Hidden Hearing Loss & Hyperacusis After Gunshot

Hi everyone,

in the research on my hearing problems, I stumbled across this forum and find it a super helpful resource.

I am 29 y.o., m, from Germany, and always considered my hearing to be excellent. I was attending some very loud raves and concerts in the past, but wore protection most of the time. At New Year's Eve 2021, however, there was a gunshot next to my unprotected right ear, which seems to have damaged it.

My symptoms in the right ear are now:

• everything is quieter, less clear, distorted
• many mid- to high-pitched sounds hurt
• my own voice roars in that ear
  
• often have listening fatigueness and a feeling of pressure in the ear
• luckily only occasional and very mild tinnitus (yet)

Two different ENT's did threshold and tympanometry tests (all perfect) and sent me home. However, my every day experience is so different compared to before the trauma. I've lost the symmetry in my world. I stopped listening to music almost entirely, because it lost its ease, it became really exhausting in a sense. Considering my intact thresholds, I believe that my condition falls under hidden hearing loss (synaptopathy) and hyperacusis.

I know that my condition is probably much less severe than other cases in this forum, but I'm still so desperate about it because I don't know what to do or how to deal with it. I'm also in fear that it gets worse or a permanent tinnitus develops, given that my hearing is now much more vulnerable than before (as I gather from what many people write in the forum).

I would like to get my condition further examined, with an ABR for instance. Do you have any advice for how and where to get this done? Shall I ask the ENT if he can refer me to some expert clinic? If my ABR shows something, I would possibly consider a neurotrophin-3 (NT3) treatment. Someone else in the forum undergoes the same procedure currently, I'm excited for the results:

https://www.tinnitustalk.com/threads/stem-cell-secretome-treatment.46583/

Btw, I'm using Astaxanthin in order to increase NT3 for months now but without any effects. I don't really believe in it, but in lack of alternatives I will still ramp up the dosage now.

Does anyone else suffer from a similar condition? I'm very happy to exchange experiences, treatment ideas and coping strategies.

 

Hi, welcome to the forum!

Those are symptoms related to exposure to very loud noise. Some people call that "acoustic shock disorder". Depending on the symptoms you can have tinnitus, or hidden hearing loss etc...

The root cause of your troubles is clear: the gunshot.

Damage produced by noise is cumulative, so be careful with loud noises... and good luck!

 

Hey @tenforce, first and foremost I'm sorry you're going through this nightmare. It can very well be exhausting. We can't turn off our ears and so much of our perception is dictated by the ears, second only to maybe the eyes.

I too am excited and hopeful for @Tau's results but in the mean time I have some good news to share. I know of an individual who got better with respect to pain after his gunshot after 3 years. 6 months ,while seeming like an eternity, is actually a small amount with respect to hyperacusis. One thing I would underscore is to protect BOTH your ears from noise exposure going forward. You can read @Brian Newman's post.

I'm getting an ABR test tomorrow. I'll let you know how it goes!

One last thing. You mentioned something quite peculiar and rare; your own voice roars in the ear. Do you mind expanding on that? It sounds like autophony.

Glad your tinnitus is manageable. Keep living life but be vigilant and protect your hearing when needed.

 

Thanks @Juan and @SD7 for your welcoming and kind words. I definitely will try to protect my ears, both of them!

@SD7, where do you get your ABR done? At an ENT's or some other specialist? I still don't know how to exactly ask for it. Don't know if I can convince my ENTs about my plans with NT3... When the thresholds were fine, they just sent me home as if there were no other possibilities or diagnostics. Yeah and please let us know what your results are!

Regarding the roaring: Not sure if roar is the right word (not a native speaker), maybe it's better called booming. It is a bit like your voice sounds when you clog your ears. I suspect that it is somehow because my hearing, especially of the more mid-high frequencies is reduced, which makes the parts of my voice that are transmitted by the bone more dominant.

 

@tenforce, did you have the Brainstem Auditory Evoked Potential test to detect hidden hearing loss?

 

An ABR test may not detect synaptopathy if it's mild. My very first ABR did not show abnormalities (I already had distortions then), but after a month the second one did.

 

Hey @tenforce.

I sadly wasn't able to do the ABR test as they first did an LDL test and my LDLs were sadly too low and they decided not to move forward until some time passed as the ABR test can get up to 90-100 dB.

In the states I had an ENT familiar with hyperacusis refer me to an audiologist for OAE, ABR and LDL testing.

LDL update and possibly ABR in 3 months from today.

 

@PortugalTheMan, not yet, but I'm currently assessing the possibilities where to get it done. I definitely want to get it done, even if I have to pay for it by myself (not sure the German public insurance covers it).

@Tau, that's very interesting to know. Does it help that in my case only one ear is affected, so the other's ABR can serve as a reference?

@SD7, sorry to hear! Never heard about low LDL being a problem before. Can you do something to increase it?

 

It may actually be useful to compare wave I (signal at the cochlea) between the ears!

 

Now I got my ABR done. It was a 80 dB measurement with clicking sounds for about 2 minutes on each ear. I attached a copy of the results, if anyone is interested. (My right ear is the problematic one.)

Wave I to wave V amplitudes seem similar for both ears. However, to me this is still no real evidence against the cochlear synaptopathy that I suspect in my case, because (i) to me the measurement looks very noisy, not sure if the waves can even clearly be identified, (ii) I read that it is necessary to test at different (also higher) volumes to see the synaptopathy and (iii) there is still the possibility that my synapse loss is simply too mild to be detected.

These are all *my* interpretations. My ENT told me that the latencies are fine and that the amplitudes have no meaning at all. She further told me, that the only thing a sound trauma could damage are the hair cells, and that this would show up in a threshold test. She has never heard of hidden hearing loss or cochlear synaptopathy and the bottom line was, that I should learn to deal with the condition. She said that in 10 - 15 years, age related hearing loss will set in anyway. That is what you want to hear, lol!

I'm not sure what to make out of this. But already from pure logic, I cannot expect to get diagnosed with something that the doctor hasn't even heard of. My plan is now to get in touch with a clinic that is more professional and closer to research...

 

When I had my ABR they said in order to get a good wave form to detect synaptopathy they would likely need to go up to 100dB. I have hyperacusis/noxacusis so I didn’t agree. 80 was where I stopped.

 

I found this to be a nice guide: ABR: An Illustration of Auditory Dysfunction, but ultimately one needs an otologist to look at it. A simple ALR click is often not enough.

 

I've been having the exact same problems since my ears were cleaned with a hospital suction device. Everything sounds really harsh and hits my ear almost violently, especially percussion. If you figure out anything about the etiology, please post. I'm considering ossicular chain dislocation or problems with the eardrum. It doesn't even feel like hearing loss, but ear dysfunction.

 

Couldn't this be hidden hearing loss be damage to hair cells outside of the tones tested, instead of synaptopathy?

 

In the meanwhile I was at an ENT clinic to do some further tests, like pressure measurement (which was normal), high-frequency audiogram (which turned out to be fine @dbeats), and word recognition in noise (where I performed a bit worse than average). They couldn't tell me anything new, only that they are no specialists for synaptopathies either and that they offer me an MRT to check for an inflammation of the hearing nerve (which I might do in the next year).

I'm actually not so sure any more that I have (only) synaptopathy. The one-sided hearing loss is always there (which I can check with headphones), but the ear pressure, autophony, hyperacusis and clicking sounds when speaking or swallowing (also all one-sided) seem to be fluctuating. I went to a chiropractor who focussed on my neck area, and three days later all symptoms (except the hearing loss) got much better, which made my whole condition much more bearable. However, all symptoms returned a week after. It could be entirely random and not related at all, but I will definitely further pursue the chiropractor approach to make sure. (I have to add that the tests I mentioned above, including the pressure test, were all done in that one week where the most annoying symptoms were gone...)

Right now I start to speculate about a Patulous Eustachian Tube (PET) or other ventilation/pressure related (maybe in addition to a synaptopathy). I have to read more about it, but many of the described symptoms seem very familiar. Finally, I have to also consider a stress related psychosomatic cause.

The search goes on, I will keep you updated. Let me know if you have any related experiences!

 

I saw the chiropractor again this week, and two days later some of the symptoms (autophony, hyperacusis) became better once again. This is either a big coincidence, a case of placebo, or indeed something with the ear tubes related to the alignment of the neck vertibrea (which were again adjusted and the attached muscles were massaged).

 

It was a NUCCA type that aligns C1 and C2 or was it a regular Chriropractor?

I'm glad to hear it is working for you. I will see a NUCCA specialist in two weeks to start the process.

 

A belated welcome to the community @tenforce.

I am also curious about what type of chiro you saw, NUCCA or regular (who just focused on your cervical spine).

My current working theory is focused on chiropractic treatments and their connection to the nasal cavities, in particular the Eustachian tubes, so I’ll be very interested to see if this leads to any results for you. Good luck!

@NYCGuy - I will assume that you are also in NYC. Which NUCCA specialist are you going to? I haven’t yet found one in the city that I feel particularly excited about trying.

 

I'm going to one in NJ, the one in NYC uses atlas and I went with the regular one that uses the hand.

Molland is the guy's name in NJ.

 

Seems like you are going to be in good hands as the positive reception seems extremely high going by Google reviews.

@hartstreet, there is a upper cervical chiropractor in Manhattan named Dr. Matt Glass. I know a few people who went to see him and they love the guy.

 

I don't know if it'd be better to go to Matt Glass. He is even closer to me. He does NUCCA, right? You know anybody who went to him?

 

One of my co workers mentioned Glass and I believe she still sees him regularly. She told me “Glass is my go-to neck therapist.” According to her, Glass does not do any of those crazy loud cracking maneuvers, and he is much more gentle, but effective. This coworker has a relative who also sees him.

These are his qualifications taken from his website.

• Dr. Glass is one of just a handfull of Chiropractors in the world that has training in 3 different Upper Cervical Procedures: 1. Qsm3 (Quantum Spinal Mecahnics) 2. NUCCA 3. Knee Chest Specific

• Worked and Trained with the only triple board certified Chiropractor in the U.S. and the founder of Quantum Spinal Mechanics(QSM3)

• Post Graduate studies in X-Ray Physics, Spinal Mechanics, Upper Cervical Neurology, and Chiropractic Philosophy.

• Certified Crossfit Level 1 Trainer

• Certified Crossfit Kids Trainer

• Member of Delta Sigma Chi – Professional Chiropractic Fraternity

 

Thank you so much!

 

I called him and now I'm in total doubt which one to go. Seems similar but at the same time very different. Dr. Glass is nice but it seems he doesn't have X-ray so you have to go to another place to get them once and that's all.

The other NUCCA seems to keep getting X-ray during the process, to see how everything is involved.

I will have to make a decision this week. I know for sure my tinnitus is due to neck and TMJ. I remember the night that I got tinnitus was when I moved my jaw forward and that's when everything started.

 

I think the continual X-rays may be more beneficial in your case.

 

@NYCGuy, @hartstreet, I went to a regular chiropractor, who checked everything, but focused on the cervical.

I have never heard about the NUCCA thing, does it even exist in Germany?

Compared to Dr. Glass, mine is probably much less sophisticated when it comes to the qualifications. Anyways, it seems to help. But yet again the positive effects, mostly just having less of a pressure feeling, gradually went away again after a week, sadly.

 

Glass isn’t on the NUCCA website, though I don’t think it matters. Ultimately you just want someone who is doing something other than the high velocity cracking. I was going to go to AMAYU in midtown, because it was the closest one to my office when I searched the NUCCA website. I wouldn’t stress too much which one is best, they all seem highly rated and take generally the same approach - when in doubt, I’ve always gone with convenience. Particularly if you’ll potentially be making lots of visits, I imagine cutting down travel time will be nice.

For Glass, he said you had to go elsewhere to get X-rays? Or he just didn’t use them? I have a number of MRIs, I wonder if he could work with them.

Unfortunately, I got COVID-19 for Christmas, so I had a pretty substantial setback. If I were to try to look at it positively, it sort of confirmed that my tinnitus is related to these roots causes I’m exploring, i.e., Eustachian tubes and neck, since all of those issues have gotten worse together. Here’s hoping they can all get better together, and ultimately all be cured together too.

 

I checked the NUCCA website and unfortunately they aren’t in Germany, but I bet there is some equivalent. The big difference is just that it isn’t that high velocity whipping action of the neck, and is focused on the cervical spine. My doctor says the whipping action can cause strokes, though I’m not confident it’s well established and it’s a calculated risk worth taking for me if it works. My regular chiro just wasn’t focused enough on the cervical spine, more of a generalist.

AtlasPROfilax, which is a different type of upper cervical treatment, intending to massage the muscles and tendons around the cervical spine, is from your neighboring Switzerland, and I imagine is also in Germany, if you wanted to explore other options. After NUCCA, that’s going to be my next stop.

 

He said it was a very special 3D X-ray and that it was taken somewhere else. He said he just needs them once and then works from there.

Others NUCCA I went to said they do X-ray very often to keep track of the alignment and when you go and they do X-ray and everything looks good they don't adjust you but seems Glass works differently.

 

@tenforce, just reading your story, I was wondering how are you today? Did the hidden hearing loss improve? I'm experiencing that now at work. I'm 7 weeks post sudden acoustic trauma.