Is Audiogram Worth It?

is it worth getting an audiogram (covered by insurance)? as best i can figure if it's normal they will say it's TMJ or neck strain or whatever so I go off and look for causes on my own effectively. if it isn't normal and there is damage to my inner ear, then there is nothing they can medically do to fix it.

so .. is this just another useless medical test?

 

@mike jones If I were you I would have all tests done that ENT recommend on my auditory system including an audiogram. One's health is the most important thing.
Michael

 

yes, agreed but nothing is risk free. i am worried about the chance that the audiogram could actually make things worse. if there is no upside then why take the risk. is there any upside?

 

@mike jones. I have severe tinnitus and have had many audiograms over the years without any problems. Take the test. It will detect any hearing loss and you should have a Tympanometry test too and MRI scan.

 

I had an audiogram done; it is really no big deal. Insurance covered it. I was only on the hook for the co-pay, which is fine. Anyway, when I had mine done, the technologist sent out such frequencies only an elephant could hear IMO.

 

Its a baseline thing that every future Consultant (and you will see at least a few) will want to see, so you may as well do it now. Whether it is of any use? I don't think it is personally because most of us get told our hearing is fine based on the results, and that's where most Specialists seem to want to leave it, which almost makes the test a hindrance. Tinnitus/hyperacusis does not generally equate with significant hearing loss (at the frequencies tested for anyway). It does help to remind them that you already know you aren't deaf, and that isn't why you came to them, because truly, a lot don't seem able to make the distinction. I know that every medical clown I saw talked (ignorantly) about tinnitus when my issue was hyperacusis. In Medical practice, tinnitus tends to be a trigger word which once mentioned often brings the shutters down on any further investigation.

You may get lucky though, as our Mr Leigh did with the English NHS (of all places).

 

@PaulBe Now now Paul, leave my NHS alone...lol

 

Truth is Micheal, I wish our Medicare system was half as pro-active with hearing issues.

 

so just to be clear: what could the audiogram show that could possibly improve the situation?

 

As usual, excellent post PaulBe.
Ironically a girlfriend of mine just contracted T and we joke about how she got it even though its no laughing matter.
Of course unlike me, she went to an ENT and had the obligatory audiogram. Great hearing like she has always had. She has mild to moderate T with H. That's it. ENT said, good hearing and you have tinnitus. It may fade with time. Next in line please. Almost a bad joke. Why I went to the my GP and he said, you have T. How is your hearing? I said fine. I believe I have some Hyperacusis though. He nodded and said get used to it.

 

@stophiss so the answer from your post is the audiogram can really show nothing helpful yeh?

 

It can show you quite a few things (carhart notch, losses, conductive vs sensorineural, etc)

 

It is helpful to know one way or the other the current state of your hearing per the standard audiological testing tool, if only as a reference for future medical or other interventions, and, as I mentioned before, any Specialist help you may seek (be it Medical or Audiology) will see them asking for one or ordering one. For better or worse its what they work with right now.

GregCA just up there is a good reference for the potential value of the test for differential diagnosis if you look for some of his posts. His take on it is worth looking at.

 

Not much. Perhaps expose less than perfect hearing which many have with and without T...or perfect hearing which many have with and without T. If you can provide some proof that having an audiogram can somehow improve T, please explain.

A very tall woman pays a visit to her doctor to try to get to the bottom of her height. The doctor gives her a thorough physical, blood test, MRI's, virtually all tests known to man. After pouring over the data the doctor tells the woman, you are tall and we don't know why other than you probably had a good diet growing up and your parents are tall. Oh btw, did either have tinnitus?....lol.

 

Greg,
Please explain how examining the nuances of an audiogram that you describe can improve a person's tinnitus.
Thanks

 

Well it can take a very long time to explain all the things you can find out of it, so I'll simply give you one example.

Say you find in your audiogram that you have conductive losses in the low frequencies, often a sign of otosclerosis.
You can then run a CT scan and possibly exploratory surgery to confirm.
If that is confirmed and you undergo surgery, you have about a 50/50 chance of getting rid of your T with the surgery. That's more than improving T, it's getting rid of it (in roughly 50% of the cases).

A Carhart notch in the audiogram should also send you down the same path, btw, with the same odds of getting rid of your T.

 

Greg,
I have heard the term conductive. Is it related to bone configuration aka transmission/conduction of sound through the bones that could be surgically altered? Is there any other kind of loss and if so what kind of loss would that be? Any other low hanging fruit so to speak that thru testing could manifest a cure with intervention?
Many thanks

 

The hearing anatomy is composed, at a high level, of outer ear, middle ear, and inner ear. Between your ear drum and your inner ear (aka cochlea) is a set of 3 bones that conduct the sound waves mechanically. They are called the malleus, incus and stapes. These bones are meant to transmit the sound as faithfully as possible, and they are responsible for the "conductive" part of the hearing. Sometimes there is a pathology in these bones. In that case, there is a chance surgery can help. A stapedotomy is essentially a replacement of the stapes bone (the smallest bone in the human body) with a prosthesis (nowadays often made of titanium). There are more complicated surgeries where the whole ossicular chain is reconstructed. The goal is the same though: re-create the mechanical linkage between the ear drum and the inner ear.

Once the mechanical wave hits the inner ear, it is transformed into electrical impulses through the whole cochlea processing (organ of corti). That area is responsible for the "sensorineural" part of the hearing. As of today, we don't really know how to fix those, or even how to pinpoint with accuracy where the issues lie.

When you get a hearing test, you get sound from 2 sources: a small speaker into your ear, and some kind of buzzer on a head bone (often mastoid). The former tests "air conduction" (going through the middle ear bones), and the latter bypasses that. A difference between an Air and Bone measurements is called an "air bone gap", and is indicative of conductive losses (since bypassing the middle ear bones yields better results).

If you have conductive losses, there is a chance that something can be done for you (some of these surgeries have been performed for about a century). Another easy way to test for conductive losses is to do a Rinne test. In general, you want multiple tests run to get more confidence in the results, because the only way to truly confirm is to "go in and check", which involves opening up your eardrum to "see what's behind" (which is quite invasive).

 

@GregCA A very informative post and well written...
Michael

 

Beautifully written Greg. Thanks so much.

Is a Neurotologist versus say an ENT doctor the correct type of medical professional to visit who can perform the types of testing that would determine if there are conductive otosclerosis related loss?

If hearing shows no deficit across the frequency spectrum, is it impossible to have otosclerosis?

Lastly, is hyperacusis normally related to otosclerosis?

Thanks again.

 

Disclaimer: I am not a doctor.

An audiologist should be able to perform a hearing test. From the hearing test you can see if there is an air bone gap. The audiologist may be reluctant to interpret the test (they often want to "defer to your ENT doctor"), but they should really be able to tell. You should also be able to tell (they aren't hard to read).

Another clue to look for in the hearing test is the stapedial reflex. If it is absent, it's another sign that the ossicular chain may not be moving as freely as you'd want.

Then an ENT doctor can perform the Rinne test. That is also a very simple test. All you need is a tuning fork.

Finally both an ENT doctor and/or an neurotologist should be able to read a CT scan for clues (areas of lucency). Note that it's not obvious to read a CT scan correctly: it took a few doctors to read mine correctly. The first few ones didn't see anything wrong with it. I persisted because I wanted answers.

If hearing shows no deficit across the frequency spectrum, then otosclerosis wouldn't be my first suspect.

As for hyperacusis, I don't think it's just linked to otosclerosis (there are examples of one without the other). I used to have severe hyperacusis prior to my stapedotomy. Now I still have H every once in a while, but not in the same debilitating form.

Note: not all conductive losses are attributable to otosclerosis. There are other pathologies that can trigger conductive losses.

Good luck.

 

Wonderful information Greg. Thanks so much and makes a lot of sense. It should be part of a sticky.
Many thanks.

 

I have had two audiograms. No problem with the hearing part of the test but each time they have puffed air in to test pressure I have had TTS symptoms sometimes lasting for months afterwards.

 

Nothing wrong with having an audiogram. Will they help anything just by having the test?? NOPE. It's more of an all around information gathering on your general hearing health. Never hurts to know how things are and the test is relatively quite short. A little piece of mind knowing everything you can about hearing and frequency loss.

Just get er done. Won't harm you.

 

It's actually quite more than a puff. They pressurize your ear drum and it can be sometimes uncomfortable.
You can decline that part of the test (I've declined it multiple times on the ear that underwent surgery).

 

do you have to go to the hospital to have an audiogram done or do they do that sort of thing at hearing centers??
also i called the ENT about my T symptoms and they told me to see audiology, is there a difference???

 

@lari
I got mine done at a major hospitals in my area. Of course you can go to a clinic or something for yours. However it might not be covered by insurance if you live in 'murica.

 

I just went to the ENT today. GregCa, you said just about everything he told me! When he looked at my audiogram, he thought I was the perfect candidate for surgery! I have hearing loss of 40 in my left ear and less in my right ear. He got the tuning fork and started his testing on my forehead. The sound went straight to my left ear. He tested my right ear and left ear, first on the bone, then for ear conduction. We were both surprised that the ear conduction was louder and the bone conduction went straight to my left ear.

He explained the surgery. That right now, he is not convinced that I would be helped by the surgery, but maybe. He said the surgery could relieve my tinnitus, but no promises. He thinks my best bet for now is to get my hearing aid and come back in a year. I am only qualified for one hearing aid with my insurance, although both the ENT and the audiologist believe I would benefit with two hearing aids.

I'm wondering what kind of hearing aid will benefit me the most and how will it work with my in-ear-monitors on stage? I'm open to opinions! It's time to get my hearing aid.

The ENT also suggested masking, but I can ignore my ringing usually. How does adding more noise to my world help the ringing?

Thank you for starting this thread! This is where I am today!

 

Song Interpreter, did he say he thought that you had was specifically otosclerosis? if not, what kind of surgery was he talking about?

 

Yes. He thought maybe the bones were not functioning correctly, but could only see that with surgery. I'm not very interested in surgery. Right now, the risk is greater than the possible benefit.

I have mixed hearing loss.