give anything to have that back! and should have the side effects been talked about prior to second stape? no one ever told me about these side effects, is that because Bells and SSNHL are so rare? and why is it i cant find anyone that has had both conditions happen to them, along with a stape falling out! all i hear is its so rare ! to get one never the less both side affects? thanks
Brief Answer:
This situation is not that rare.
Detailed Answer:
Hi,
Thank you for writing back.
1. This situation is not that rare. It is under-reported.
2. Unilateral otosclerosis is more often seen in male patients.
3. The first result was good. Revision stapedectomy always carries a greater risk of a dead ear (2 to 5%) and this is always informed to the patients before revision surgery.
4. The reference to Bell's Palsy is a misnomer. Bell's Palsy refers to an unknown temporary facial nerve paralysis XXXXXXX to exposure to cold. In your case this is s facial nerve palsy under investigation. It should recover after treatment.
5. The delayed facial palsy and the delayed loss of hearing point to a displaced prosthesis. Upload the latest audiogram . Did you have any vertigo?
6. If this ear does not recover, a BAHA device will help.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
This situation is not that rare.
Detailed Answer:
Hi,
Thank you for writing back.
1. This situation is not that rare. It is under-reported.
2. Unilateral otosclerosis is more often seen in male patients.
3. The first result was good. Revision stapedectomy always carries a greater risk of a dead ear (2 to 5%) and this is always informed to the patients before revision surgery.
4. The reference to Bell's Palsy is a misnomer. Bell's Palsy refers to an unknown temporary facial nerve paralysis XXXXXXX to exposure to cold. In your case this is s facial nerve palsy under investigation. It should recover after treatment.
5. The delayed facial palsy and the delayed loss of hearing point to a displaced prosthesis. Upload the latest audiogram . Did you have any vertigo?
6. If this ear does not recover, a BAHA device will help.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you again for your response.
1. My facial palsy has recovered approximately 85% after approx 5 months, i still have no eyebrow movement and 90 % smile ability on one side do you think this will recover more or is there a possibility this is permanent also?
2. You mentioned "displaced prosthesis" are you referencing the 1st Stape that fell out or the 2nd Stape being place incorrectly suring surgery?
3. After first Stape i recover 3 days with some dizziness, after second Stape 7 days with very bad balance issues, was in bed 7 days could not stand up. I still suffer from some imbalance when i first wake up and if i move by head quick, my first step is not the same as before, seems weaker.
4. I dont have the audiogram's i have requested them .
5. I had my 4th Intratympanic Steroid injection this tuesday, doctor said that was last one, now he has scheduled me to have an MRI and after the results he is going to call me. So i'm on no medication now, i feel like we should try more medications, he indicates that swelling caused my eighth cranial nerve and i don't understand why we don't keep trying to reduce the swelling, everything i read seem's to imply that the nerve still might not be dead, just frustrated!
1. My facial palsy has recovered approximately 85% after approx 5 months, i still have no eyebrow movement and 90 % smile ability on one side do you think this will recover more or is there a possibility this is permanent also?
2. You mentioned "displaced prosthesis" are you referencing the 1st Stape that fell out or the 2nd Stape being place incorrectly suring surgery?
3. After first Stape i recover 3 days with some dizziness, after second Stape 7 days with very bad balance issues, was in bed 7 days could not stand up. I still suffer from some imbalance when i first wake up and if i move by head quick, my first step is not the same as before, seems weaker.
4. I dont have the audiogram's i have requested them .
5. I had my 4th Intratympanic Steroid injection this tuesday, doctor said that was last one, now he has scheduled me to have an MRI and after the results he is going to call me. So i'm on no medication now, i feel like we should try more medications, he indicates that swelling caused my eighth cranial nerve and i don't understand why we don't keep trying to reduce the swelling, everything i read seem's to imply that the nerve still might not be dead, just frustrated!
Brief Answer:
Details as discussed below :
Detailed Answer:
Hi,
Thank you for writing back.
1. This is the normal rate of recovery in facial nerve paralysis. NCS ( Nerve Conduction Studies ), EMG ( Electromyography ) and ENoG ( Electroneuronography ) also help predict recovery when these are done in the initial stages. There is no sure way of predicting recovery, however in your case this should take a year.
2. By displaced prosthesis I am referring to the second one. Check the operative notes for details.
3. Severe vertigo after stapes surgery is an indicator of impending hearing loss.
4. Get an HRCT Temporal Bones done along with the MRI. The prosthesis will not be visible on MRI but may show up on the CT depending upon the type and material of the prosthesis. Get details from your surgeon. Swelling of the eighth nerve, though not expected here, will show up on the MRI. The need for re-exploration can be decided based on the clinical examination, scans and audiograms.
5. Prognosis for recovery in such cases us poor, however further treatment should include HBOT (Hyperbaric Oxygen Therapy ). Did you get a BAHA device trial?
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Details as discussed below :
Detailed Answer:
Hi,
Thank you for writing back.
1. This is the normal rate of recovery in facial nerve paralysis. NCS ( Nerve Conduction Studies ), EMG ( Electromyography ) and ENoG ( Electroneuronography ) also help predict recovery when these are done in the initial stages. There is no sure way of predicting recovery, however in your case this should take a year.
2. By displaced prosthesis I am referring to the second one. Check the operative notes for details.
3. Severe vertigo after stapes surgery is an indicator of impending hearing loss.
4. Get an HRCT Temporal Bones done along with the MRI. The prosthesis will not be visible on MRI but may show up on the CT depending upon the type and material of the prosthesis. Get details from your surgeon. Swelling of the eighth nerve, though not expected here, will show up on the MRI. The need for re-exploration can be decided based on the clinical examination, scans and audiograms.
5. Prognosis for recovery in such cases us poor, however further treatment should include HBOT (Hyperbaric Oxygen Therapy ). Did you get a BAHA device trial?
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank You Again, Just a couple more clarifications
1. "displaced prosthesis" if this is possible how is it i had hearing for approx four months ? do you think the Stape has again failed possibly causing this dead ear?
2. Why does the 7 days of vertigo after surgery indicate impending hearing loss?
3. Why do you not think the 8th nerve is not swelled? I thought all the treatment i was getting was to reduce the swelling and save the nerve from dying? if not the 8th nerve what caused this ?
Thank You
1. "displaced prosthesis" if this is possible how is it i had hearing for approx four months ? do you think the Stape has again failed possibly causing this dead ear?
2. Why does the 7 days of vertigo after surgery indicate impending hearing loss?
3. Why do you not think the 8th nerve is not swelled? I thought all the treatment i was getting was to reduce the swelling and save the nerve from dying? if not the 8th nerve what caused this ?
Thank You
Brief Answer:
Details as discussed below:
Detailed Answer:
Hi,
Thank you for writing back.
1. There can be a umber of reasons for this. For example, a partially displaced prosthesis can come in contact with the facial nerve or the nerve may have come in contact with an instrument. There can be loosening of the prosthesis, necrosis of the incus, perilymph leaks and so on.
2. Vertigo indicates stimulation of the labyrinth or a perilymph fistula.
3. The damage is expected in the cochlea. Damage to the eighth nerve will be an additional problem, if any. There can always be a coincidence of multiple unrelated conditions in medicine. After investigations, this can be narrowed down.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Details as discussed below:
Detailed Answer:
Hi,
Thank you for writing back.
1. There can be a umber of reasons for this. For example, a partially displaced prosthesis can come in contact with the facial nerve or the nerve may have come in contact with an instrument. There can be loosening of the prosthesis, necrosis of the incus, perilymph leaks and so on.
2. Vertigo indicates stimulation of the labyrinth or a perilymph fistula.
3. The damage is expected in the cochlea. Damage to the eighth nerve will be an additional problem, if any. There can always be a coincidence of multiple unrelated conditions in medicine. After investigations, this can be narrowed down.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank You again for your reply
Last question or best opinion, its been 35 days since my ear went dead, the doctor has stopped any treatment and i'm now awaiting my MRI in two weeks, at this point is the 8th cranial nerve now dead if in fact it was swelling that caused this? if not what is the percentage in you opinion that i will ever get any of my hearing back? also the Tinnitus is pretty regular , and from time to time I get a ringing that is more pronounced than normal , its a long deep ring that last for 30 seconds or so
Thank you
Hello, I have uploaded some of the files from procedure.
Last question or best opinion, its been 35 days since my ear went dead, the doctor has stopped any treatment and i'm now awaiting my MRI in two weeks, at this point is the 8th cranial nerve now dead if in fact it was swelling that caused this? if not what is the percentage in you opinion that i will ever get any of my hearing back? also the Tinnitus is pretty regular , and from time to time I get a ringing that is more pronounced than normal , its a long deep ring that last for 30 seconds or so
Thank you
Hello, I have uploaded some of the files from procedure.
Brief Answer:
Recovery of a dead ear is unlikely.
Detailed Answer:
Hi,
Thank you for your query.
1. Spontaneous recovery in sudden sensorineural hearing loss is most likely in the first 2 to 3 weeks. After this it unlikely without treatment. Up to 50 % people can have some spontaneous improvement , however, this applies to normal inner ears, not operated cases.
2. The MRI Scan is expected to be normal.
3. The operative notes are perfectly fine.
4. The fluctuating tinnitus needs observation.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Recovery of a dead ear is unlikely.
Detailed Answer:
Hi,
Thank you for your query.
1. Spontaneous recovery in sudden sensorineural hearing loss is most likely in the first 2 to 3 weeks. After this it unlikely without treatment. Up to 50 % people can have some spontaneous improvement , however, this applies to normal inner ears, not operated cases.
2. The MRI Scan is expected to be normal.
3. The operative notes are perfectly fine.
4. The fluctuating tinnitus needs observation.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello again,
So based on the note's the doctor mentions the condition of the ear after the first stape had fallen out, does this in any way make it more likely that i would end up with the dead ear, also based on the notes and what we have discussed, what is your opinion if you can give one most likely caused the dead ear and why are you certain the the MRI will be negative, do you not think that a virus had any roll in this?
Thank you
So based on the note's the doctor mentions the condition of the ear after the first stape had fallen out, does this in any way make it more likely that i would end up with the dead ear, also based on the notes and what we have discussed, what is your opinion if you can give one most likely caused the dead ear and why are you certain the the MRI will be negative, do you not think that a virus had any roll in this?
Thank you
Brief Answer:
Details discussed below:
Detailed Answer:
Hi,
Thank you for writing back.
1. From the notes it appears unlikely that any complications were expected. As mentioned before, revision stapes surgery carries a higher risk of complications.
2. The most likely causes are a displaced prosthesis, necrosis long process of the incus and a perilymph fistula.
3. The MRI is expected to be normal as there does not seem to be any active infection (including viral infection ).
4. Upload any audiograms, if available.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Details discussed below:
Detailed Answer:
Hi,
Thank you for writing back.
1. From the notes it appears unlikely that any complications were expected. As mentioned before, revision stapes surgery carries a higher risk of complications.
2. The most likely causes are a displaced prosthesis, necrosis long process of the incus and a perilymph fistula.
3. The MRI is expected to be normal as there does not seem to be any active infection (including viral infection ).
4. Upload any audiograms, if available.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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