More Questions / Concerns from a Newbie :(

[500_miles]

Hello,

I would immensely appreciate anyone's (and esp. @attheedgeofscience) input & advice.

My tinnitus appeared during a head cold and concurring noise (poss. barotrauma) incident...

1) Four weeks later, should I consider it permanent / chronic? What are the chances of ever experiencing complete silence again?

2) Is it true that "healing" ears are more susceptible to further noise induced damage? An emergency alarm, a solid wood slamming door, a screaming child and a repeatedly honked car horn in very close proximity caused a spike in my tinnitus and muffled hearing and I am extremely worried...

3) How long does it take for the damage to show up on audiological (ABR / OAE) tests? I've read that inner ear hair cells don't die immediately after being attacked. I have an appointment tomorrow that I need to know if I should postpone due to the above recent events.

4) If my tinnitus is caused by hearing loss in the higher frequencies, will it show up on ABR / OAE tests? What is the range usually tested? I've had two inconclusive audiograms so far but they only went up to 8kHz.

5) What are your thoughts on adaptive noise-reduction earplugs that automatically adjust to changing sound levels?

6) Is there anything else I should know / take / do?

Thank you all so much and I'm sorry I only have questions and not much else to contribute to this amazing forum (bless you @Markku).

 

[attheedgeofscience]

1) Four weeks later, should I consider it permanent / chronic? What are the chances of ever experiencing complete silence again?

38.2%...? 54.7%...? I don't think anyone can answer those questions. Window-of-opportunity for certain types of subjective tinnitus ends 48 hours after the initiation of symptoms of tinnitus. After that, it is wait-and-see. There may well be pharmacological treatments coming - and so the question is if you are basing your question on a treatment/no treatment in the future (re: "complete silence again"). Doctors such as professor Jeanmonod are the only experts who would have the competence to declare a patient's tinnitus chronic. This happens after one year or more after onset as well as attempts to have treated the condition. By the time patients show up at his clinic, the diagnosis will typically be "chronic and resistant tinnitus".

Are there cases where tinnitus goes away after 4, 8, or 12 weeks after onset? Yes there are.

2) Is it true that "healing" ears are more susceptible to further noise induced damage? An emergency alarm, a solid wood slamming door, a screaming child and a repeatedly honked car horn in very close proximity caused a spike in my tinnitus and muffled hearing and I am extremely worried...

Not sure if there is any literature on that (I don't believe there is). Personally, I believe tinnitus sufferers to be more susceptible to further damage (= risk of deterioration in loudness/pitch). A fallacy therefore - in my opinion - is that
tinnitus sufferers tend to rely on the standard guidelines of noise exposure.

There was a poll earlier on within a thread - and this is the current standing of the votes:

www.tinnitustalk.com/threads/healthy-vs-damaged-ear.6856/#post-81960

So the consensus among members of this forum seems to be that folks with tinnitus are more prone to further damage.

Just this evening, I was "saved" by my consistent use of earplugs whenever I am outside of my home (I never let my guard down). I was walking through an underground tunnel for pedestrians in order to cross a busy street. Inside the tunnel, some teenage kid thought it could be "funny" to try his fan horn (because of the acoustics inside the tunnel, no doubt). I was only two meters away from him when he decided to do it. Similar incident happened to me around x'mas time when a military grade fire-cracker went off some 10 meters away from me. I could feel the pressure wave of the air - that's how bad it was. In both cases, and with 33db earplugs, no harm was done.

3) How long does it take for the damage to show up on audiological (ABR / OAE) tests? I've read that inner ear hair cells don't die immediately after being attacked. I have an appointment tomorrow that I need to know if I should postpone due to the above recent events.

The following is a description of the recovery prognosis that takes place after an auditory insult:

While sensorineural hearing loss in the chronic stage is irreversible, all or part of it may recover in the acute stage thanks to cochlear repair mechanisms. The more severe the acute hearing loss is, the less likely spontaneous recovery becomes and the higher the risk for permanent damage and loss is. Usually, hearing recovery is most pronounced in the hours and days following the onset of acute hearing loss and tapering off over 4 to 5 weeks. In human beings, loss of cochlear hair cells or neurons is irreversible.

Source: http://aurismedical.com/inner-ear-disorders/hearing-loss

Audiological testing cannot diagnose tinnitus directly; it can only provide an indication. Definitions of hearing loss are not related to tinnitus but to the ability to detect speech (= 0-8 kHz range). So whether or not you have hearing loss is of little relevance (even though many healthcare professionals seem to think otherwise).

4) If my tinnitus is caused by hearing loss in the higher frequencies, will it show up on ABR / OAE tests? What is the range usually tested? I've had two inconclusive audiograms so far but they only went up to 8kHz.

Not sure about standards of ABR or OAE tests. Sorry. I believe these were developed to test hearing loss in infants. How much they are used in adult audiology, I actually do not know. I don't believe they are that common (for adults). And I also believe it varies a fair bit depending on the geographical location (as to how much they are used in adult audiology).

5) What are your thoughts on adaptive noise-reduction earplugs that automatically adjust to changing sound levels?

I have no opinions on that. To be honest, I did not even know that existed. I use standard 33db NRR earplugs. Nothing else. And I remember to use them correctly too.

6) Is there anything else I should know / take / do?

Keep yourself updated on clinical trial developments, perhaps? It couldn't hurt.

attheedgeofscience
13/MAY/2015.

 

[Vincent R]

Hi @500_miles

You seem to be in severe distress. I'll focus on the questions where I have something to contribute with.

2) Is it true that "healing" ears are more susceptible to further noise induced damage? An emergency alarm, a solid wood slamming door, a screaming child and a repeatedly honked car horn in very close proximity caused a spike in my tinnitus and muffled hearing and I am extremely worried...

There are probably no way to know for sure, but if you're worried out of your mind anyway, the best option might be to protect yourself for the time being. Wear foam earplugs in situationens where you might get surprised by sudden loud noises. Make sure to insert them properly:

Save foam earplugs, you might want to consider custom-made earplugs for musicians, active noise reduction headphones (like bose) and passive noise reduction headphones (like sennheiser). If you protect your ears too much, this might feed H, but in some cases this is perhaps better than being constantly scared of T getting aggravated. Decide for yourself.

5) What are your thoughts on adaptive noise-reduction earplugs that automatically adjust to changing sound levels?

I'm not sure what you mean, but if you're talking about earplugs with electronics that cancel out surrounding sounds, I think they're wasted effort. I've read a study for hunters who wants the best protection, and normal hearing protection works just as fine or better than the fancy stuff, and may also be easier to use.

6) Is there anything else I should know / take / do?

If the stress, fear and anxiety caused by T gets too much to handle, there're applications of meditation techniques that works very well as a last resort. They're healthier than psychofarmaca, and I suspect they're also more effective. If you would reach that point of desperation, please feel free to PM me, and I'll do my best to guide you through the process.

 

[Nucleo]

I think ateos was pretty thorough.

Regarding ABR tests, there is research showing there is another mechanism of hearing loss that cannot be detected even with high frequency audiograms. They call it ''hidden hearing loss''. It is essentially damage to the neuronal pathways between the inner ear and the brain, which leads to a net decrease of neuronal input to the auditory cortex. This type of damage was previously believed to be secondary to cochlear inner hair cells destruction but it might not be exact. There is a possibility that your inner ear mechanoreceptors are still intact, and the nerve endings relaying to electrical signals to the brains are damaged/missing which could lead to hearing disorders even with normal audiograms.

http://www.jneurosci.org/content/31/38/13452.long

ABR for the diagnosis of tinnitus is not used in clinical settings, only for research at the moment. Altough you could probably get it done if you insisted on it. I'm not sure your average audiologist/ENT would agree to do such a test or even know how to interpret the results.