How Is SNHL diagnosed?

[Samir]

Hello!

I met with an audiologist who told me I may have sensorineural hearing loss (SNHL). But I don't have a lot to go on but the word of an audiologist and an audiogram. The audiogram showed a mild 30 dB dip at 6 kHz.

I don't trust that test very much. I was stressed out at the time and the audiologist had issues putting the bone conduction transducer on me. She wanted to skip that part of the test and just rely on the air conduction measurements. Is that normal? It was a private audiologist and hearing aid clinic.

A few months later, I went to an ENT clinic at a public hospital, met with an audiologist and did a new test. The new test showed about 15 db at 6 kHz. Maybe my hearing healed somewhat while I waited for the hospital appointment. Or it just was a better measurement, I don't know.

Besides doing the standard hearing test, what else can be done to ensure I really have SNHL? Is there a test to objectively verify this? Instead of just asking me to press a button when I think I hear a sound?

 

[PaulBe]

You could simply have the test repeated. If the same result occurs under better conditions, then that's pretty good evidence.

 

[Samir]

You could simply have the test repeated. If the same result occurs under better conditions, then that's pretty good evidence.

Good point! That's a logical and scientific approach. But since I suspect I may have endured some type of hyperacusis or phonophobia I am not so eager on repeating these hearing tests too often. I was exposed to a loud sound which is why I suspected hearing loss and went on to do the hearing test.

I think I also had what is called TTTS (tonic tensor tympani syndrome). I had sever spasms in my left ear, which was most pronounced at night and it disturbed my sleep. The spasms have almost completely subsided. I do occasionally get a spasm but the (tensor tympani) muscle only contracts one or three times rapidly. The hyperacusis or whatever it's called has subsided as well. But since December last year I have had periods of tinnitus.

 

[GregCA]

I was stressed out at the time and the audiologist had issues putting the bone conduction transducer on me. She wanted to skip that part of the test and just rely on the air conduction measurements. Is that normal?

What did she struggle with? It's like a buzzer hooked on a belt that you tighten either against your mastoid bone or forehead. I'm a bit at a loss about what could go "wrong" there.

At any rate, without a bone conduction test you will not know if your losses are conductive or sensorineural.

Other than that, yes an audiogram is generally what is used to diagnose SNHL. Just like anything, it may be a good idea to repeat the experiment a couple of times to have multiple independent data points.

 

[Samir]

What did she struggle with? It's like a buzzer hooked on a belt that you tighten either against your mastoid bone or forehead. I'm a bit at a loss about what could go "wrong" there.

She was unable to put it on my head because it kept popping off. It wouldn't stay on me. Something wrong with the headband or something, I don't know.

At any rate, without a bone conduction test you will not know if your losses are conductive or sensorineural.

Exactly! Which is why I found that unprofessional. Especially since it is my left ear that I had issues with. She had already done the right ear, she wanted to skip the left ear.

Other than that, yes an audiogram is generally what is used to diagnose SNHL. Just like anything, it may be a good idea to repeat the experiment a couple of times to have multiple independent data points.

I would like to put up my audiogram here but I there appears to be something wrong with the upload function. I keep getting an error.

I will go back to the ENT clinic at the end of Janury to see an ENT doctor who specializes in ear problems and tinnitus. Hopefully he will offer me another hearing test.

 

[Samir]

There is no bone conduction mark on either of my audiograms at 6 kHz which is where I had a dip. Is bone conduction test not possible at 6 kHz?

There is a technique where sound is used to test the cochlear function. This is based on Otoacoustic emissions (OAE). Is this the best available method for objectively testing for SNHL? I have read that this type of test is often inaccurate and the results are difficult to interpret.

 

[Samir]

Here is my first and second audiogram. I did the first one in July 2016 and the second one in October.

Are these diagrams indicative of SNHL?

First:

Second:

 

[Ed209]

We've been discussing the reliability of audiograms in another thread, and interestingly enough I raised the point that a situation could arise where someone is told they have a mild hearing loss, only to have another test and find they haven't. Your post is a real life example of this.

Were the tests done in an isolation booth, or just a quiet room?

Were both tests done under the same conditions? (Same background noise; isolation booth)

I'm with others here on the bone conduction problem. It is so simple to do that I can't believe someone would have a problem with it. In my experience they tend to want to skip the bone conduction part if the air conduction results are ok. Whether this is laziness or something, I don't know, but I had to ask for mine because they also wanted to skip it. I thought I'm paying top dollar here, I expect a thorough examination.

 

[Samir]

We've been discussing the reliability of audiograms in another thread, and interestingly enough I raised the point that a situation could arise where someone is told they have a mild hearing loss, only to have another test and find they haven't. Your post is a real life example of this.

Hi!

Are you referring to yourself here? I see you have started a new thread where you compare your two audiograms.

https://www.tinnitustalk.com/threads/the-natural-improvement-between-my-two-audiograms.19535

Is that the thread? There is also this one:

https://www.tinnitustalk.com/threads/audiogram-and-other-test-results.7623

Either way, I personally don't trust audiograms very much. Exactly for the reason you pointed out in one of the threads above: because they tend to naturally fluctuate. They are difficult to control because there are so many variables involved, both with the environment, audio equipment, calibration, human error, etc.

Were the tests done in an isolation booth, or just a quiet room?

Good question! Now that you ask me... I'm not sure I know the difference. I have to think about it...

It was a dark room, with black walls... not exactly like in a recording studio but some kind of dampening I believe. There was a windows through which I could see the operator and she closed the door on me. So yeah... I'm pretty sure it was what you call isolation booth.

Are you saying that there are audiologists that do not use an isolation booth?... that seems very unscientific and unprofessional.

Note that I had never done this kind of test ever in my life! I never had any problems with hearing... or I never noticed I had any problems.

Were both tests done under the same conditions? (Same background noise; isolation booth)

Both tests were done in what you call an isolation booth. But not at the same clinic. The first was in a private audiologist and hearing aid clinic. The second was at an ENT clinic of a public hospital.

I'm with others here on the bone conduction problem. It is so simple to do that I can't believe someone would have a problem with it. In my experience they tend to want to skip the bone conduction part if the air conduction results are ok. Whether this is laziness or something, I don't know, but I had to ask for mine because they also wanted to skip it. I thought I'm paying top dollar here, I expect a thorough examination.

Some audiologists give a bad name to the whole profession, for sure. Since I had never done this type of test I was not sure what I was going in for. I didn't even know there is such thing as "bone conduction". But now that I know I would always insist on having it done, and having it done properly and with care.

 

[Samir]

The first test was done with Otometrics OTOsuite software, some supra aural headphones for air conduction and B71 bone conduction transducer. Calibrated 2015-06-24.

The second test was done with Interacoustics Equinox software, one of those widely used Telephonics headphones and bone conduction transducer of unknown model. Calibration date unknown.

The second test diagram is very cluttered. There are a lot of crosses and circles and all that. It's hard to read. But it appears they have done the masking thing at 4K. They didn't do that on my first test.

What's most interesting to me about the bone conduction measurement is that it never once went past the the 4K mark for some reason? I would have been very interested in seeing how I perceived sound at 6K by means of bone conduction, since this is the red zone where I had a 30 dB drop by air conduction. Any idea why they never tested bone conduction at 6K? Aren't these transducers capable of those higher frequencies?

 

[Juan]

Here is my first and second audiogram. I did the first one in July 2016 and the second one in October.

Are these diagrams indicative of SNHL?

First:
View attachment 12005
Second:
View attachment 12006

According to that audiogram, you dont have much to worry about.

6.000 is a frequency that typically gets damaged easily with noise shocks, exposure to very loud noise, and the first dip could be due to that. The dip is just in that frequency and not the others.

The other audiogram may show that you recovered a bit after resting.

If I were you, I would not give this matter further thought. Even if you noticed your hearing a bit fluctuating or changing etc... take into consideration that any hearing issues, even a normal otitis, take very long time to fully heal or partially recover (even 2 months). Give it time and relax; with that audiogram you have nothing to worry about right now. Just be careful with very loud noise, as everyone should do, any person with normal hearing.

 

[GregCA]

Are these diagrams indicative of SNHL?

Your hearing looks pretty normal actually.
You just have that weird 6 kHz dip, which seems to have recovered.
If you were going to an ENT doctor here, they'd probably draw a horizontal line at 30 dB and tell you "your numbers are above this line, it's considered normal" and send you home.

 

[Samir]

According to that audiogram, you dont have much to worry about.

6.000 is a frequency that typically gets damaged easily with noise shocks, exposure to very loud noise, and the first dip could be due to that. The dip is just in that frequency and not the others.

The other audiogram may show that you recovered a bit after resting.

If I were you, I would not give this matter further thought. Even if you noticed your hearing a bit fluctuating or changing etc... take into consideration that any hearing issues, even a normal otitis, take very long time to fully heal or partially recover (even 2 months). Give it time and relax; with that audiogram you have nothing to worry about right now. Just be careful with very loud noise, as everyone should do, any person with normal hearing.

That gives me hope! I have an appointment at the end of this month to go back to the ENT clinic I visited last time. Only this time I will meet with an actual ear doctor (ENT) and not just a hearing doctor (audiologist). He's supposed to be very good. He's a chief of the ENT department and specializes in ear pathologies and has deep understanding of tinnitus.

 

[Samir]

It's not so much my hearing I worry about anymore. It's this high pitch buzzing kind of sound I seem to hear in my left ear. I simply call it tinnitus in lack of a better word or better understanding of what it is I hear. But I can tell by the stories told by other members here that mine is a minor tinnitus. If it is subjective tinnitus. I'm kind of hoping that it is objective tinnitus and that there is another underlying cause for it that I can treat, other than hearing loss I mean.

If it is subjective tinnitus I have, even if it is a mild one, I fear it is caused by hearing loss. I had an acoustic incident in February 2016 where my computer sound card sent out a sudden, very loud, screeching noise.

I had my Sony in-ear type of headphones on me at the time. I pulled my headphones out quickly, in a split second. Unfortunately this was not the first time it had happened! It had happened 3 or 4 times the year before and I was dumb enough to continue using that stupid computer and sound card.

The incident frightened me real bad the first time. I remember jumping out of my chair! But as I continued to use it I guess had grown accustomed to it or whatever and I was less afraid of it, but I would always pull out or pull off my headphones when it happened.

I had stopped using in-ear headphones since the first time. I started using my supra aural AKG headphones. I hardly use headphones of any kind anymore. If I have to, I prefer the supra aural kind. I will never again use in-ear headphones! What a dumb invention! Devestating for your hearing, for sure! The experts who have been warning people about these gadgets for years now are not stupid. I had to afflict a hearing loss on myself - even if it may not be so bad by the looks of it - in order to understand the warning. You don't know what you have until you lose it...

So there you have it! That's the background behind it, why I suspect I may have some SNHL now.

The first thing I developed after these incidents were ear spasms, something I think of as TTTS now. This is what I went to see an audiologist for at first. I had a whooshing sound and irritation of my left ear. It was the worst around July, so this is when I started investigating.

The TTTS has almost completely subsided now. I do get that but rarely and only short periods. Then I started hearing clicks, which then turned into this high pitch buzzing kind of sound. Clicks had almost completely subsided by the time I started to hear constant buzzing. I do get the clicks still but rarely. It's the buzzing now that bothers me most.

What's interesting about the buzzing is that it seems to change in intensity or volume sometimes when I chew my food. Same frequency, just fluctuating intensity when chewing. I can only register this sometimes. I try not to listen for it. Sometimes when I turn my head left or right it seems to change. There were times where it would completely stop, for a few seconds, then come back again. This is usually in the mornings when I'm in bed.

Quite spaces, especially the bedroom is the worst for me. This is when I am most reminded of this buzzing sound. Sometimes when I wake up though I don't hear it at all! Then it starts again when I least expect. It's really weird stuff. I recently had this weird experience where I would hear like a whooshing sound in the rhythm of my heartbeat. That never happened again.

So what is my take away of all this? Take care of your ears people! Don't use headphones! Especially not so called in-ear or earbuds type of headphones. Don't use "airpods" either! If you have to, use the supra aural type. Lastly, keep the volume down! Find a more quite room to listen in if the ambient noise is too distracting, don't turn the volume up because of ambient noise! You can also try noise canceling headphones. If you're a music and audio enthusiast, invest in a limiter, not an amplifier! You have to protect your hearing from sudden sound explosions. With increasingly more complex technology used in audio equipment (and everywhere else) it's a question of when, not if your equipment will go out of control.

 

[PaulBe]

I had several tests done at different locations by different Audiologists when this all started and they basically all correlated give or take a reasonable margin of variation. There is the natural sensitivity of the test, and then there is the competence of the operator.