What Should I Expect / Ask About at First Examination?

So tomorrow I am getting down to a clinic for an examination for this ear noise that I have had for some days now. Mother says people have stuff that comes and goes / insists it wont last for a lifetime as I fear. Just looking to rule out basic stuff.

I have health/doctor anxiety from the past and what should I expect when I tell him / her of my problem? Any painful stuff?

Also is there something I should specifically ask about considering it's a small clinic?

 

The size of the clinic shouldn't matter. Plenty of us have been shafted and insulted in big clinics.

Ask them about steroids. You are still inside the window where they may do some good. If they say no, ask why, in fact, ask what experience and knowledge they have concerning tinnitus and what they know about treatments. If they don't know about TRT (regardless of what others may say for or against it here) then they don't know about tinnitus.

 

Where or how would this steroid be injected? I heard its only for hearing loss associated with tinnitus but I have no hearing loss that I can notice

 

Hi @Alex Brussel

I personally feel it is too early for you to be seen at ENT ( Ear Nose Throat) if you have straight forward tinnitus that was caused by loud noise. If you have additional symptoms such as: Balance problems, dizziness, deafness or continuous pain in the ears then this is a different matter and you should be seen much earlier. The ear is a very delicate and sophisticated organ. With the onset of tinnitus most ENT doctors prefer to leave things alone as the ear will often right itself. A period of up to 6 months is preferable to wait to be seen at ENT providing there are no additional symptoms as I've mentioned above. Many people habituate to tinnitus within the first 6 months and sometimes it goes away.

Below is a sample of text at what is likely to happen when you go for your ENT appointment. Please click on the link at the bottom of the page to read it in full in my article: Tinnitus, A Personal View.

All the best
Michael


When you see your ENT specialist the question you're first likely to be asked is: how long have you been experiencing tinnitus and when did it start? Is this the first time that you have noticed ringing in your ears? Do you experience the noise in just one ear or is it in both and whether the tinnitus is constant or intermittent? You will probably be asked to explain in detail what the tinnitus sounds like, does the noise change or remain the same? Tinnitus can vary considerably between people from buzzing, whistling, ringing and sometimes musical tones are heard. Some people hear multiple tones.

One of the most common sounds is hissing, which resembles white noise as if a radio has been tuned between two stations. These questions are important so try to remain calm. You will probably be asked when does it bother you the most and how does it affect your quality of life and day to day living and whether you are able to work? A common question is do you have any idea what might have caused the tinnitus, as many things can cause it. Whilst this is going on your doctor will be listening and observing your body language as this can give an indication of how the tinnitus is affecting you physically and emotionally. The questions are necessary for it is you that is experiencing the tinnitus, as no one else can know what you are going through. Notes will be taken about your medical history and whether you are taking any medication. Some medicines, beta-blockers for example can cause ringing in the ears and aspirin has been known to cause it too.


Your occupation could also give an indication as to the cause of your tinnitus, especially if you work in a noisy environment or operate machinery where noise levels are high. You may be off work sick due to your tinnitus which is not uncommon. An important piece of information is what do you like to do socially. Do you attend nightclubs or visit places where music is played loud regularly? Many people enjoy a night out on the town and have experienced ringing in the ears after they have left a club. Going to gigs and clubs and subjecting one’s hearing to high sound levels over a period of time can cause tinnitus to become permanent so it’s something to keep in mind.


With noise induced tinnitus it is often the case a person can also experience hyperacusis, this is having a sensitivity to sound or certain sounds that become very irritating to the ears and sometimes even painful. I will be covering hyperacusis in more detail later on as I feel it deserves to be explained in much more detail and how people are able to get it treated since it is closely linked with tinnitus. You will probably be asked if you are sensitive to sounds and if so what are they?

At some point your doctor is likely to look into your ears using an Auriscope to inspect the ear canal and also the eardrum. It is similar in size to a small hand held torch and has a magnifying glass attached. A light shines through this allowing the doctor to see if there is any wax-build up in the ear which is another thing that can cause tinnitus. If everything is fine this part of the consultation will be drawing to a close. The next step is, you will probably be asked to take a hearing test, which will be carried out by an Audiologist in a sound proof room. You will be given a pair of headphones to wear and a selection of audible tones will be played and you will be asked to press a trigger on a hand held device when you hear each one. https://www.tinnitustalk.com/threads/tinnitus-a-personal-view.18668/

 

You wouldn't necessarily know if you had hearing loss. And not injected steroids. Tablets. Prednisolone is the usual one of choice. An acute onset of tinnitus can certainly be associated with a degree of hearing loss, although without a proper assessment by a competent Audiologist you may never know. Hearing loss can be concealed within the mix of everyday sounds, but can be detected with the proper testing, and it doesn't take much hearing loss to bring tinnitus along with it, as many of us here know. @Michael Leigh 's primer above is actually a good starting point for getting your head around all this. Personally, I wish I'd seen just one competent Doctor among the many I saw in the first year. The thing I would add is that I personally think everyone with sudden onset tinnitus should be treated as early as possible with a course of corticosteroid medication for its anti-inflammatory effect. This is fairly generally accepted as an emergency treatment for sudden hearing loss, of which tinnitus is often a symptom, although it holds no guarantee of success.

 

Why not?

 

Because I don't think anyone at GP level would even talk about it with him. If you ask too much too soon they tend to just shut you down. Docs can be opinionated pricks. My own opinion is that high dose IV steroids for a period of at least a week followed by a maintenance course of pred for up to a month then tapered is the way to ensure blood levels get high enough in the area needed, and stay that way for the time probably needed (mind you I have no facts whatsoever to back this up with). Alex is going to a strange clinic where they don't know him in what sounds like a small town so requesting all that would get him shut-down super quick, but inquiring about steroid tablets and raising the issue of therapeutic window might get a half decent GP thinking because these days most would have likely heard enough of this to consider it fairly and look further into it (we would hope...).

I'd love to see a paper on extended course high-dose IV steroids to treat acute-onset tinnitus with or without new SNHL, if any such papers existed. Its just one more area that is seriously lacking in mainstream research.

 

I thought when most people reference steroid injections, they were referring to intratympanic steroid injections.

 

No, I'm thinking systemic. Intra-tympanic is still basically a form of topical application and entry to the bloodstream depends on the rate of absorption from wherever the stuff lands. There is no maybe with intravenous administration.

 

Paul, there is a good deal of research showing that antioxidants can significantly reduce damage before and AFTER acoustic trauma. Free radicals are generated for 7-10 days following trauma. The sooner you give them, the better. You won't ever hear an ENT mention this treatment.

 

It says the cause of his/her tinnitus is from " Accidental self-afflicted blow." An ENT needs to make sure that at the least the eardrum is not damaged.

Alex, keep your appointment with the ENT.