The Natural Improvement Between My Two Audiograms

There was a discussion on here a while back where I spoke of how my ears naturally recovered without any treatment (can't find the thread). Having only taken NAC, magnesium and vitamins (not sure if this had any affect on the result). At the time I couldn't find the original audiogram for comparison, well today I found it, so as promised I'll post it below.

As you can see in 8 months my ears recovered at various different frequencies. Although my left ear at 8khz does show a 5db drop (not entirely sure if this is down to my ENTs penmanship, as there appears to be a dash right on the 10db line ).

 

I would kill for such an audiogram, 5db is nothing and well within error margin.

 

What i find interesting is although my left ear compares very similar to yours, my right ear ear has a couplennof 30db drops at 3 and 4kz. Yet from how you have previously described your t i would say mine is a bit milder than yours. Weird??

 

My most recent audiogram(see above,IPhone app which actually showed the exact same results my audiologist did so recommend it)

I have a 5db curve at 4000hz bi-laterally which is indicative of noise induced hearing loss isn't it?

 

If Liberman is correct then maybe Eds synaptic loss is greater than yours?You may have lost more haircells but your underlying neurons are still intact or at least more so than myself and Eds.

Sounds like a logical explanation,or maybe me and Ed have greater damage in the upper frequencies?I can still hear up to 16,000hz so maybe synaptopathy might be the causative factor here,who the hell knows really lol.

 

5-10dB is within the margin error. Moreover, I guess the two tests were not performed at the same place.

Nothing significant here if you ask me, but in the two cases, your hearing is good in the everyday range

 

Your responses are supporting what I was originally trying to say. A lot of people were exclaiming that LLLT improved their audiograms, so the point I'm kind of making is that mine improved whilst doing nothing at all.

I'm not sure what the exceptable margin of error is, but in either case my second audiogram was up on every frequency bar one in one ear.

My conclusion, going by my results, is that the audiograms naturally fluctuate anyway. This in no way correlates to my tinnitus which is exactly the same. I would say I have hidden hearing damage and in fact I'd be interested, from a scientific point of view, to see what an ABR test would show for me.

 

I would love to take two test in a row , I am sure they would show improvement.
Even with a day between , just because of learning how a test works and , differences between days.
I am sure that going to one test in one location and then go straight to another would show differences.
These tests are very coarse and dependent on environment, headphones , operator , etc.

Such differences could be between 5 to 10 db in my opinion.

 

Audiometric recovery doesn't equal hearing recovery in the sense that synaptopathy and the resulting loss of speech-in-noise comprehension is not measured here. This is the same as temporary treshold shifts; in the past it was thought that hearing actually recovered, but Liberman and others have shown us that this is not the case. There might still be damage of a different kind.

It is in fact highly questionable what the audiogram actually shows; there are lots of different variants of measuring equipments between audiologists which can result in different results from one audiologist to the other. Next to that; hair cells are thought not to recover, especially not after longer periods of time. Maybe the brain compensates in some way for this damage, resulting in normalized tresholds... But in that case; what are we actually measuring? If that is the case it cannot be said we are measuring hair cell damage.

I think that in the light of recent developments, the value of audiometric measures has been greatly reduced and should be questioned as a viable way of measurement for hearing acuity.

 

Actually, the audiologist equipment is specifically calibrated to prevent differences across audiologists, and provide consistent readings to the patient.
Whether they strictly comply with the rules and keep their equipment calibrated is another question, but it's the same as taking your weight at one doctor vs another. You'd expect the scales are calibrated in both so the results match (within some reasonable margin of error). Audiology is no different.
In other words, unless you have a suspicion that there is foul play, you should trust that the readings are calibrated and comparable, from one audiologist to another.

 

I completely agree @Vinnitus. As a diagnostic tool it's quite a weak test. It's surprising how little hearing tests have advanced. Basically not at all in the last 4 or 5 decades.

 

Agreed, this is also why there is usually an error margin of like 5dBHL to 10dBHL. Still in reality proper calibration requires human effort, and where human effort is involved fluctuations might occur.

But even if all those devices are properly calibrated, the other point still stands; what are we actually measuring with an audiogram? Especially while knowing about the recent revelations by Liberman et al. Audiometric results might show what looks like "recovery", but no "recovery" is possible as far as we are aware in the scientific literature. Hearing does not recover, it only gets worse. At least as far as the cochlea is involved. So what does this "recovery" actually mean? It is not like the hair cells spontaneously started working again... Must be some compensatory mechanism at work.

 

Yea @GregCA, you should ideally get a calibration date on all tests, such as in my second one.

 

There is clearly a big set of unknowns in how the hearing apparatus works.
The compensatory mechanism you describe is something I learned from a BTA video where the scientist (yes, I'm using singular because he's the same guy in pretty much all their videos) explained that you could have hearing loss (as in, damaged cells somewhere) and not visible in an audiogram, because the smaller signal now gets amplified to "look like it would have been without any damage". This was just a hypothesis of course, but it made some sense and could explain the whole "hidden hearing loss". Someday we'll prove or disprove that hypothesis.

 

I agree. In fact, in light of recent developments, the audiogram is even more worthless than previously thought. Damage might still have occurred despite what it shows. It is incomplete at best and we are (once again) left quite empty handed both in diagnostic tools as in the treatment of a lot of hearing disorders.

 

I actually quite frequently exchange emails with Liberman(extremely nice guy)and haircells can and do recover after noise trauma usually a month after such trauma has occurred and has been seen to happen up to two months post trauma.

But this is exactly what Liberman is pointing out,just because your thresholds have recovered doesn't mean your hearing has recovered as these synapses almost certainly didn't survive the trauma as they're much more vulnerable to damage than haircells.He told me that synaptic damage isn't immediate but usually occurs slowly after the trauma has passed,@Reinier is proof of that judging from his experience that I read about in another thread.

Reiner suffered an acoustic trauma,muffled hearing that recovered to a certain degree then followed by tinnitus/distortion and Hyperacusis a month post trauma,this matches up with Libermans claims that synaptic damage or retraction happens slowly after the trauma has long passed,in some cases it can be immediate but according to him it can happen up to months post trauma.

Makes a lot of sense especially when you read a lot of stories here,people saying they got T suddenly but then go on to say that they were at a concert two months prior,maybe they did damage these synapses but simply didn't notice only now that T has arrived do they begin to notice.

The good news is,according to Liberman these nerve fibres survive for decades after they have detached from their membrane as seen in many patients who receive cochlear implants.There have been patients who were deaf since the age of 15 who received a cochlear implant when they were 35 years old and the nerve fibres were still there he told me.Also,he noted findings in these patients that their T went away once these nerve fibres were stimulated hence why he believes these fibres cause T and H in the cases of noise induced hearing loss.

I have the emails if you'd like to see them,makes for some interesting reading.

 

Who knows lol. I can hear up to 18khz in both ears

I'd like to read them please Bill.

 

I don't test past 16,000hz,reason being that I have to raise the volume quite a bit to hear 17 and 18,000hz and I fear of it doing some form of random ear damage so I don't want to push it.
I can hear 16,000hz easily so I'm happy enough with that,I'm 24 so that's good enough for me,17 and 18 are there alright but are mostly wanked if I'm honest lol.

Yeah no problem,I'll pm the two most recent ones he sent me to you now.

 

Hm, well, if hair cells do recover, this would explain the "natural recovery". My impression was always that they did not recover at all.

This also means that there can be no such "recovery" after a longer period of time since trauma (>2 months). Would be interesting to see if that occurs.

I would like to see these e-mails too, if it's not too much effort...

 

Haircells can indeed recover from stressed states but usually no more than a month post trauma two tops from what they've seen in mice studies including dissection post termination.

Funnily enough in cases of SSNHL people have seen hearing improvement months after the incident has occurred meaning that haircells do indeed have the capacity to recoup after an injury,how much they recover is never certain,so many variables involved etc.

No problem,I just sent a few recent ones to Sam there so I'll send them to you now.

 

So what's the verdict in my case? And, for that matter, anyone else who has reported an improvement (LLLT or otherwise?). Do you believe there's a tangible difference (improvement) or an expected variation within defined limits.

If the margin of error really does fall within 10db (one of my results changed by 15db) then I'd say the audiogram is a poor method of measurement. To be out by so much, can in effect, take you from a mild hearing loss to being normal from one measurement to another.

I'm quite intrigued by this and have often wondered how reliable they really are. Especially after reading a thread on the supposed improvements LLLT has made to people's hearing, with the conclusions being based on their audiograms.

You've all made some good contributions, so I'd be interested in your opinions.

 

If possible I'd love to read the emails, sounds relevant to my interests.

I wonder with these windows of opportunities, how some people do feel they have improvement in the long term, upwards of 2-3 years. We all know of the few and far between but still existent cases where someone says their noise induced tinnitus disappeared 2/3 (or more) years after incident. I always wonder if that is not a case of regeneration, but a case of damaged hearing mechanisms degrading more completely so that they stop sending the information causing T or other symptoms, perhaps "hidden hearing loss" moving into plain hearing loss could result in someones subjective symptoms improving. Of course we also know of people with noise induced H which they feel resolves or improves after years. Hard to tell what is inner ear regeneration, what is brain plasticity, what is further damage/degradation resulting in the lessening of subjective symptoms.

@Ed209 I wouldn't put much faith in those audiograms for an accurate comparison, since they look like they are from two different places. But most importantly, if you feel your symptoms have improved then that is awesome. You know your ears best.

 

@Ed209
1) The LLLT audiograms showing improvement at the LLLT clinic have not been cross-correlated with audiograms at other clinics.
2) Your T must be above 8KHz. We only see half of the story with standard audiograms.

 

I find your audiograms to be quite important Ed,the reason being that to me at least,your hearing did improve noticeably between audiograms and this same thing is reported by people who under go LLLT not long after their acoustic trauma,so was it LLLT or natural recovery like seen above?Did LLLT actually do anything at all or did it take credit for natural recovery in the same way TRT does for Hyperacusis?

So I for one am really glad you posted this and actually think it was very smart idea,I know some feel that the threshold differences between your audiograms fall within the margin of error but I can't imagine that their would be so many errors in your first audiogram,unless of course the audiologist was drunk?I had three seperate audiograms done a month apart when things went crap for me last year and all were done in different hospitals,each of them were exactly the same apart from a 5db difference at one frequency at my last appointment to which the audiologist told me it was her mistake and should have been 5db better than it was making it match my two previous audiograms.

As for LLLT there are reports of it improving hearing years after hearing loss but this is somewhat anecdotal hence the efficacy debate that still rages on to this day,if LLLT can improve hearing thresholds significantly post let's say the two month mark then it has quite solid ground to stand on in my opinion.

Also,your audiogram is only half the story,we have no idea what the above frequencies are like or how bad the hearing loss is there,0-8000hz could have survived relatively intact but above that might be a disaster zone for all we know.

 

My main T frequency is around 12.5khz (I'm pretty sure my hearing turns into a ski slope at 8 kHz). I find it bizarre that it's not standard practice to test the full spectrum in tinnitus cases (or at least up to 16khz). I know audiograms are primarily used to test the speech frequencies, but more data can only be a good thing, regardless of the fact that there's no treatment option. The whole thing is just geared around hearing aids.

 

ATEOS had his audiograms done at a seperate location,I believe his audiograms and improvement matched that of the results given to him at Wildens clinic.

But,he was still quite early into it so it could have been natural recovery etc.

Also his audiograms were done up to 16,000hz,something I've learned that no audiologist here in Ireland does.Best I've gotten is 0-10,000hz and that's it.

 

When I first got T and had my hearing checked I never even knew about these upper frequencies,when they told me my hearing was perfect I thought that was it,that all my frequencies are in good health and there's nothing more to test.

Years later I find out that they basically only test half of your cochlea,the completely ignore the frequencies above 8000hz,no wonder so many people with T are misdiagnosed as idiopathic,for all we know 9,10,11,12,13,14,15 and 16000hz are probably completely shot.

 

My tinnitus is no different. I posted this info because I said I would - a couple of months ago - if I ever found my original results. I knew the newer results showed improvements across the board, so I thought it was worthy of debate.

I'd add the tests were both paid for privately by respected professionals. I stipulated that I wanted good accuracy in both cases, and the conditions were indentical. The equipment and headphones were also the same. If a different location is enough to change the results by this margin, under the same conditions, then I'd say audiograms are a very poor measure of our hearing. Surely a 10+ db margin of error should be unacceptable as a measuring standard? As stated in my other post, this could be the difference between mild hearing loss and normal hearing. Seems a poor standard to follow if it truly is this plastic.

 

Audiograms do seem to be largely worthless for a lot of us on this board regarding our conditions. They are more commonly used in order to diagnose people with severe hearing loss, and calibrate (and sell) hearing aids. A 10db margin of error is apparently acceptable when youre primarily dealing with elderly people with losses like 60db or something severe like that.

I think it is easy to see why there is a fairly big margin of error in audiograms, there is a human element on both sides, you clicking the button, and the person playing the sounds and recording your thresholds. The tests are very archaic, since they often only test up to 8k, and only 8 frequencies within that range. Also, the steps of the sounds they play seem to be in greater steps than 1db, I'm not sure if they do big steps do get near your threshold, and then test in small steps near your threshold to determine where it is more exactly, but when I had my tests done, I always felt that even the operator could have been spending a bit more time finding a result at a given frequency.

 

@SilverSpiral

Tell me about it. Having an audiogram is like stepping back into the 70's.