Does Your Doctor Listen to Your Ears?

Discussion in 'Support' started by Dr. Nagler, May 26, 2015.

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Have you had an ENT examination where your doctor actually listened to your ears with a stethoscope?

  1. Yes

  2. No

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    1. Dr. Nagler

      Dr. Nagler Member

      Location:
      Atlanta, Georgia USA
      Tinnitus Since:
      04/1994
      Hi All -

      In another thread I posted a story about a patient of mine:

      The third patient is a female in her mid-30s who lived in the Midwest. She presented with a six-month history of increasingly loud ringing in her left ear. She had been to three ENTs, all of whom told her that she had tinnitus and had to learn to live with it. She became distracted, distraught, and depressed. She tried a number of different medications and treatment protocols all to no avail. In desperation she flew all the way to Atlanta to see me. (Talk about scraping the bottom of the barrel!) I took a history and reviewed all of her records. The next thing I did was examine her (which is sort of what doctors do!) I looked in her ears, and then I listened to her ears with a stethoscope. I also listened to her neck and all over her head with a stethoscope. Nothing particularly noteworthy in any of that. Finally I inserted a small electronic amplifier into both ear canals and listened again. It was at that point that I was able to detect a sound in her left ear similar to the sound she was describing. It was a venous hum, the sound of turbulent blood flow coursing through the low-pressure venous system (as opposed to a bruit, the sound of turbulent blood flow in the high-pressure arterial system). I turned my attention again to her neck and in a very quiet room was able to trace the origin of the sound to a point high up in her left jugular system. I asked one of my colleagues in vascular radiology to do a selective venous jugular study. He found a tight stenosis, which he gently dilated up over two sessions. And she was cured! Although she had been told by three different ENTs that she had tinnitus, as it turned out she did not have tinnitus at all. What she had was a somatosound emanating from her distal jugular venous system. (And the very last thing she needed was the TRT that she came to me for originally!)

      Almost everybody on this board has been to an ENT at one time or another because of tinnitus. I would like to know how many of those ENTs actually took the time to listen to your ears as part of your examination.

      Thank you.
       
    2. Nucleo

      Nucleo Member Benefactor

      Tinnitus Since:
      02/2011
      None. Only visual inspection.
       
    3. Ricky81
      Worried

      Ricky81 Member Benefactor

      Tinnitus Since:
      July 14, 2014
      Cause of Tinnitus:
      Assault/Contusion/Ear Infection
      None.. ENT only looked down my ears via some flashlight but I do have mri results and ent said it looks ok.

      Dr. Nagler.. maybe I should come visit you in atlanta. In a quite room.. I hear a heartbeat sound in my left ear.. if I twist my head it goes away.

      My T does not change with Head movement.
       
    4. Telis

      Telis Member Hall of Fame

      Location:
      Calgary
      Tinnitus Since:
      11/2013
      Been once, visual inspection only.
       
    5. marqualler
      Nerdy

      marqualler Member Benefactor

      Location:
      Minneapolis, MN
      Tinnitus Since:
      10/2014
      Cause of Tinnitus:
      Ear infection / Mild Noise Induced Hearing Loss
      @Dr. Nagler, I have visited a couple of different ENTs and neither have actually "listened" to my ears like that. Would be an interesting request to make and perhaps I will ask my ENT to do this when I make a new appointment in the near future. Going generally to get fitted with musicians' earplugs--I've found that the ones you buy are OK but to a limited degree because my ear canals are slightly different sizes and my ear canals seem to point "up" as opposed to vertical--very strange indeed.

      Thanks for the interesting conversation starter!
       
    6. Beth
      Inspired

      Beth Member Benefactor

      Location:
      England
      Tinnitus Since:
      quite a while...
      No, I paid £125 (it had to be cash) for a 10 minute maximum visit with ENT, just a torch shone in ears and a quick hearing test, not even proper equipment. Session ended with me being told to get used to it as I'd probably have it for life.
       
    7. Dr. Nagler

      Dr. Nagler Member

      Location:
      Atlanta, Georgia USA
      Tinnitus Since:
      04/1994
      I think it's really pitiful when the patient has to tell the doctor how to perform a proper examination.
       
      • Like Like x 1
    8. lapidus

      lapidus Member

      Location:
      Sweden
      Tinnitus Since:
      1999
      Cause of Tinnitus:
      Noise induced
      I didnt even know it was a thing.
       
    9. Dr. Nagler

      Dr. Nagler Member

      Location:
      Atlanta, Georgia USA
      Tinnitus Since:
      04/1994
      I located a wav file with the amplified recording from patient to whom I was referring at the start of this thread and will attach it to this post. I first recorded from her right ear canal (which was normal) and then from her left ear canal (with the venous hum).
       

      Attached Files:

    10. skoupidis

      skoupidis Member

      Tinnitus Since:
      09/2014
      Cause of Tinnitus:
      Acoustic trauma or mvc
      I wish we had doctors like you in my country. I have been to about 20 doctors and all came to the conclusion that I have to live with this without listening to my ears. Nobody. There were also those that didn't even bother to look properly...
       
      • Agree Agree x 2
    11. tinnitussufferer
      Angry

      tinnitussufferer Member

      Location:
      UK
      Tinnitus Since:
      1/2004
      i have not had mine listened to. People need to be made more aware of what it is they are experiencing. I have seen numerous people on here posting that they have tinnitus when in fact it turned out to be caused by blood vessels or something similar.
       
    12. Dr. Nagler

      Dr. Nagler Member

      Location:
      Atlanta, Georgia USA
      Tinnitus Since:
      04/1994
      Interesting survey results so far. And sad. Of the 26 people who have responded so far to my little survey here, not even one reports that an ENT listened to his or her ears.

      You go the doc because you have ringing in your ears ... and the doc doesn't bother to check to see if it's your ears that are actually ringing!
       
    13. LadyDi
      Busy

      LadyDi Member Benefactor

      Location:
      Florida, USA
      Tinnitus Since:
      06/2013
      Cause of Tinnitus:
      Barotrauma/airplane
      Very interesting, @Dr. Nagler I have been to quite a few ENTs/otolaryngology experts since my tinnitus came along, including two well-regarded inner ear surgeons/specialists that I had to travel a ways to see. No one ever has put a stethoscope to my ears. I always assumed because I was told I have subjective tinnitus, no one else could hear it. Thank you for this post.
       
    14. Dr. Nagler

      Dr. Nagler Member

      Location:
      Atlanta, Georgia USA
      Tinnitus Since:
      04/1994
      That's backwards (although as a patient, there's no way you would know.) An ENT cannot rightfully tell you that you have "subjective tinnitus" unless he or she has first very carefully listened to your ears to rule out the possibility that you have "objective tinnitus."

      You are welcome.
       
    15. Carm

      Carm Member

      Tinnitus Since:
      04/01/2011
      The poll goes to show how crooked most doctors are.

      What are they doing??
       
    16. soundmachine
      Buzzed

      soundmachine Member Benefactor

      Location:
      USA
      Tinnitus Since:
      03/2014
      Cause of Tinnitus:
      Acoustic + Ototoxicity
      Nada...zip. Just an audiogram and a patronizing pat on the shoulders that I have to "live with it". Yea...medicine (and all of its deep understanding) to the rescue....NOT!
       
    17. Dr. Nagler

      Dr. Nagler Member

      Location:
      Atlanta, Georgia USA
      Tinnitus Since:
      04/1994
      Well, that's harsh!

      Look, I know far more doctors than you will ever know. Many are ignorant about one thing or another. That's why they take Continuing Medical Education courses. But in my experience relatively few are actually "crooked."
       
      • Like Like x 1
    18. Carm

      Carm Member

      Tinnitus Since:
      04/01/2011
      Have you read posts by people? Most doctors dismiss tinnitus patients. They know tinnitus is impossible to treat so they don't even bother.

      There is no prescription they can write so they give up before even trying anything...

      It's sad! :cry:
       
      • Agree Agree x 1
    19. carlover
      English

      carlover Member Benefactor

      Location:
      London
      Tinnitus Since:
      1986
      They are of course not crooked but when they see you have come in for Tinnitus they want you out their office double quick.......I see from the RNID Forum a while back there are protocols half an inch thick they are supposed to put in practice in the UK,more chance of winning the lottery
       
      • Hug Hug x 1
    20. marqualler
      Nerdy

      marqualler Member Benefactor

      Location:
      Minneapolis, MN
      Tinnitus Since:
      10/2014
      Cause of Tinnitus:
      Ear infection / Mild Noise Induced Hearing Loss
      I have seen a lot of doctors in my lifetime and I wouldn't say that any of them are "crooked" either, but I think there is something to be said about being an informed and educated patient.

      For instance I have been a longtime patient of an ophthalmologist who has treated my chronic inflammation in my eyes caused by Bleferitis, and I recently asked him about using Fish Oil supplements to help as a supplement to my dry eye condition. Much to my surprise, when I asked him about it, he actually cited some studies that showed that there is some link to fish oil supplements and aiding in dry eye relief. Although we agreed that I would stay on my Restasis eye drops, the fish oil supplements have also seemingly given me a slight increase in my vision clarity and dry eye. All because I did some research on my condition and asked him questions.

      For the most part I think most doctors will check you and see you "in and out" because of the nature of their schedules. That is probably a debate to be taken up somewhere else, which seems to be more to do with the nature of the health care industry in general, a much bigger and more complex topic.

      I have a lot of friends who are med students or residents and soon to be MDs, and not one of them is who I would consider "crooked". But I also do think having a mutual level of trust is extremely important, and doing a little homework before your appointment can help.
       
      • Agree Agree x 1
    21. skoupidis

      skoupidis Member

      Tinnitus Since:
      09/2014
      Cause of Tinnitus:
      Acoustic trauma or mvc
      Actually, this sound is quite different than mine: Mine is very high pitched (~15000Hz) and it is not synchronous to heartbeat as this recording of your patient is. So, this is what pulsatile T sounds like..
      My sound however, does have certain water flaw sounds at times, like a brief running of liquid that ends quickly and while at it, T seems to be a lot lower. When the liquid flaw ends, T starts up again. And I also get brief loud spikes in every step I take wile walking. A zip zip zip sound.
      I don't know if this qualifies as pulsitile tinnitus, somatic tinnitus, or T caused by microvascular compression, as my MRI AC shows I do have...
       
    22. Dr. Nagler

      Dr. Nagler Member

      Location:
      Atlanta, Georgia USA
      Tinnitus Since:
      04/1994
      ENT is a surgical discipline. You have a non-surgical problem largely involving the auditory pathways within the brain ... and you go to an ear surgeon for help with it. No wonder you leave frustrated! Likely the doctor is as frustrated as you are!

      Why not contact the doctor's office before making that appointment ... and ask whether the doctor has an interest in seeing, evaluating, and treating tinnitus patients. If the answer is no, you have saved both you and the doctor a lot of grief.

      I think @marqualler had it exactly right earlier, when he said that as patients we should do a little homework.
       
    23. Dr. Nagler

      Dr. Nagler Member

      Location:
      Atlanta, Georgia USA
      Tinnitus Since:
      04/1994
      Everybody's tinnitus is unique.

      No. What I have recorded is not pulsatile tinnitus. What I have recorded is an example of one type of venous hum.
       
    24. Nucleo

      Nucleo Member Benefactor

      Tinnitus Since:
      02/2011
      Well GPs do refer us to ENTs...
       
    25. Dr. Nagler

      Dr. Nagler Member

      Location:
      Atlanta, Georgia USA
      Tinnitus Since:
      04/1994
      Then ask your GP to refer you to an ENT who he or she knows to be particularly interested in the evaluation and treatment of tinnitus sufferers.
       
    26. marqualler
      Nerdy

      marqualler Member Benefactor

      Location:
      Minneapolis, MN
      Tinnitus Since:
      10/2014
      Cause of Tinnitus:
      Ear infection / Mild Noise Induced Hearing Loss
      FWIW--in a separate practice of medicine, the field of psychology, I have been "interviewing" potential therapists who may be able to help me by asking them if they have ever treated patients with tinnitus. Although I consider myself mostly habituated, I would still like to see a therapist who "understands" tinnitus more than the average person so that if it comes up in therapy, it is something he or she might have some background in. As it happens, the first person I contacted had not treated patients with tinnitus before, but she sent a message out to her psychology listserv and had a number of colleagues provide her with information about how it can be managed. Since she has other approaches that I like (including incorporating yoga and Eastern philosophies alongside CBT and Western philosophies) and she has shown herself to be adaptable to other patients' needs by learning about tinnitus, she may have a new long-term patient in me!

      Just goes to show that I really do think the doctor-patient relationship is a 2-way street and in order to get the most out of it, one needs to make sure that the 2-way street is established.
       
      • Agree Agree x 1
    27. undecided
      Fine

      undecided Member

      Location:
      Greece
      Tinnitus Since:
      04/2014
      Cause of Tinnitus:
      Unknown.
      Very interesting topic and survey.

      Not one of the ENTs or neurotologists I have visited (and there were many) actually took the time to listen to my ears.
      Visual inspection only.

      Out of all of them, one is supposedly an expert in pulsatile tinnitus (Aristides Sismanis) and has publications on the subject. He didn't even bother.
      I actually had to ASK him to listen... he looked around for a stethoscope (he had one buried somewhere in his office) and he 'listened'. I don't know what the hell he was listening though because he didn't really seem to know what to listen for and his office wasn't the quietest place to begin with...

      He certainly did bother asking for his 100 euros visit fee though. He was quite thorough about that.
       
    28. Carm

      Carm Member

      Tinnitus Since:
      04/01/2011
      Many doctors don't listen to patients' wishes or requests.

      It's not unusual for a doctor to feel offended if you try to show them something they don't know about...

      They are megalomaniacs...
       
    29. vasil

      vasil Member

      Tinnitus Since:
      July 2014
      Nope. I had and still have some neck troubles and pains, so its worth a try, if I manage to find a good enough doctor to do this.
      The first ENT i visited, didnt manage to find that i had eustachian tube inflamation or whatever it is called. And he was the head of the ENT departament in the local hospital. The second one found it for 10 seconds, so its probably not that hard for a specialist.
       
    30. patwalsh
      Confused

      patwalsh Member

      Location:
      England , Isle of Wight
      Tinnitus Since:
      March 2015
      I'm due to go and see the ENT consultant on the 2nd of June . My T is in my left ear. Do you think I should mention this to him?
       

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