A Mixed Treatment: Acoustic Trauma and/or Vascular Compression? Do Most Have Both?

Not knowing exactly where my Tinnitus is coming from (2 possible reasons), I decided to do a mixed treatment: Something that can do both good, considering I am still not a chronic case (3 and a half month since my acoustic trauma).

Now my real problems started in September 2014 when an alarm went off for about a minute and I didn't cover my ears for that time. I was close to it, so I just happened. The T in my right ear went crazy! Now I did have noticed T before, only I didn't give it much attention since it obviously wasn't that loud.

After trying corticoids, stugeron, vitamins, HBO therapy, to no avail, I made an MRI for the ears that gave some results: Microvascular compression of the VIII cranial nerve due to AICA pressure. This put me on a new track: The anticonvulsants. Neurontin was the first choice.

Now this drug Gabapentin (Neurontin) is a treatment choice for trimental neuralgia. Thus, having a similar condition such as microvascular compression of the acoustic nerve, it is recommended for that too. I myself cannot forget that acoustic trauma of mine, and a study for Neurontin that makes it good for acoustic trauma cases! http://www.ncbi.nlm.nih.gov/pubmed/16652071#

So I took it (3x300mg a day).

Sadly, I have to say that after 1 month zero results came from it. I may continue for a bit further, my doc said it could take months, I am also considering Tegretol as an alternative.

I will also try corticoids (weekly injections) and Gigko at the same time, to cover nerve/cochlear inflammation and possible cochlea regeneration. And also nerve vitamins, neurobion injection at first, pills later. All these in hope of covering both nerve and cochlea damage. As much as anyone can cover it...
I will not try other circulation drugs though (stugeron, antivom, betaistine) since they may conflict whith Neurontin or Tegretol.

In reply to a post from another topic that I transfer here:

I decided to try Tegretol because other people have had positive results with it, and because my doctor agreed to it due to my microvascular compression of the VIII cranial (auditory/cochlear) nerve.
I do not know of any doctor here who suggestes intratymbanic steroids. I don't know their results if any. And I have tried HBO therapy (15 sessions) with no success.

So, anyone that have a suggestion for this mixed kind of therapy is welcome to tell. Also, jow many of you have had your ears checked for signs of mvc (microvascular compression)?
I was wondering if it is a random finding, not really taking any part in Tinnitus. Since this forum is like an open source study, it would be useful to investigate the connection between mvc, Tinnitus and acoustic trauma.

 

If it is mvc compression the only real treatment is surgery.
Surgery has very high risks for more serious problems.
Have you audiogram before and after alarm sound or only after ?
After alarm sound hearing in high frequencies improved in the time frame of 20 days or not ?
Post your audiograms

 

No audiogram in my hands before alarm. One exists, 3 months before the alarm, but the damn doctor didn't give it to me, so I don't have it! If I knew what was to come, I would ask for it. Unfortunately I cannot remember how it looked, although, I think it was very much alike the post trauma ones judging by the doctors comments then. But this is pure speculation. I have looked everywhere for that audiogram, but I don't have it. I don't suppose the doctor kept it either...

All audiograms after acoustic trauma are the same, no changes.
Isn't there a positive way to know weather your problem lies in the cochlea or the nerve?

 

Yes there exist methods to identify the source of problem.
One exam is SISI test with audiometer other OAEs (otoacoustic emisions) and ABR.
If you have recruitment in frequencies of hearing loss then cochlear damage exits
otherwise altered ABR indicates nerve damage.
But the neuroaudiologist must know good his work and spend time (4 hours) to make clinical diagnosis with these tests because the borderline is narrow we speak for high frequencies and "relative moderate-small hearing loss" so clinical diagnosis maybe difficult with these tests.
I bet my money to good OAEs machine not screening cheap machine to diagnose the problem.
If DPOAEs doesn't exist in in the frequency range of your hearing loss then is cochlear damage.
This test easy if the right machine exists it's not an expensive machine it used to
check the hearing in newborn kids so you will find for sure in clinics for newborns ( http://www.paidon-agiasofia.gr/?cat=12&sub=12.03.05&view=view ) .

 

Happy new year!

As you can see, may audiograms are not in accordance... Do you know what to make out of them? The first is always tha bad ear (right one).

 

Does this qualify? http://www.paido-orl.gr/pediatricaudiology.html
This ENT also promotes LLLT as a treatment, but uses only a 40-50 mW machine (660 nm).
http://tinnitus.gr/orl-laser.gr/about orl laser.htm
http://tinnitus.gr/tinnitustherapy.html
PS: I guess you can read greek?

 

Your first audiogram has the well known 6khz notch i had the same but much worse -60db
and -55db at 4khz -40db 3khz also and other frequencies affected -25db i recovered with
iv methyprednisolone 40mgx3 every 8 hours for 7 days and then tapering.
I got it after 24 hours of the hearing loss.
This first audiogram seems to be symmetric so an acoustic trauma is more possible than mvc.
mvc also causes this notch.
Get pentoxyfilline/piracetam/vitamins a/b/c/d/e/aminoacids/creatine/acetylcysteine/magnesium/methyprednisolone/HBO
(personally i don't believe laser but who knows)
I hope some from these will help.
I have fluctuating hearing like in the frequencies around 6khz and only 5db-10db down the hearing gives me bad T.
How you found that you have mvc ? Because in mra mri is very difficult to see this problem.
I think that you got also acoustic trauma from mri machine (maybe this is the reason for worsening) ...

 

Still, no certain conclusions there... Take a look at the other audiograms. The doctors could not even agree on that simple case... What I hear while closing the ear is more certain: The right ear cannot listen as clearly as the left one. So the audiogram shouldn't be symmetrical according to my feeling. Not to mention where the H and T come from (all 3 sounds from the right).

Did it help you? I am certain you are referring to this http://alt.support.tinnitus.narkive.com/kI4kAjZH/p-p-s-tinnitus-cure-long I think you yourself may have posted it in another forum right? Is this a known treatment? Haven't heard of it. In what dosage should these 2 (pentoxyfilline/piracetam) be used?
Also, tried HBO, 15 sessions, did not do anything. And mag for about 1 month...

I don't know how can you be sure of that... I don't know where my T starts.

No, not MRA, it was an MRI expecially for the ears (λιθοειδών). I was sent by my ENT (acouologist) to a specific MRI center and a specific doctor (radiologist) was preferably asked to right the finding. My ENT seemed to have experience in this field, so even though I already had MRI of the brain and neck, another MRI of the ears was considered more important. But since now It seems only to have confused me, since Gabapentin did not do anything for my T in 1 month that I take it. And I can't help but feeling that an acoustic trauma started it all, or worsened it all really badly.

Where did you get that? No I didn't have an acoustic trauma from the MRI, I was wearing protection and my T and hearing is at the same state from the very beginning almost 4 months now, no changes whatsoever.

 

Read it http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2793889/
1) if you have stacato / typerwriter tinnitus
2) if you have altered abr
3) if your sweep OAEs / DPOAEs are ok
4) responds to carbamazepine
then there is possible to have mvc of 8th nerve
but there is possible even if 1/2/3/4 are false
the only definitive test is human eye (surgery to see).

Can you describe what type T you have and how loud ?
Have you distorted hearing ? Have you hyperacusis ?
T is constant or fluctuating and have spikes ?
head movements can produce sometimes T spikes ?
You experience "small short duration sudden hearing loss" ? For example if you hear the fan from pc sometimes suddenly background noise lowers and T makes a spike that resolves after some seconds of its own ?

Nerve damage does not alter so much the audiogram but the hearing is distorted.
A trial from 1945 says that 50% section of acoustic nerve does not alter audiogram thresholds.
In nerve damage with good audiogram you can have bad speech discrimination due to distorted hearing. Have you done high frequency audiogram and OAEs ?

 

An interesting paper indeed.
Can't say if my T is a typewriter one. I do have one of my 3 T sounds feel like a telegraph though...
I haven't done ABR, OAE, DPOAE. None of the 13 doctors I visited suggested these exams, and I fear if I don't pursue them, none will ever do here in Greece. I guess I really have to do them? If you have any suggestions as to where to do them feel free to post them please. I know you post one in Athens, but this is closer to where I live: http://www.paido-orl.gr/pediatricaudiology.html

I also haven't tried tegretol (carbamazepine), although I did try Neurontin (Gabapentin) for 1 month with no results.

I have 3 sounds: a high frequency tinnitus (the most troublesome), a continued telegraph style one, and a constant hiss.
My main trouble is the high pitch/frequency one (around 15000Hz, old crt TV sound) , it fluctuates a bit, there are days that it stays constant and loud, and other days it may reduce in volume. When it reduces my day is happy and hopeful, I start being bothered by the second and third sound, the hiss and telegraph (totally ever constant) which show more, absent the big one. So it is safe to say that the high T does come down a bit. It produces spikes though but they subside. Now this only happens a couple of days a week. The other days feel like a constant spike... pure hell!

I do have distorted hearing. And hyperacusis. I don't know which I hate the most: It gives me the chills just listening to a plastic or paper bag being squashed. The s and c in words annoy me. High tone speeches and voices annoy me, especially female high tone voices. Noisy cars and motorcycles easily annoy me.

Well, while walking, I do hear a sudden spike in every step I take. It is loud and very very short: It goes like this:"zip zip zip...". I cannot say my T changes much due to neck movements, but it changes A LOT when I open wide my mouth: It reaches its full spike, and stays constantly there as I keep my mouth open. It comes back to normal when I close it. The sound always comes from the right (the bad) ear.

Can't say I do. This may happen once in a while in my other ear, the left. But it subsides quickly. Perhaps in a good day I may be able to experience something like that in my right ear also, while the T gets a spike and subsides a bit, but usually it spikes regularly and constantly.

This is the conclusion that a doctor of mine reached: No hearing trauma shows in audiogram (no 4000 dip, though it declines above 6000), so, nerve damage is more possible. The following MRI confirmed that, mvc is found in the right side due to AICA pressure inside the acoustic pore.
Now if I close my good ear, a conversation is not that clear, mostly due to the tinnitus. The sounds also come a bit muffled, like coming from a closed room. Unlike my good (left) ear where all is clear.

As I said, no high frequency audiogram is done, no OAEs. I want to do them but nobody does them.

So, what do you make out of all these? Acoustic trauma or nerve damage due to vascular conflict? And why? Your opinion is highly appreciated. Could an acoustic trauma aggravate a nerve damage from mvc?
What would you do next if you where me?

 

You just described all of my symptoms

 

Yes loud sounds can aggravate a problem from mvc.
In mvc the mechanism of damage is due to demyelination of nerve this is the reason that the compression exists from birth but problem appears later because myelin is not destroyed and insulates the nerve from vascular electricity.
When myelin destroyed nerve loose insulation and the problem appears.
Myelin is the insulator of nerve fibers if it is destroyed then electric loads travel between
nerve fibers . This phenomenon is known as crosstalk and exists also in telecommunication wiring.
If you don't make HF audiogram / OAEs / ABR then you walk in dark alone.
Make a telephone in medical school / university of athens and ask them where you do HF audiogram and OAEs and ABR.It's 100% that most university hospitals do these types of exams. Of course plain ents is only for mucus so not loose your time with them.
This type of surgery (mvd) has many complications some most of them are serious so surgery is last resort treatment.
in reality if you can't live anymore and all medications failed.
Also have any symptom from vestibular system ? dizziness / vertigo ?

 

No, no dizziness or vertigo, at all. The strange thing is that all my problems started after that acoustic trauma incident... Hyperacusis, tinnitus, hearing loss. I didn't have them before. But I did experience smaller tinnitus from time to time before, a sense of fullness, less noise tolerance and trouble sleeping. Not in this degree as now though.

I guess since Neurontin does not do any good perhaps I should try another drug (Tegretol?) and my next step would be to find where to do these exams HF audiogram/OAEs/ABR. Will they provide positive results? I also have the MRI...

 

I told you where to go http://www.paidon-agiasofia.gr/?cat=12&sub=12.03.05&view=view
or make a phone to them to suggest you other clinic with reputation.

Stop neurontin this will give you bigger problem i don't think that tegretol will help
but if you want to try it ...
Have you tried supplement to help cochlea to recover i say that because you problem is not chronic.
HBO / intatympanic steroids with lidocaine / creatine / aminoacids / magnesium / acetylcysteine
/ B3 / b12 / b6 / A / B / C / D / E / piracetam / pentoxyfilline and more

 

Tried HBO and mag 2 and a half months after acoustic trauma, didn't work.
Intraympanic steroids with lidocaine is something none of the doctors Ive visited suggested or even mentioned. I wouldn't know who does that either... here in Greece. Tried neurobion injections didn't do a thing. And stugeron for 2 months.

 

Ok did OEM and ABR to a doctor, he said the first shows damaged cochlea cells in both ears and the ABR is normal. Don't know how safe it is to deduce such a thing from a 2 min exam (and about 5 min the ABR). Here are the exams:

 

Damaged cochlea means there is no cure with surgery.
This does not mean that your T is 100% from damaged cochlea.
Where is the high frequency audiogram ? It is critical exam.

 

No such thing, nobody I've been too does it here in Salonika. Why is it critical?

 

You have not searched very well.Do a high frequency audiogram to see hearing in high frequencies.
If the hearing is the same in both ears and only right has T then you can suppose mvc for right ear.

Have you seen any improvement from onset ?

 

The improvement I have seen is that if my T was a 9 at onset, now it becomes a 4 at times, there are good days and bad days. At the beginning it was a constant 9 for about 3 months, couldn't sleep without pills. My H though is bad all times, and I feel I lack certain frequencies, I have a terrible destroyed coming from certain high frequencies such as a plastic bag or paper folding or something.

Really, I cannot find where to conduct a HF audiogram. Is there a place you might know?

 

(continues from another topic):
Now no doctor in Greece would perform mvd surgery, they don't even attribute my T to mvc. And all this without even looking at the MRI or ABR that show signs of microvascular compression!

 

@skoupidis To answer your questions: My tinnitus was sudden onset, unilateral, pulsitile tinnitus with no acoustic trauma. It sounded like a high-pitched car alarm going off in my head. I also developed severe H in that ear. Best to you!

 

An alarm is like continuous and fluctuating. Is it like that? Or it is not continuous? When you say pulsatile you mean intermittent, with interruptions? Mine has no stopping, only lots of flux! It may have a pulsatile state but I cannot tell! Like a pressure cooker only in its calm state, not when it goes like a train, if you get my meaning...

 

Pulsitile means that it is in sync with your heartbeat. So it is not continuous. Mine fluctuated a lot at first. It seemed like a moving target until the later days.

 

I cannot understand what "moving target" means. Could you be more specific? An example of natural sound silmilar to your t perhaps?
How are you doing today? Tinnitus wise and the rest (dissiness, sight)?

 

Moving target means that it fluctuates and moves around. My tinnitus has changed from a high-pitched piercing sound to more of a broadband sound. Yesterday it sounded like it was going away, but today it is more pronounced. I am still in the early stages of healing, so there is a lot of change going on daily. The vertigo (dizziness) will take about three months of vestibular rehabilitation exercises. The neurosurgeons said they were really careful, but they had to really pull on my vestibular nerve. I still wake up with double vision, but once I am up it goes away. My pupils are starting to respond more and are not as dilated, which helps. You can read more about some of this in the thread: Medical (Neurological) Explanation of Tinnitus. We got a bit off topic, but nobody seemed to mind.

You may want to send your ear MRI to a Neuroscience Institute for an evaluation of whether or not you are a candidate for MVD. A competent neuro radiologist, along with renown neurosurgeon and neuro-otologist, is critical in making this evaluation. I had a complete team of several neurosurgeons working on my case.

 

Your T responds to lorazepam + retigabine ?

 

@1MW My ringing did respond to Klonopin. I had a bad reaction to lorazepam (paradoxical effects) and have not taken Retagabine.

 

Mvc syndrome is known to be responsive to certain medication such as Carbamazepine (Tegretol). Or perhaps other anticonvulsants like Neurontin. Have you tried any of those before surgery?

 

I had a bad reaction to Carbamazepine. I went off it after a week. I have been on Neurontin at a low dose for a year. Not sure if it does any good, but I think I notice a difference when I forget to take it. My MVC was pulsatile and was very easily diagnosed with an MRI, MRA, and then a specialized MRI of the ear. I tried all noninvasive treatments possible for a year before having surgery. Most of the treatments made it worse with the exception of cold laser, which often helped. The surgery was my only option for padding that nerve from the artery. It was only going to get worse.