Hyperacusis — Related to Middle Ear or Inner Ear?

Do you think hyperacusis is middle ear or inner ear related? or related to the hearing nerve?

There are tests to try to ascertain this, but they are loud, as one test is evoked potentials and the other is the dreaded magnetic resonance. The MRI makes it possible to see the hearing nerve, muscles and tiny bones in the middle ear, they can also have a look at the inner ear apparently. Having H, has anyone endured a MRI aimed at looking at the hearing nerve?

The test "otoacoustic emissions" can apparently discard in a good % cochlear hyperacusis. Have you guys had this test?

 

I have.
To look at the middle ear bones the CT scan is a better tool.
The MRI is often used to rule out acoustic neuroma, but it can reveal other things too.
Ideally you use both tools if you are still fishing for a root cause.

I think my hyperacusis was mostly due to my middle ear, because it went from severe to almost unnoticeable after my stapedotomy.

 

I have heard that there is another surgery used now to treat hyperacusis, that consists of cutting the muscle attached to the hammer bone, that seems to be the tensor tympani muscle.

How do you perceive sounds after the stapedotomy? I mean, both the stapes muscle and the tensor tympani muscle are designed to enhance or dampen sound, to regulate the amount of sound delivered to the inner ear.. so, do you notice sounds more "natural", more harmful, more balanced? how would you describe it? Do you still feel pressure after loud sound, tightness inside the ear, clicking, after the surgery?

I have to read a lot more about those 2 surgeries (cutting tensor tympani or stapes) and consider this for the future.

So did you have the MRI to see whether the stapes muscle was giving trouble? What exactly did doctors find in the MRI to offer you the stapes surgery? Do you know was the cause of your hyperacusis?

 

Yes there are other options out there. Another cutting edge one is the round & oval window reinforcement.

I regained most of my hearing in the low frequencies, i.e. up to 1kHz. Above that I have sensorineural losses that a stapedotomy isn't supposed to address, so they haven't recovered obviously.
So the sound perception is obviously much better (I had 50 dB losses in the low frequencies).

I don't notice much difference to be honest, but it could be because my T is so overwhelming that it masks all the details of the natural sounds coming in.

I haven't been exposed to loud sound so I can't answer the first question. I don't feel tightness inside the ear or clicking. I do feel some discomfort every once in a while, but that could also be from my hearing aid in the ear canal. I have the occasional hyperacusis, but it's very rare (maybe once a month or so) and very mild.
I have to be mindful of the level of effort I exert with my overall body: a simple application of force to open a "stuck" jar lid could have repercussions on my ear and trigger hyperacusis. Since I noticed that, I have been much more careful about using strength.

I don't think a stapedotomy is recommended unless you have conductive losses (likely due to otosclerosis).

My stapes muscle wasn't giving trouble. It was the bone that was a problem (well, its contact with the cochlea). My root cause was difficult to diagnose (ran into a few misdiagnosis before narrowing it down), and it took a CT scan and an experienced neurotologist to provide the correct hypothesis (after seeing half a dozen other experts who couldn't find it, in spite of having the exact same data in hand: conclusion being that you need second, third, fourth and possibly more opinions).

I don't know exactly the cause of my hyperacusis, but I know it went away after replacing my stapes bone with a prosthesis, so I strongly suspect that the middle ear was involved in my H.

 

I think the most common answer is that it is the inner ear, specifically the hairs in the cochlea and nothing can be done to replace the damaged ones at this point in time. There is some promising research being done. There are other causes, but from the research I have done it appears that the damaged hairs is the most prevalent cause by a very wide margin.

 

Thanks a lot for your answers Greg! Very detailed and helpful.

In the last few months I have been visiting doctors. The audiometric tests have revelead a 20-25 db drop in hearing in the low frequencies, up to 1kHz (however the bone conduction of sound is a bit better). This is a new drop that was not there one year ago, and my perception of sound is quite different now, less rich and subtle. The high frequencies continue deteriorating, but are not too much changed over this year (around 20-30 db loss at 4kHz and 30-40 at 8kHz).

Sooner or later I will need to have an MRI to look at the middle and inner ear, but right now I am leaning towards postponing it for a few months or a year. This is a test that could set me back badly and I am not too sure of what's to gain from it. Doctors are not very clear about what they expect to see, as apparently an accoustic neuroma is very rare, and they are not very sure about the benefits of middle ear surgery in my case. I had a CT scan and it revealed nothing that could trigger H or deteriorating hearing.

 

What I have been told is that cochlear damage can be discarded in a good % with the otoacoustic emissions test, that does not require listening to loud sound. It is a short 5 minutes test that plays a range of frequencies from low to high through a kind of earbuds. Also, ENTs tend to attribute hearing loss to sensorineural causes when they see a hearing drop in high frequencies that is sustained in time and above 30-40 dbs (a lower loss could be conductive).

So in theory to see if there is nerve damage one needs to undergo an MRI, and also to see the cochlea in more detail, to complete the hints of the otoacoustic emissions test.

To me all this testing is quite frustrating, as one is left in the Catch-22 situation where if one wants to fully know there is no nerve damage, a very loud test, an MRI, is required. And whatever the outcome of the MRI, the solution is hardly better than just coping with the problem (unless they find something very rare and able to correct with surgery, which is very unlikely anyway).

 

I just read an article in a semi recent New Yorker magazine that detailed the nerve damage behind the hairs and said that scientists have discovered that a lot of hearing loss is caused by that. They are hopeful that they can find a way to repair that damage and that it is an easier problem than repairing the hairs. But there is no treatment for either today. At this point, finding out which type of irreparable damage you have is of little value, so I would not get an MRI.

 

Hi GregCA,


I think I might be in a similar situation as you. I have had hyperacusis/tinnitus in my LEFT ear for a few months now with no hearing loss (tested) or perceived distortion of sounds etc. MRI came clean too. However, I recently noticed that when I use bone-conducting earphones (Aftershokz), my sound tolerance level is like a normal person's, I can crank up the volume on those like nobody’s business (I did just to test, but otherwise am careful not to). Had a wisdom tooth removed this morning with earplugs blocking air-conduction of sound but crazy loud bone conduction with his drill, no problem at all. It is only with normal everyday sounds that are air-conducted (through ear drums and middle ear onto the cochlea) that it hurts my ears. And it is the worst through normal air-conduction headphones.


This tells me that my inner ear and auditory nerves and central auditory pathway are not where my hyperacusis is. So most likely it is middle ear. My family also has a history of otosclerosis. My sister had conductive hearing loss on one side from otosclerosis and had a successful stapedectomy. I also have significant conductive hearing loss since childhood (I am 34 now) in my RIGHT ear likely due to otosclerosis. I never bothered to look into it too much though since I was functioning normally with just the left ear without any problems.


However, as I said I got hyperacusis/tinnitus in the left ear a few months ago and it has really been bothering me and I am looking really hard for a solution since it is interfering with my daily life really bad.


The problem is that most ENTs do not think my hyperacusis could be a bone problem because they say bone problems (otosclerosis) lead to hearing loss, not hyperacusis. You say “It was the bone that was a problem (well, its contact with the cochlea). My root cause was difficult to diagnose (ran into a few misdiagnosis before narrowing it down), and it took a CT scan and an experienced neurotologist to provide the correct hypothesis”


Could you please give some detail on what the diagnosis was? What the “contact with the cochlea” problem was? Was it just hardening of the tissue as in most otosclerosis cases which causes hearing loss since the stapes can’t strike the cochlea (oval window) hard enough? Or was it like not striking at the right spot, causing hyperacusis when a part of the stapes was hitting on the cochlea outside the oval window, or something like that? What procedures/tests were performed to reach the diagnosis?


Any other info would be really appreciated too, as I am really frustrated with not being able to find any solutions, and your case seems very similar to mine.


Thanks!

 

There aren't many tools to visualize and confirm root causes for H, so for me the logical process that led me to think that the middle ear was a likely culprit in my H is that the stapedotomy (a middle ear surgery) reduced my H almost completely. So the middle ear was either directly involved, or indirectly somehow.

Nobody went so far as being interested in figuring out the mechanics of my H, so it's all conjecture.

My initial presentation was sudden sensorineural hearing loss, so I first went through the course of corticosteroids, first oral, then intratympanic. After about 6 to 8 weeks, the sensorineural losses turned into conductive losses in the low frequencies, with a 55 dB air-bone gap "created" in those 6-8 weeks. Nobody can explain how you get such a loss in such a quick amount of time, but with such an air gap, a CT was ordered, and after showing it to half a dozen doctors who couldn't see anything abnormal, I finally reached a guy who told me "hhmmm, I see some radiolucencies that could be a sign of otosclerosis - that would explain your symptoms and the audiogram results".

So that was it, from then on, I did the surgery, with the understanding that if the surgeon doesn't confirm the presence of otosclerosis when he takes a look at the middle ear, then he won't be pursuing the surgery (it would then just be "exploratory surgery"). But he did see an otosclerosis focus there, and so he went through it.

 

Hmm.. thanks for the info... it's so annoying having to run around to so many specialists before any one of them catches something... glad that worked for you!

 

Yes that's why I always insist on people getting 2nd and 3rd opinions or more and not give up early when "everything looks good".

 

That's disgraceful. I'm sure the TRT crowd are too busy fapping to their own confirmation bias.

Greg I think you told me once before but I can't remember, before the operation, what sensations did your H consist of, and what sounds provoked it?

 

Does anyone have middle ear myocly? Perhaps I have some tips for you. What works for me is turning on the vaccum cleaner . Listen to that sound and after a few minutes it's gone. Or listen to music with in ear headphones, music with a low base (or hard rock music) . Sometimes it helps to listen to the sound of the hood, you know the one above your cooking stove. It's all temporarily but the annoying feeling goes away. More quickly than when you don't do anything about it. Let me know if it works for you