Dear attheedgeofscience I Need Your Valuable Opinion

Dear @attheedgeofscience,

Thank you very much for sharing with us your theory regarding hearing loss and T and your experience with LLLT/stem cell/HIFU. I developed T during mid-Oct and when I went to ENT/Audiologist at late Oct my hearing test turned out normal. T didn't go away and I went to Otoneurolwogist again and did a hearing test again including high frequency range. The test result has been withheld from me despite my effort to urge the Dr. to give me the HF audiogram. When I finally managed to get the audiogram I was shocked to discover there is a sharp decline (25dB) at 16kHz for the right ear. I wonder if it's the reason behind my T. Whether it is induced by Ototoxic drug (only took a very small amount) or AT I am not sure, but I do remember prior to developing T I had H, slightly muffled hearing preceeded by dizziness and balance issue, but I can't link it to any specific acoustic event (I have never been exposed to loud noise) that happened during the period. I've heard that stem cell treatment has improved your T and hearing. So far none of my doctors are helpful (my doctors did not recommend intratympanic injection as they conclude I have "normal" hearing, and my neurologist=doesn't know anything about EEG's value in diagnosis of T, plus he refused to prescribe me any medicine and he told me there's nothing he could do for me, ENT=the usual wait and see attitude) and I urgently need advice from someone who has experience. It would be very nice if you could give me some personal opinion/suggestions. Where can I find a Dr. who is really helpful and knowledgeable in T so that I can get a proper diagnosis and evidence-based treatment at this acute stage? Thank you very much.

xv

 

The medical literature on very high frequency audiology is generally weak. For historical (and practical) reasons, audiology has been focused on the speech frequency range only, and therefore not too much is known about what types of hearing loss should be expected in the higher frequencies above 8 kHz.

Depending on your age, if you showed your audiogram to the average ENT, he/she would be shocked too because... your hearing is generally very good (in the region above 8 kHz - and also below). Of course the opinion of an ENT in this specific matter is not too important as the average ENT could go through his or his entire career without ever diagnosing a single patient based on a high frequency audiogram! The average ENT would assume that everyone past the age of 30 has a measurable amount of hearing loss (say 25/30 db starting at 12,5 kHz and progressively getting worse towards 16 kHz). However, this assumption is not necessarily true. Your audiograms reflect that it is entirely possible to preserve high frequency hearing "all the way", so to speak...

So what do I see... well, there is some discrepancy between your left- and right ear at certain frequencies (eg. at 2, 8, and 16 kHz). If your tinnitus is tonal (and intrusive) and the test non-pulsed, it is possible that your tinnitus influenced the result. As indicated earlier on - and depending on your age - your hearing is either good or very good (in general). However, "dips" on an audiogram such as that at 16 kHz, right ear, is of concern according to the literature developed by the inner ear specialist, Dr. Wilden. Audiology cannot be used to diagnose tinnitus directly, but Dr. Wilden has refined his understanding of audiology in relation to tinnitus, and has come to the conclusion that hearing loss worse than 10db in combination with "dips" are a cause for concern (= risk of tinnitus). He therefore sets the bar higher than the average ENT who says that tinnitus is only possible when actual hearing loss is diagnosed ie. a threshold worse than 25 db in the speech frequency range (for adults - and 15 db for children, I believe).

My journey into the world of experimental medicine was concluded by my visit with Prof. Jeanmonod in Switzerland. After this visit, it is safe to say that there are four overall possible origins of tinnitus:

• an origin related to a dysfunction in the brain
• a cochlear origin
• a muscular-tension origin
• a possible emotional/psychological origin

The average doctor in the world will use phrases such as "tinnitus is a brain thing" once it is declared chronic (eg. after 6 or 12 months). This is likely not to be true. At least not entirely true. Auris Medical has currently raised captial worth $126M for their company in relation to their otology therapy development programme. And to use your own word, I was "shocked" when I learnt that AM-102 - which I have disclosed details on in the AM-102 thread - is yet another intratympanic delivered application (presumably aimed at chronic cochlear tinnitus). Auris Medical would not have invested that much money into otology research if they did not believe that tinnitus - at least in some cases - is of a cochlear origin.

I do not have a medical background, but it is my understanding/opinion that unilateral ototoxicity is possible (but not likely) with eg. eardrops used one side only (risk being somewhat higher if there is perforation of the eardrum). Ototoxicity from oral (and especially IV) medication is also possible but takes a while to develop and generally only occurs from the really nasty stuff such as aminoglycosides antibiotics - but there are anecdotal accounts of bad experiences from "lesser events". I believe it is also possible to develop tinnitus from following the wrong tapering of certain types of medication (ie. "cold turkey" as opposed to a slow taper). How such wrong protocols would manifest themselves in terms of audiology (if at all) is unclear to me.

I cannot really advise you what to do. I have shared my own story and insight with various therapies. Since there is no way to diagnose subjective tinnitus objectively (except for a certain type of tinnitus known as brain(wave) dysrhythmia), I cannot really advise you as to how to proceed, I am afraid. You will have to make your own interpretation. Sadly. This is the reality of (modern) medicine in the year... 2014... well 2015, actually.

 

-25dB drop and at those high frequencies is not that significant in my (amateur) opinion. There is also probably +/- variance of 10-20dB easily, and again, especially at those very high frequencies.

 

Your audiogram looks pretty good to my untrained eye... if only a bit like a roller coaster. Everything up to 8khz seems to be okay with the slight dip at 2k and 8k being within the threshold... which I believe is 20db?

After that one would expect the higher frequencies to continue going down. Yours really don't that much until you hit 16khz and then what is strange to me is that they go back up. I am no doctor and I can only compare it to mine but when I was given an audiogram my 2-8khz was ok until 8khz it started to drop, and then farther and farther straight down as I went up the scale.

I'm curious, can you hear sounds at 14khz and 18khz and just not 20khz? I wonder if your chart or mine is unusual.

In my case, the doctor didn't know why my hearing was dipping at 8k. I asked about the higher ranges too but she didn't seem to care as there is a lot of variability in hearing those ranges especially as you age. For example, I'm 30 and I believe she said it was slightly out of the ordinary but nothing to worry about. My dip started going on a tail dive at 14khz.

I did also ask if hearing loss in the higher frequencies is related to antibiotic ototoxicity and she couldn't say definitively but did say that would be the range of hearing where it would be seen. The 2-4khz is where acoustic trauma normally hits from what I gather.

So uhm yeah, not really sure what I'm contributing but I would be interested as to what causes dips at 2k, 8k, then 16khz and then back up to normal. Anyone else have that or is my audiogram the odd one out?

 

I personally think this looks great. You're hearing at -10 db! That's ridiculously soft.

 

Well, like stated before me. I think you have excellent hearing. Here is some average normal tresholds:



Source: https://ispub.com/IJORL/10/2/4039#

Additionally I red a study some time ago which concluded that most people have slightly worse hearing in right ear than in left above 8000Hz.

If the graph and the study I linked is valid, you have such a good hearing at 18kHz and 20kHz that either you are a new born baby or there is some calibration issues with the device you were tested with. I assume former

 

Few months ago I could hear tones up to 18400 at 39. Now I cannot hear 10000 in my left ear after the cold that got into me.
I wish I would have that kind of hearing. Music with high frequencies is so pure.

 

I'm 41, having bad T since more that 4½ years now. I'm a professionnal musician and studio owner/producer for 25 years. I always took care of my ear, but they've seen some loud music, sometimes, but not as much as one may thinks... Believe it or not, but my audiogram (Medium Frequencies AND High Frequencies) is not far from the one of the OP.



However, I'm struggling with a very high pitched T (14.5KHz) - reference level range from 50 to 90db on the bad days)- and added since 6-8 months, a mix of white/pink noise, in L and/or R ears depending on the days...

I have a low white cells and platelets count in my blood (around 3.0 and 80 000) known and unexplained for 20 years now.

For me, there's 2 or 3 possibilities; a terrible emotional/psychological shock (which I had 5 years ago), or some bacterial disease like Lyme (which I'm currently being treated for; it could also explain my blood problem, and many other symptoms I have besides my Ts), or some unknown virus.

Clearly, there's many causes possible for Ts, which is why this condition is so hard to cure.

Still wishing for a cure for all of us. It's a very hard condition to deal with, believe me, I know what I'm talking about.

 

The audiograms shows a notch at 4 khz. This is well defined in the litterature as a sign of early noise-induced hearing loss. This would not be surprising given your professional history as a musician.

 

I agree on that. But I'm -15 db, which I believe to still be in the normal range...

 

-15 at age of 41 is perfect, no doubt

 

Sarcastic or serious here?

I never said 'perfect', I said 'normal range', that I 'believe' to be from 0 to -20.

That being said, I would be curious to see the results of let's say a 6-7 years old child, that is known to have good/normal hearing.

 

Why sarcastic? This audiogram is very god for 31 old person, and for 41 is perfect.

Just look post number 6 by Zahcarian, and picture.

 

Well, sorry, I wasn't sure what you meant exactly...

My ears are sadly not perfect anymore, but I think I'm not too bad at all for my age, especially with my professionnal background. Believe me, now it's NEVER more than 70 dba in my studio. Most of the time crusing in the 55-65 range... I'm so afraid to have more ear problems...

I'm about 90% sure my Ts are due to anxiety

 

It is more then often that audiogram is opposite to the real condition of our ears...that is why there is so many cause of t, not just hearing loss... And yes, at least anxiety is always little brother of t, sometimes I suppose even his father!