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What Causes Hearing Loss, Ringing In Ear And Anxiety Post A Pierced Eardrum?
Question: I had fluid in my ear and was losing hearing from it over the last couple of weeks. Doctor gave me Ciprodex for 8 days and my ear was not improving, but got worse - itchy feeling, full of fluid, build-up. Doctor then gave me Azithromycin 250 mg for 5 days and referred me to ENT. On 5th day of finishing this last antibiotic, my right ear was still clogged and felt like a golf bolf was stuck in there plus I had lost hearing (all right ear). ENT pierced my eardrum, suctioned out the fluid and passed air through it. This procedure was done 3 days ago on XXXXXXX 26, 2016. There was no change in my sensation and hearing felt worse. He conducted hearing test immediately after the procedure and these tests showed significant hearing loss in right ear (down to the 50 dcbl mark) compared to left ear which was normal/perfect. Air pressure test showed right ear graph flat-lined while left ear normal. I have severe high-pitched ringing in my right ear following the procedure which I did not have before, and deafness in my right ear plus it feels and sounds like I am submerged under water on the right side of my head when I talk. I can't hear sounds or others or myself talk except through the left ear. It's been 3 days since the ENT procedure and I'm still ringing in the right ear and feeling deaf. When I sleep I feel and hear pulsating "whoosh" vibrating through my right ear (pulsating matching rate of my heart beat). I have been having very high anxiety over the last 3 days over this and feeling of complete desperation and am overwhelmed. I am unable to function, focus, concentrate, feel scared, world around me feels different. This sudden loss of hearing is not what I was prepared for and am not adjusted to. I've had perfect hearing all my life - played piano for 18 years, highly active, very good at hand-eye coordination sports like tennis, basketball, and avid cyclist, etc. Since the ENT procedure I have stopped all physical activity and am afraid of the impact on my health and wellbeing, plus I am missing work. This is all having a great impact on my life, whereas, before I was extremely a motivated and high performing individual. I was unable to go to the office these last 3 days in light of the anxiety, ringing, deafness, etc. for which I went to the emergency at the hospital to see if they could help me. They tried to contact the ENT and found out he was not going to follow up with me until March! Emergency doctor then insisted he see me sooner and got an appointment for me next Tuesday on February 2nd. Even though I didn't want to go back to that ENT since he just did a procedure on me without giving me options or talking to me to tell me what he was doing and why, the Emergency doctor recommended I keep the ENT appointment since that ENT had done the procedure. Is this hearing loss permanent? What can be done as a next step? What questions should I ask the ENT in follow up? Note - there were no tubes put in my ear after the ear drum was cut by the ENT. I was just given Pulmicort prescription to use with NeilMed nasal rinse.
Brief Answer:
There is no cause for worry.
Detailed Answer:
Hi,
Thank you for your query.
1. The appearance of the tinnitus and persistent hearing loss means that there is still a large amount of fluid still trapped behind the ear drum. I must emphasize that this is common and will settle down. This is disconcerting for most people. Remember that this is common and not a cause for worry.
2. It is surprising that the hearing test and the impedance tests were done after the procedure. Ideally there should be a baseline recording. Upload any test results that you may have. Other wise enquire if the 50 dB hearing loss is conductive or not. If it is conductive, it will recover and the tinnitus, hearing loss, pressure and discomfort will settle down with medication. The impedance graph is expected to be flat with either fluid or a perforation.
3. A trial with medication should include also include anti-allergic , mucolytic , anti-inflammatory medication, short term decongestant nasal drops, steam inhalation and auto-inflation exercises in addition to the medications prescribed to you. This should be done before a procedure.
4. The myringotomy procedure is a very delicate and common procedure performed millions of times a year worldwide and hence no major complication is expected. It is known to cause a temporary exacerbation of symptoms in some people and hence this is usually explained to the patient in advance. This may not be due to the procedure itself, but due to decompression, active underlying process and so on.
5. A ventilation tube would have been ideal. The incision may close soon and negate the beneficial effect of the procedure.
6. A conductive hearing loss should be temporary and you should insist on medication till you can follow up.
I hope that I have answered your queries. If you have any further questions, I will be available to answer them.
Regards.
There is no cause for worry.
Detailed Answer:
Hi,
Thank you for your query.
1. The appearance of the tinnitus and persistent hearing loss means that there is still a large amount of fluid still trapped behind the ear drum. I must emphasize that this is common and will settle down. This is disconcerting for most people. Remember that this is common and not a cause for worry.
2. It is surprising that the hearing test and the impedance tests were done after the procedure. Ideally there should be a baseline recording. Upload any test results that you may have. Other wise enquire if the 50 dB hearing loss is conductive or not. If it is conductive, it will recover and the tinnitus, hearing loss, pressure and discomfort will settle down with medication. The impedance graph is expected to be flat with either fluid or a perforation.
3. A trial with medication should include also include anti-allergic , mucolytic , anti-inflammatory medication, short term decongestant nasal drops, steam inhalation and auto-inflation exercises in addition to the medications prescribed to you. This should be done before a procedure.
4. The myringotomy procedure is a very delicate and common procedure performed millions of times a year worldwide and hence no major complication is expected. It is known to cause a temporary exacerbation of symptoms in some people and hence this is usually explained to the patient in advance. This may not be due to the procedure itself, but due to decompression, active underlying process and so on.
5. A ventilation tube would have been ideal. The incision may close soon and negate the beneficial effect of the procedure.
6. A conductive hearing loss should be temporary and you should insist on medication till you can follow up.
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. Chakravarthy Mazumdar
Dear Dr. XXXXXXX Bhatti,
Thank you for your timely and comprehensive response. As you can understand, I am in a great sense of worry that I may have permanent hearing loss. I also wondered why the hearing test was not done before the ENT procedure. I also asked the ENT if the fluid was all removed and he answered yes in the affirmative. I had gone to the emergency next day and it was confirmed there that they also did not see anymore fluid behind the broken ear drum. Neither was the ear red inside, so no sign of infection which could mean the antibiotic worked. Before piercing the ear drum, the ENT used a tuning fork and I heard all the sound in my right/affected ear. He said that was a good sign indicating conductive hearing loss due to the fluid. He then proceeded to pierce ear drum. The ENT who had done the eardrum piercing procedure ordered a CAT Scan after he saw the hearing test results showing significant hearing loss. He kept asking if there was family history of hearing loss at childhood - which I assured him that there was not. I had extra sensitive hearing all my life so much so that I could hear the neighbour's tv in a house next door. The 3rd point you made in your answer makes sense - I believe the GP physician was trying to administer those pre-operative methods. I guess I am very concerned whether the Myringtonomy was necessary and if there was another way the fluid from middle ear could have been removed. How come I didn't feel better after the procedure but worse? These are my concerns now, especially the ringing in my right ear that was not there before and a blocked yet hollow feeling on right side of my head where I cannot hear anything. Do you know if I can regain my hearing and if this tinnitus can stop? Should I ask another ENT to help repair the pierced ear drum and will this make a difference? I am seeing the ENT who did this procedure on Tuesday February 2nd. Should I ask him about why tubes were not placed and is it too late or necessary to add them now? What kind of medication are you suggesting that I ask for until the follow up?
Thank you kindly for your help and expertise. Best regards, XXXX
Further to my last follow-up reply/question, I forgot to let you know that the ENT determined I had mixed hearing loss following the Myringtonomy procedure and hearing test results. Hence the CAT Scan. I still don't understand how I can have sudden hearing loss when I could hear just fine and was healthy at Christmas and early January!
Thank you for your timely and comprehensive response. As you can understand, I am in a great sense of worry that I may have permanent hearing loss. I also wondered why the hearing test was not done before the ENT procedure. I also asked the ENT if the fluid was all removed and he answered yes in the affirmative. I had gone to the emergency next day and it was confirmed there that they also did not see anymore fluid behind the broken ear drum. Neither was the ear red inside, so no sign of infection which could mean the antibiotic worked. Before piercing the ear drum, the ENT used a tuning fork and I heard all the sound in my right/affected ear. He said that was a good sign indicating conductive hearing loss due to the fluid. He then proceeded to pierce ear drum. The ENT who had done the eardrum piercing procedure ordered a CAT Scan after he saw the hearing test results showing significant hearing loss. He kept asking if there was family history of hearing loss at childhood - which I assured him that there was not. I had extra sensitive hearing all my life so much so that I could hear the neighbour's tv in a house next door. The 3rd point you made in your answer makes sense - I believe the GP physician was trying to administer those pre-operative methods. I guess I am very concerned whether the Myringtonomy was necessary and if there was another way the fluid from middle ear could have been removed. How come I didn't feel better after the procedure but worse? These are my concerns now, especially the ringing in my right ear that was not there before and a blocked yet hollow feeling on right side of my head where I cannot hear anything. Do you know if I can regain my hearing and if this tinnitus can stop? Should I ask another ENT to help repair the pierced ear drum and will this make a difference? I am seeing the ENT who did this procedure on Tuesday February 2nd. Should I ask him about why tubes were not placed and is it too late or necessary to add them now? What kind of medication are you suggesting that I ask for until the follow up?
Thank you kindly for your help and expertise. Best regards, XXXX
Further to my last follow-up reply/question, I forgot to let you know that the ENT determined I had mixed hearing loss following the Myringtonomy procedure and hearing test results. Hence the CAT Scan. I still don't understand how I can have sudden hearing loss when I could hear just fine and was healthy at Christmas and early January!
Brief Answer:
Your hearing needs to be assessed again.
Detailed Answer:
Hi,
Thank you for writing back.
1. The ventilation tube is placed to allow air into the middle ear and not primarily for fluid drainage. Some fluid can be sucked or drained out via the myringotomy but there is no way to drain all of it. After treatment, the fluid production reduces as the middle ear is aerated.
2. If there is a mixed hearing loss, it is not expected. Your hearing must be assessed again urgently. This time insist on a report that you can upload.
3. As compared to a conductive hearing loss (expected), a sensori-neural hearing loss component is a medical emergency with a treatment window of barely 4 to 6 weeks. It is defined as a reduction in hearing by 20-30 dB in 3 contiguous hearing frequencies developing instantaneously or over 48-72 hours.
4. There is no need to attempt a repair of the ear drum. A myringotomy incision heals quickly and well.
5. I can suggest medication, if you upload a Pure Tone Audiogram (PTA), an Impedance Audiogram Tympanogram) and endoscopic images of the ear drums (if possible).
I hope that I have answered your queries. If you have any further questions, I will be available to answer them.
Regards.
Your hearing needs to be assessed again.
Detailed Answer:
Hi,
Thank you for writing back.
1. The ventilation tube is placed to allow air into the middle ear and not primarily for fluid drainage. Some fluid can be sucked or drained out via the myringotomy but there is no way to drain all of it. After treatment, the fluid production reduces as the middle ear is aerated.
2. If there is a mixed hearing loss, it is not expected. Your hearing must be assessed again urgently. This time insist on a report that you can upload.
3. As compared to a conductive hearing loss (expected), a sensori-neural hearing loss component is a medical emergency with a treatment window of barely 4 to 6 weeks. It is defined as a reduction in hearing by 20-30 dB in 3 contiguous hearing frequencies developing instantaneously or over 48-72 hours.
4. There is no need to attempt a repair of the ear drum. A myringotomy incision heals quickly and well.
5. I can suggest medication, if you upload a Pure Tone Audiogram (PTA), an Impedance Audiogram Tympanogram) and endoscopic images of the ear drums (if possible).
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. Chakravarthy Mazumdar
Dear Dr. XXXXXXX Bhatti,
Thank you for your timely reply. I am very grateful to you for your advice and tremendous wealth of knowledge. You have given me more information than any other doctor from my city in the past 3 weeks. This information you provided me will certainly help me ask all the right questions now in my follow up with emergency services and the ENT here in Toronto.
Here are my follow-up questions:
1) Yesterday I had a moment where I blew my nose and a sudden air passage opened in my affected right ear through which I could hear sound. This lasted only a few seconds before the passage closed again when I swallowed and I felt deaf again on right side. This morning, I woke up with intense, piercing deep pain in my inner ear. I tried holding my nose and blowing out my ear - again for a brief couple of seconds I had an opening that allowed me to hear and then it closed again. My right side hearing is still next to negligible. Should I continue to blow through my nose/ear, or will this damage the eardrum that is repairing itself from the myringtonomy conducted 5 days ago with no tubes?
2) Thanks for your suggestion that the ENT here should have put tubes in to help with aerating the middle ear. Since the myringtonomy was performed 5 days ago, and eardrum is probably healing/closing up quickly, will it be advisable to have another ENT open up the eardrum again to put in the tubes? Will doing this within a week of the last procedure cause permanent or long term damage to the ear drum or its ability to repair itself well a second time? Please note - I still have constant strong ringing (tinnutus) in my right ear after the myringtonomy - what does this mean? I did not have this problem before myringtonomy.
3) Because of medical bureaucracy here, I won't be able to get a second opinion from another ENT here until February 9. Meanwhile, I am concerned time is passing and the window of opportunity to save my hearing is closing based on your timeframe of 4 - 6 weeks. As you may recall from above, the first ENT who did the myringtonomy ordered hearing tests and diagnosed me as having mixed hearing loss. I am going to see him this Tuesday - even though I am hesitant to go back to him, but emergency doctor at hospital recommended I keep the appointment. I will insist this time on urgent hearing tests and ask why he did not put in the tubes. Is there anything else I should ask him for - such an urgent referral to a specialist clinic for hearing loss? My concern is that he is primarily a cosmetic surgeon practising ENT on the side. Also, is there something else I can do for self-care to save my hearing until I get to see the second ENT for 2nd opinion and treatment?
4) I am also going to emergency tomorrow to try and get into the medical system quicker with another ENT. The sudden loss hearing clinic at Sunnybrook Hospital in Toronto seems to have a good ENT team. I am going to Sunnybrook emergency tomorrow to ask for a referral to the sensori-neural sudden loss hearing clinic. When I had called them last week, the admin assistant told me that my loss of hearing was not sudden as it has been a while since I lost it (first time January 13 due to fluid build up, followed by second time after myringtonomy on January 26). As such, she was not treating me as an urgent case, and indicated that all requests get pooled in one administrative centre and triaged. I am concerned that by the time I get an appointment it could be too late. You mentioned I have 4 - 6 week window to get this issue addressed. How do I convince the system tomorrow when I go to the Sunnybrook emergency that I need to see a Sunnybrook clinical ENT on an urgent basis? What can I tell them?
Thank you very much for your kind, diligent and expert help. I hope we may save my hearing.
With kind regards, XXXX
Thank you for your timely reply. I am very grateful to you for your advice and tremendous wealth of knowledge. You have given me more information than any other doctor from my city in the past 3 weeks. This information you provided me will certainly help me ask all the right questions now in my follow up with emergency services and the ENT here in Toronto.
Here are my follow-up questions:
1) Yesterday I had a moment where I blew my nose and a sudden air passage opened in my affected right ear through which I could hear sound. This lasted only a few seconds before the passage closed again when I swallowed and I felt deaf again on right side. This morning, I woke up with intense, piercing deep pain in my inner ear. I tried holding my nose and blowing out my ear - again for a brief couple of seconds I had an opening that allowed me to hear and then it closed again. My right side hearing is still next to negligible. Should I continue to blow through my nose/ear, or will this damage the eardrum that is repairing itself from the myringtonomy conducted 5 days ago with no tubes?
2) Thanks for your suggestion that the ENT here should have put tubes in to help with aerating the middle ear. Since the myringtonomy was performed 5 days ago, and eardrum is probably healing/closing up quickly, will it be advisable to have another ENT open up the eardrum again to put in the tubes? Will doing this within a week of the last procedure cause permanent or long term damage to the ear drum or its ability to repair itself well a second time? Please note - I still have constant strong ringing (tinnutus) in my right ear after the myringtonomy - what does this mean? I did not have this problem before myringtonomy.
3) Because of medical bureaucracy here, I won't be able to get a second opinion from another ENT here until February 9. Meanwhile, I am concerned time is passing and the window of opportunity to save my hearing is closing based on your timeframe of 4 - 6 weeks. As you may recall from above, the first ENT who did the myringtonomy ordered hearing tests and diagnosed me as having mixed hearing loss. I am going to see him this Tuesday - even though I am hesitant to go back to him, but emergency doctor at hospital recommended I keep the appointment. I will insist this time on urgent hearing tests and ask why he did not put in the tubes. Is there anything else I should ask him for - such an urgent referral to a specialist clinic for hearing loss? My concern is that he is primarily a cosmetic surgeon practising ENT on the side. Also, is there something else I can do for self-care to save my hearing until I get to see the second ENT for 2nd opinion and treatment?
4) I am also going to emergency tomorrow to try and get into the medical system quicker with another ENT. The sudden loss hearing clinic at Sunnybrook Hospital in Toronto seems to have a good ENT team. I am going to Sunnybrook emergency tomorrow to ask for a referral to the sensori-neural sudden loss hearing clinic. When I had called them last week, the admin assistant told me that my loss of hearing was not sudden as it has been a while since I lost it (first time January 13 due to fluid build up, followed by second time after myringtonomy on January 26). As such, she was not treating me as an urgent case, and indicated that all requests get pooled in one administrative centre and triaged. I am concerned that by the time I get an appointment it could be too late. You mentioned I have 4 - 6 week window to get this issue addressed. How do I convince the system tomorrow when I go to the Sunnybrook emergency that I need to see a Sunnybrook clinical ENT on an urgent basis? What can I tell them?
Thank you very much for your kind, diligent and expert help. I hope we may save my hearing.
With kind regards, XXXX
Brief Answer:
Get the audiograms done first.
Detailed Answer:
Hi,
Thank you for writing back.
1. The most important investigation is a hearing test and an ear-drum examination.
2. If you keep blowing your ear, the myringotomy incision may take longer to heal.
3. Ventilation tubes can be inserted without lasting damage of the ear (scarring is possible, but in most cases none is visible). The problem is that a traditional myringotomy incision is circumferential (so that it gapes) and the traditional incision for a grommet is radial (so that it grips the grommet). Both are usually taken in the antero-inferior quadrant of the ear-drum.
3. It all depends upon the audiometry test results. If there is a conductive hearing loss, it will recover. If there is any sensori-neural hearing loss, it should ideally be treated within 4-6 weeks. Salvage therapy is effective up to three months in about half the patients. I do not believe that your delay is unmanageable. Let an ENT Specialist rather than a Plastic Surgeon mange this.
4. Insist on an urgent referral as you developed many symptoms suddenly, for example the tinnitus, pain and hearing loss. Sudden hearing loss, by definition, means either immediately or over 48-72 hours. Ask the admin if it was their own ears and hearing, what would they have done?
I hope that I have answered your queries. If you have any further questions, I will be available to answer them.
Regards.
Get the audiograms done first.
Detailed Answer:
Hi,
Thank you for writing back.
1. The most important investigation is a hearing test and an ear-drum examination.
2. If you keep blowing your ear, the myringotomy incision may take longer to heal.
3. Ventilation tubes can be inserted without lasting damage of the ear (scarring is possible, but in most cases none is visible). The problem is that a traditional myringotomy incision is circumferential (so that it gapes) and the traditional incision for a grommet is radial (so that it grips the grommet). Both are usually taken in the antero-inferior quadrant of the ear-drum.
3. It all depends upon the audiometry test results. If there is a conductive hearing loss, it will recover. If there is any sensori-neural hearing loss, it should ideally be treated within 4-6 weeks. Salvage therapy is effective up to three months in about half the patients. I do not believe that your delay is unmanageable. Let an ENT Specialist rather than a Plastic Surgeon mange this.
4. Insist on an urgent referral as you developed many symptoms suddenly, for example the tinnitus, pain and hearing loss. Sudden hearing loss, by definition, means either immediately or over 48-72 hours. Ask the admin if it was their own ears and hearing, what would they have done?
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. Chakravarthy Mazumdar
Dear Dr. Bhatti,
I have uploaded my audiogram report for you to review on this site/page. I hope you receive it. Grateful if you could please keep it confidential for your own official use and not for circulation, posting, or sharing. Please destroy once viewed.
Today, I managed to get referred to another ENT who is well-known in his scientific field and practice at Sunnybrook Hospital in Toronto. He specializes in middle ear disorders and his name is Dr. XXXXXXX Lin. Sunnybrook has a leading sudden hearing loss clinic (SHLC).
Dr. Lin first conducted the hearing tests today before doing any procedure. He also looked at the hearing tests done under the first ENT/cosmetic surgeon from XXXXXXX 26 (as per attached). The hearing test today showed more or less the same results, except the right ear had worsened. So a week later since the first myringtonomy, the symptoms (tinnitus, etc.) were increased and hearing decreased.
The ENT today suggested a few options: 1) let the body heal naturally on its own, but this hasn't seemed to work over time and waiting any later may cause me to lose more hearing; 2) put me on very strong antiobotics/steroids orally (though this could be hard on stomache and system and is very aggressive treatment - the steroid/antibiotic he named started with "pro..." - I can't remember the name. 3) He suggested going through the ear drum again and injecting steroid directly into the ear canal. He is planning on treating me like this for 3 days in a row.
Today he did the procedure - and I must admit, I did not feel pain or fullness or discomfort like I did with the other ENT/cosmetic surgeon from last week. This ENT surgeon at Sunnybrook first froze my eardrum and canal (the other doctor never did that). Then this ENT today spent a lot of time using suction to pull the fluid out. He found it was very thick and so viscous that he had a very hard time in pulling it out, and also found my membranes along the ear canal extremely inflamed, so it was hard for him but he managed to pull out quite a bit of fluid (I could hear it/feel it - it was thick and plugging the suction instrument). He saved some culture for lab testing at my insistence, though he said it was so thick and viscous he wasn't sure what they might be able to do with it, but he sent it to the lab in any case.
He told me his goal is to get rid of the conductive hearing loss through this procedure and bring my hearing back up to as close as possible to the level where I can hear better. But for the sensori-neural loss, he can't do anything for that. He thinks the infection may have contributed to that component if the liquid in my ear kept building and went untreated over a long period of time. He said symptoms don't show up right away until fluid reaches to a certain level in the ear canal, and then people experience sudden hearing loss. If left undiagnosed or untreated for too long, infection can affect sensori-neural hearing. His goal now is to close the gap between the conductive hearing and sensori-neural and to bring me as close as possible to normal hearing. Please see attached audiogram graphs.
The following are the medications the ENT today prescribed: Cephalexin 500 mg (1 tablet 4 x daily - 7 day course).
The steroid he is injecting into my middle ear/ear canal through ear drum is Dexamethasone 10 mg/ml (10 ml).
Please note - he had to make an incision higher than the first doctor into my eardrum. He said the first incision had healed and scabbed over.
I am rather worried now because I just read your answer, and you mentioned that tubes are radial incisions versus the other type of incision made in the eardrum. It is done Does this mean my ear drum is damaged forever or will not recover to full potential or will have long term negative impact?
Is tinnitus connected with eardrum healing? Will the tinnitus stay forever with whatever sensori-neural loss I might have?
I hope I am in good hands. Does the above make sense to you or have I made another mistake in proceeding with the above procedure? Is it safe or harmful with other unintended side effects? Any longterm benefit? Is it going to help me? I am not sure if the tubes for aeration would have removed the thick, glue-like viscous material that seems to have been deposited/stuck deep in the inner ear. However, I am not an expert and turn to you - please advise.
Many thanks for your ongoing help in this medical dilemma. I hope, if possible, that I might see your answer before 10:30 a.m. my time in Toronto tomorrow, as my appointment with the ENT at Sunnybrook is at 11:30 a.m. for day 2 of the procedure described earlier (steroid injection into ear).
With gratitude, and kind regards, XXXX
Dear Dr. Bhatti,
Good morning my time.
Further to my last set of questions, thought I would let you know that I woke up this morning with some moistness in my right ear, and when I dried it with towel, it was yellow (I guess this is like puss?). I also feel better after the procedure that the specialized ENT from Sunnybrook did yesterday, but still have hollow sounding voice on right side when I talk and ringing in my right ear. I am going back to hospital this morning as requested yesterday by ENT for day 2 of continued procedure from yesterday. I must say that I believe my hearing and swallowing is slightly feeling better after procedure yesterday. This is a huge difference compared to my symptoms that got worse after myringtonomy a week ago under the ENT/cosmetic surgeon who obviously did not get all the fluid out and sent me home with no follow up except a cat scan. I think this new ENT who is inner ear specialist at Sunnybrook is more skilled as his incision in my ear drum did not hurt or leave me with a pierced feeling like the last doctor's did.
Hope you can answer my questions from last note above this morning my time. I wanted to ask - is it too late to get the tube put in even if the cut was not radial? I still have chance to ask for the tube since I have 2 more days of procedure (i.e. continued fluid suction and steroid injection).
Thank you kindly, XXXX
I have uploaded my audiogram report for you to review on this site/page. I hope you receive it. Grateful if you could please keep it confidential for your own official use and not for circulation, posting, or sharing. Please destroy once viewed.
Today, I managed to get referred to another ENT who is well-known in his scientific field and practice at Sunnybrook Hospital in Toronto. He specializes in middle ear disorders and his name is Dr. XXXXXXX Lin. Sunnybrook has a leading sudden hearing loss clinic (SHLC).
Dr. Lin first conducted the hearing tests today before doing any procedure. He also looked at the hearing tests done under the first ENT/cosmetic surgeon from XXXXXXX 26 (as per attached). The hearing test today showed more or less the same results, except the right ear had worsened. So a week later since the first myringtonomy, the symptoms (tinnitus, etc.) were increased and hearing decreased.
The ENT today suggested a few options: 1) let the body heal naturally on its own, but this hasn't seemed to work over time and waiting any later may cause me to lose more hearing; 2) put me on very strong antiobotics/steroids orally (though this could be hard on stomache and system and is very aggressive treatment - the steroid/antibiotic he named started with "pro..." - I can't remember the name. 3) He suggested going through the ear drum again and injecting steroid directly into the ear canal. He is planning on treating me like this for 3 days in a row.
Today he did the procedure - and I must admit, I did not feel pain or fullness or discomfort like I did with the other ENT/cosmetic surgeon from last week. This ENT surgeon at Sunnybrook first froze my eardrum and canal (the other doctor never did that). Then this ENT today spent a lot of time using suction to pull the fluid out. He found it was very thick and so viscous that he had a very hard time in pulling it out, and also found my membranes along the ear canal extremely inflamed, so it was hard for him but he managed to pull out quite a bit of fluid (I could hear it/feel it - it was thick and plugging the suction instrument). He saved some culture for lab testing at my insistence, though he said it was so thick and viscous he wasn't sure what they might be able to do with it, but he sent it to the lab in any case.
He told me his goal is to get rid of the conductive hearing loss through this procedure and bring my hearing back up to as close as possible to the level where I can hear better. But for the sensori-neural loss, he can't do anything for that. He thinks the infection may have contributed to that component if the liquid in my ear kept building and went untreated over a long period of time. He said symptoms don't show up right away until fluid reaches to a certain level in the ear canal, and then people experience sudden hearing loss. If left undiagnosed or untreated for too long, infection can affect sensori-neural hearing. His goal now is to close the gap between the conductive hearing and sensori-neural and to bring me as close as possible to normal hearing. Please see attached audiogram graphs.
The following are the medications the ENT today prescribed: Cephalexin 500 mg (1 tablet 4 x daily - 7 day course).
The steroid he is injecting into my middle ear/ear canal through ear drum is Dexamethasone 10 mg/ml (10 ml).
Please note - he had to make an incision higher than the first doctor into my eardrum. He said the first incision had healed and scabbed over.
I am rather worried now because I just read your answer, and you mentioned that tubes are radial incisions versus the other type of incision made in the eardrum. It is done Does this mean my ear drum is damaged forever or will not recover to full potential or will have long term negative impact?
Is tinnitus connected with eardrum healing? Will the tinnitus stay forever with whatever sensori-neural loss I might have?
I hope I am in good hands. Does the above make sense to you or have I made another mistake in proceeding with the above procedure? Is it safe or harmful with other unintended side effects? Any longterm benefit? Is it going to help me? I am not sure if the tubes for aeration would have removed the thick, glue-like viscous material that seems to have been deposited/stuck deep in the inner ear. However, I am not an expert and turn to you - please advise.
Many thanks for your ongoing help in this medical dilemma. I hope, if possible, that I might see your answer before 10:30 a.m. my time in Toronto tomorrow, as my appointment with the ENT at Sunnybrook is at 11:30 a.m. for day 2 of the procedure described earlier (steroid injection into ear).
With gratitude, and kind regards, XXXX
Dear Dr. Bhatti,
Good morning my time.
Further to my last set of questions, thought I would let you know that I woke up this morning with some moistness in my right ear, and when I dried it with towel, it was yellow (I guess this is like puss?). I also feel better after the procedure that the specialized ENT from Sunnybrook did yesterday, but still have hollow sounding voice on right side when I talk and ringing in my right ear. I am going back to hospital this morning as requested yesterday by ENT for day 2 of continued procedure from yesterday. I must say that I believe my hearing and swallowing is slightly feeling better after procedure yesterday. This is a huge difference compared to my symptoms that got worse after myringtonomy a week ago under the ENT/cosmetic surgeon who obviously did not get all the fluid out and sent me home with no follow up except a cat scan. I think this new ENT who is inner ear specialist at Sunnybrook is more skilled as his incision in my ear drum did not hurt or leave me with a pierced feeling like the last doctor's did.
Hope you can answer my questions from last note above this morning my time. I wanted to ask - is it too late to get the tube put in even if the cut was not radial? I still have chance to ask for the tube since I have 2 more days of procedure (i.e. continued fluid suction and steroid injection).
Thank you kindly, XXXX
Brief Answer:
There is no cause for worry.
Detailed Answer:
Hi,
Thank you for writing back.
1. There is no uploaded audiogram visible. Please contact YYYY@YYYY for help.
2. As suspected, there does seem to be a component of SNHL. You finally seem to be on the right track for treatment. A Myringotomy and grommet insertion is usually not a painful procedure. It is good that the ear discharge has been sent for culture. The second incision was done as per the points elaborated earlier. There will be no damage to the ear-drum.
3. The mainstay of treatment of ISSNHL (Idiopathiic Sudden SensoriNeural Hearing Loss) in a non diabetic is high dose steroids. Other medication includes anti-virals, blood thinning agents, rheologic or blood flow improvement medications, neural tonics, Carbogen (vasodilator) and Hyperbaric Oxygen Therapy (HBOT), if available.
4. Right now, for any salvage treatment, trans-tympanic steroids and HBOT is strongly recommended. An anti-viral added to the trans-tympanic steroid treatment is a better combination in your case.
5. The tinnitus should decrease with treatment however there is no way to predict this.
6. Currently I am conducting a study with two grommets inserted into the same ear drum to facilitate trans-tympanic drug delivery by the patient at home and thus obviate the need to visit a doctor for every injection. Many ENT Specialists use multiple ear-drum punctures for injecting steroids into the middle ear.
I hope that I have answered your queries. If you have any further questions, I will be available to answer them.
Regards.
There is no cause for worry.
Detailed Answer:
Hi,
Thank you for writing back.
1. There is no uploaded audiogram visible. Please contact YYYY@YYYY for help.
2. As suspected, there does seem to be a component of SNHL. You finally seem to be on the right track for treatment. A Myringotomy and grommet insertion is usually not a painful procedure. It is good that the ear discharge has been sent for culture. The second incision was done as per the points elaborated earlier. There will be no damage to the ear-drum.
3. The mainstay of treatment of ISSNHL (Idiopathiic Sudden SensoriNeural Hearing Loss) in a non diabetic is high dose steroids. Other medication includes anti-virals, blood thinning agents, rheologic or blood flow improvement medications, neural tonics, Carbogen (vasodilator) and Hyperbaric Oxygen Therapy (HBOT), if available.
4. Right now, for any salvage treatment, trans-tympanic steroids and HBOT is strongly recommended. An anti-viral added to the trans-tympanic steroid treatment is a better combination in your case.
5. The tinnitus should decrease with treatment however there is no way to predict this.
6. Currently I am conducting a study with two grommets inserted into the same ear drum to facilitate trans-tympanic drug delivery by the patient at home and thus obviate the need to visit a doctor for every injection. Many ENT Specialists use multiple ear-drum punctures for injecting steroids into the middle ear.
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. Naveen Kumar
Dear Dr. Bhatti,
Thanks a million for your last response. I feel like we are narrowing down the management of this illness thanks to the skill and knowledgeable ENTs such as Dr. Lin and yourself.
I have tried re-attaching the audiogram report from January 26. I hope you are able to retrieve/see it. The only difference from that report and the one done on February 1st is that my right ear hearing had worsened a bit.
I will suggest to Dr. Lin your ideas of HBOT and adding anti-viral to the trans-tmpanic steroid treatment. Does the steroid he is using include anti-viral? As mentioned earlier, he is injecting Dexamethasone 10 mg/ml (10 ml). What kind of anti-viral should I propose?
The ENT also found my nasal passages on the first day were also highly inflamed. I told him that for the past year I have had trouble breathing and very thick mucous buildup making it hard for me to swallow and breath clearly, especially at night. Dr. Lin is going to refer me also to a rhinologist, but he said these issues are separate from my current middle ear/inner ear issue that he is correcting - is that correct?
I am afraid that continued sinus issues will eventually block my eustrachian tube again and cause another infection in future. However ENT is telling me there is no connection between the two - is that correct?
How do I prevent and avoid ear infection again in future? For now, ENT has given me salt water nasal rinse which is pretty good in keeping my nasal passages fairly clear.
Lastly, Dr. Lin is only doing 3 days of steroid injections. Is that enough? He said he saw a big difference today and that swelling had gone done significantly with the first injection in less than 24 hours and second injection was had today. I am going for the third injection tomorrow morning at 9:00 a.m. I continue to take the antibiotics he prescribed (Cephalexin). The ENT is predicting and suspecting that this is a one time only incident and after this treatment, he is going to look at the ear again after the ear drum has healed. He is hoping that everything will be back to normal. I explained to him that I have long term sinus issues, and right ear is always very susciptible to cold and does seem to get inflamed. However, my body has fought off all colds in the past, with occasional oral antibiotics for upper respiratory tract. I have had one vertigo attack from a flu 15 years ago, but none since.
So, given my history, and current case, and even though I had signs this past summer of my right hearing weakening, Dr. Lin is saying that won't change his current course of treatment or management plan for what I have now. Do you agree? Is this now a wait and see game after ear drum heals? Or should I insist on tubes for aeration? FYI - I asked the doctor about the tubes and he kept telling me that he thought it too aggressive a treatment for me. I guess it's because he feels like he got all the fluid out? He said with the decreased inflammation today, he was able to better see inside the ear.
I look forward to hearing your reply/thoughts to my questions above, and any further advice you may offer for medium to longterm care.
With kind regards, XXXX
(btw - my parents are originally from Bangalore! I have always had a very good experience with XXXXXXX health care anytime I visited XXXXXXX as a child and teenager growing up - never any bureaucracy in being seen on an urgent basis!).
Thanks a million for your last response. I feel like we are narrowing down the management of this illness thanks to the skill and knowledgeable ENTs such as Dr. Lin and yourself.
I have tried re-attaching the audiogram report from January 26. I hope you are able to retrieve/see it. The only difference from that report and the one done on February 1st is that my right ear hearing had worsened a bit.
I will suggest to Dr. Lin your ideas of HBOT and adding anti-viral to the trans-tmpanic steroid treatment. Does the steroid he is using include anti-viral? As mentioned earlier, he is injecting Dexamethasone 10 mg/ml (10 ml). What kind of anti-viral should I propose?
The ENT also found my nasal passages on the first day were also highly inflamed. I told him that for the past year I have had trouble breathing and very thick mucous buildup making it hard for me to swallow and breath clearly, especially at night. Dr. Lin is going to refer me also to a rhinologist, but he said these issues are separate from my current middle ear/inner ear issue that he is correcting - is that correct?
I am afraid that continued sinus issues will eventually block my eustrachian tube again and cause another infection in future. However ENT is telling me there is no connection between the two - is that correct?
How do I prevent and avoid ear infection again in future? For now, ENT has given me salt water nasal rinse which is pretty good in keeping my nasal passages fairly clear.
Lastly, Dr. Lin is only doing 3 days of steroid injections. Is that enough? He said he saw a big difference today and that swelling had gone done significantly with the first injection in less than 24 hours and second injection was had today. I am going for the third injection tomorrow morning at 9:00 a.m. I continue to take the antibiotics he prescribed (Cephalexin). The ENT is predicting and suspecting that this is a one time only incident and after this treatment, he is going to look at the ear again after the ear drum has healed. He is hoping that everything will be back to normal. I explained to him that I have long term sinus issues, and right ear is always very susciptible to cold and does seem to get inflamed. However, my body has fought off all colds in the past, with occasional oral antibiotics for upper respiratory tract. I have had one vertigo attack from a flu 15 years ago, but none since.
So, given my history, and current case, and even though I had signs this past summer of my right hearing weakening, Dr. Lin is saying that won't change his current course of treatment or management plan for what I have now. Do you agree? Is this now a wait and see game after ear drum heals? Or should I insist on tubes for aeration? FYI - I asked the doctor about the tubes and he kept telling me that he thought it too aggressive a treatment for me. I guess it's because he feels like he got all the fluid out? He said with the decreased inflammation today, he was able to better see inside the ear.
I look forward to hearing your reply/thoughts to my questions above, and any further advice you may offer for medium to longterm care.
With kind regards, XXXX
(btw - my parents are originally from Bangalore! I have always had a very good experience with XXXXXXX health care anytime I visited XXXXXXX as a child and teenager growing up - never any bureaucracy in being seen on an urgent basis!).
Brief Answer:
Mixed loss Rt. Ear, Ganciclovir, treat the nose and sinuses.
Detailed Answer:
Hi,
Thank you for writing back.
1. The PTA (Pure Tone Audiogram) confirms a mixed hearing loss with a mild to moderate sensorineural hearing loss in the Rt. Ear. The impedance Audiogram shows a flat type B graph signifying fluid in the middle ear on the Rt. side.
2. An anti-viral such as ganciclovir can be safely added to the trans-tympanic steroid injection.
3. The nasal and sinus problems lead to ETD (Eustachian tube Dysfunction) which usually leads to a Conductive Hearing Loss (CHL). Sensorineural Hearing Loss (SNHL) is more likely due to repeated infections in the pent-up middle ear secretions.
4. Initial treatment includes anti-allergic medication, nasal steroid sprays, steam inhalation and nasal saline washes. Hypertonic nasal saline washes may be more helpful in your case.
5. Get a plain Sinus Ct done if the medications do not work with 6-8 weeks.
6. You should insist on the other treatments such as High dose iv steroids, HBOT and others suggested in my previous answers (specifically point No. 3 in my fourth follow-up answer) and the time elapsed is not more than 4-6 weeks as far as the SNHL is concerned (about a week or so).
7. I would recommend the ear ventilation tubes (grommets) , however you will have go by your ENT Specialist's advice. You can have many benefits with the ventilation tubes. The improved aeration will give the ear and the ETD more tome to recover. The tubes can be used to deliver trans-tympanic steroids and antivirals over the next few weeks. The average duration/ protocol is twice a week for 6-8 weeks. Healing is based on ventilation and aeration. The myringotomy otherwise will close in a few days. (One has to keep the ear dry and avoid swimming while the ventilation tubes are in place). The tubes get extruded and fall out on their own after a few weeks or months.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Mixed loss Rt. Ear, Ganciclovir, treat the nose and sinuses.
Detailed Answer:
Hi,
Thank you for writing back.
1. The PTA (Pure Tone Audiogram) confirms a mixed hearing loss with a mild to moderate sensorineural hearing loss in the Rt. Ear. The impedance Audiogram shows a flat type B graph signifying fluid in the middle ear on the Rt. side.
2. An anti-viral such as ganciclovir can be safely added to the trans-tympanic steroid injection.
3. The nasal and sinus problems lead to ETD (Eustachian tube Dysfunction) which usually leads to a Conductive Hearing Loss (CHL). Sensorineural Hearing Loss (SNHL) is more likely due to repeated infections in the pent-up middle ear secretions.
4. Initial treatment includes anti-allergic medication, nasal steroid sprays, steam inhalation and nasal saline washes. Hypertonic nasal saline washes may be more helpful in your case.
5. Get a plain Sinus Ct done if the medications do not work with 6-8 weeks.
6. You should insist on the other treatments such as High dose iv steroids, HBOT and others suggested in my previous answers (specifically point No. 3 in my fourth follow-up answer) and the time elapsed is not more than 4-6 weeks as far as the SNHL is concerned (about a week or so).
7. I would recommend the ear ventilation tubes (grommets) , however you will have go by your ENT Specialist's advice. You can have many benefits with the ventilation tubes. The improved aeration will give the ear and the ETD more tome to recover. The tubes can be used to deliver trans-tympanic steroids and antivirals over the next few weeks. The average duration/ protocol is twice a week for 6-8 weeks. Healing is based on ventilation and aeration. The myringotomy otherwise will close in a few days. (One has to keep the ear dry and avoid swimming while the ventilation tubes are in place). The tubes get extruded and fall out on their own after a few weeks or months.
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
Dear Dr. Bhatti,
I read your last input with great interest and will convey this information to the ENT.
I had my third procedure today, and for the first time, ENT said he could see the cavity of my middle ear thanks to inflammation gone down following first two days of steroid injections. The fluid he found was clear, not viscous or coloured, and he believes it to be sterile. He used suction instrument to pull out more liquid and injected 3rd round of steroid today. For the very first time during these treatments, I felt dizzy when he injected the steroid. He said this was a reflection of more normal function of middle ear. I forgot to mention the antiviral to him and will do so tomorrow. I thought the oral antibiotic he put me on was a preventative measure to ensure all infection was addressed. I have been taking these antibiotics 4x/day since the steroid injections begun.
When I hear out of my right ear now, sounds/people talking sound faint/distant. I am hoping this will improve once the ear drum is healed?
FYI - I raised the tubes insertion again today but ENT seemed hesitant to put the tubes in saying that there is chance of infection with tubes and he has had to remove them in the past from other patients. He thinks in my case this is a one-time scenario, one time incident/infection and believes this won't recur, and this is why he thought the tubes would be too aggressive a treatment for me.
I still think the tubes should go in based on your reasoning and my history of sinus infections and trouble swallowing this past year. I think this part of my health history is new for him, because I had focused so much on the hearing loss symptoms and he is an inner ear doctor/surgeon. He has asked me for a follow up tomorrow as he wants to do another hearing test to see how much of my hearing has returned after his 3-day treatment. He will then see what next steps are required in the treatment plan.
You may recall I first lost the hearing on January 13, but lost time in treatment because GP physician didn't understand the urgency and gave me 9 days of useless Ciprodex ear drops. Second GP gave me 5 day oral antibiotic. Then on XXXXXXX 26 I had the first myringtonomy in a private clinic and results of mixed hearing loss in the audiogram you saw. I didn't received proper treatment from an ENT specialist until Feb. 1st. Hence, if I count back to XXXXXXX 13, I've already completed 3 weeks in this whole process. So pthe eriod in which to beat the SNHL is closing soon.
I recalled today for ENT that the symptoms of hearing loss began much earlier than January 13, and looks like I did not pay enough attention to the symptoms that developed over the course of the summer - i.e. I had blocked or popping right ear and increasingly trouble hearing conversations. But I unfortunately did not realize these as urgent signals because I thought my ear was acting up due my ongoing sinus, breathing and swallowing issues (constantly producing thick mucus from sinuses and throat). I have allergies to dust, which can explain my sinuses. I breathe better at night when I have an air purifier.
In any case, ENT had said he would refer me to his colleague who is a specialist in rhinology. Meanwhile, the problem I face now is that he is reluctant to put the tubes in, and I am afraid that his myringtonomy will lose its benefit when eardrum heals/closes for all the reasons you cited, including ETD. I will continue my nasal rinse (NeilMed salt rinse) mixed with Pulmicort to keep nasal passages clear. I hope that should help me with eustachian tube. I asked ENT what he would do if middle ear built up with fluid again - he said he'll look into it then, as he never saw me in the state that I described from the summer. He would have had to see me then to have determined cause/course of action.
I will reinforce the issue of ETD and concern re: right ear. Initially, I had not conveyed my history and timing of symptoms to him properly, so this is the reason he thinks it was a sudden one-time only event brought on by the cold or infection I had in early December building up to sudden hearing loss on XXXXXXX 13. I have a feeling this was a long and gradual build-up or as you note I've probably had multiple ear infections and not always known it. Previously I have had ear pain more than once, usually with a cold/flu and always in winter/cold weather. If my body cleared these infections up on its own, I may not have been aware of the effect on middle ear as I am very active and healthy sports-wise and did not realize anything truly wrong until it became critical.
Well, I will see how the hearing test results go tomorrow and let you know the outcome. I will mention point 3 (HBOT, etc.) in your 4th follow-up answer to ENT. I don't know what to do though if he refuses the treatment based on his current management plan. He seems pretty reasonable thus far though. He was doing the follow-up hearing test tomorrow to determine next course of action - I believe he will continue to monitor me and progress after ear drum heals. I might suggest to him that we talk to rhinologist and see if he thinks tubes will help with my ETD and then maybe ENT will put them in!
Thank you again for all your help. You have been a tremendous source of support for me during this trying period. But knowing I was on the right track helped me to relax and be positive and a willing patient during the operative procedures, and I'm sure this cooperation in turn helped the doctor to perform well!
I will let you know how the hearing test results go tomorrow and final outcome.
Many thanks for all your help. I hope to keep in touch. With kind regards, XXXX
I read your last input with great interest and will convey this information to the ENT.
I had my third procedure today, and for the first time, ENT said he could see the cavity of my middle ear thanks to inflammation gone down following first two days of steroid injections. The fluid he found was clear, not viscous or coloured, and he believes it to be sterile. He used suction instrument to pull out more liquid and injected 3rd round of steroid today. For the very first time during these treatments, I felt dizzy when he injected the steroid. He said this was a reflection of more normal function of middle ear. I forgot to mention the antiviral to him and will do so tomorrow. I thought the oral antibiotic he put me on was a preventative measure to ensure all infection was addressed. I have been taking these antibiotics 4x/day since the steroid injections begun.
When I hear out of my right ear now, sounds/people talking sound faint/distant. I am hoping this will improve once the ear drum is healed?
FYI - I raised the tubes insertion again today but ENT seemed hesitant to put the tubes in saying that there is chance of infection with tubes and he has had to remove them in the past from other patients. He thinks in my case this is a one-time scenario, one time incident/infection and believes this won't recur, and this is why he thought the tubes would be too aggressive a treatment for me.
I still think the tubes should go in based on your reasoning and my history of sinus infections and trouble swallowing this past year. I think this part of my health history is new for him, because I had focused so much on the hearing loss symptoms and he is an inner ear doctor/surgeon. He has asked me for a follow up tomorrow as he wants to do another hearing test to see how much of my hearing has returned after his 3-day treatment. He will then see what next steps are required in the treatment plan.
You may recall I first lost the hearing on January 13, but lost time in treatment because GP physician didn't understand the urgency and gave me 9 days of useless Ciprodex ear drops. Second GP gave me 5 day oral antibiotic. Then on XXXXXXX 26 I had the first myringtonomy in a private clinic and results of mixed hearing loss in the audiogram you saw. I didn't received proper treatment from an ENT specialist until Feb. 1st. Hence, if I count back to XXXXXXX 13, I've already completed 3 weeks in this whole process. So pthe eriod in which to beat the SNHL is closing soon.
I recalled today for ENT that the symptoms of hearing loss began much earlier than January 13, and looks like I did not pay enough attention to the symptoms that developed over the course of the summer - i.e. I had blocked or popping right ear and increasingly trouble hearing conversations. But I unfortunately did not realize these as urgent signals because I thought my ear was acting up due my ongoing sinus, breathing and swallowing issues (constantly producing thick mucus from sinuses and throat). I have allergies to dust, which can explain my sinuses. I breathe better at night when I have an air purifier.
In any case, ENT had said he would refer me to his colleague who is a specialist in rhinology. Meanwhile, the problem I face now is that he is reluctant to put the tubes in, and I am afraid that his myringtonomy will lose its benefit when eardrum heals/closes for all the reasons you cited, including ETD. I will continue my nasal rinse (NeilMed salt rinse) mixed with Pulmicort to keep nasal passages clear. I hope that should help me with eustachian tube. I asked ENT what he would do if middle ear built up with fluid again - he said he'll look into it then, as he never saw me in the state that I described from the summer. He would have had to see me then to have determined cause/course of action.
I will reinforce the issue of ETD and concern re: right ear. Initially, I had not conveyed my history and timing of symptoms to him properly, so this is the reason he thinks it was a sudden one-time only event brought on by the cold or infection I had in early December building up to sudden hearing loss on XXXXXXX 13. I have a feeling this was a long and gradual build-up or as you note I've probably had multiple ear infections and not always known it. Previously I have had ear pain more than once, usually with a cold/flu and always in winter/cold weather. If my body cleared these infections up on its own, I may not have been aware of the effect on middle ear as I am very active and healthy sports-wise and did not realize anything truly wrong until it became critical.
Well, I will see how the hearing test results go tomorrow and let you know the outcome. I will mention point 3 (HBOT, etc.) in your 4th follow-up answer to ENT. I don't know what to do though if he refuses the treatment based on his current management plan. He seems pretty reasonable thus far though. He was doing the follow-up hearing test tomorrow to determine next course of action - I believe he will continue to monitor me and progress after ear drum heals. I might suggest to him that we talk to rhinologist and see if he thinks tubes will help with my ETD and then maybe ENT will put them in!
Thank you again for all your help. You have been a tremendous source of support for me during this trying period. But knowing I was on the right track helped me to relax and be positive and a willing patient during the operative procedures, and I'm sure this cooperation in turn helped the doctor to perform well!
I will let you know how the hearing test results go tomorrow and final outcome.
Many thanks for all your help. I hope to keep in touch. With kind regards, XXXX
Brief Answer:
Your treatment is going on well.
Detailed Answer:
Hi,
Thank you for writing back.
1. The next hearing test will be crucial for further treatment planning. It is good to hear that you are improving.
2. What I tell patients of SSNHL who present early is that there is always around 50% chance of spontaneous improvement (without any treatment). This usually takes place in the initial few weeks. However, to avoid missing the first treatment window of 4-6 weeks, treatment is started. The second treatment window is up to 3-6 months, many times when the patient presents late, where salvage therapy is initiated.
3. At this stage I must emphasize that your SNHL component is mild to moderate and should improve though statistically, the chance is about 50%. In medical terms, a 20dB improvement is considered successful. In your case, it would mean a complete recovery. This is not the case sometimes for patients with severe SNHL.
4. Barring a few minor differences, such as the ventilation tubes, treatment of allergic rhinitis, sinusitis and some medication, your treatment is going on well. Hence your hearing should improve. I agree on the rest of the points and you should let your current ENT Specialist decide along with input from the Rhinologist.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Your treatment is going on well.
Detailed Answer:
Hi,
Thank you for writing back.
1. The next hearing test will be crucial for further treatment planning. It is good to hear that you are improving.
2. What I tell patients of SSNHL who present early is that there is always around 50% chance of spontaneous improvement (without any treatment). This usually takes place in the initial few weeks. However, to avoid missing the first treatment window of 4-6 weeks, treatment is started. The second treatment window is up to 3-6 months, many times when the patient presents late, where salvage therapy is initiated.
3. At this stage I must emphasize that your SNHL component is mild to moderate and should improve though statistically, the chance is about 50%. In medical terms, a 20dB improvement is considered successful. In your case, it would mean a complete recovery. This is not the case sometimes for patients with severe SNHL.
4. Barring a few minor differences, such as the ventilation tubes, treatment of allergic rhinitis, sinusitis and some medication, your treatment is going on well. Hence your hearing should improve. I agree on the rest of the points and you should let your current ENT Specialist decide along with input from the Rhinologist.
I hope that I have answered your query. If you have any more questions I will be available to answer them.
Regards.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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