Corticosteroid

Weeks of Tinnitus

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Part VIII

I wonder how I slept with the roar of pulsitile tinnitus surging with my blood pressure, heart rate, and anxiety. Somehow I managed to take the sleep vacation every night. The intratympanic corticosteroids injections only initially quieted the tinnitus. After a few hours after the treatment, the cochlea did seem to revive and the tinnitus signal increased in strength. I thought this might be a sign of healing. For the next three weeks I would see my Doctor, he would ask if wanted to continue the treatments, and then would proceed to inject the drugs through the ear drum. Some time before, on the same day, the Doctor of Audiology would give me a robust hearing screening to document any changes to my hearing thresholds.

After the 1st week of treatment, my speech discrimination improved at amplification from 60% to 88%. The 2nd week I achieved a 92% score, my best to date. Sadly, the tinnitus increased so much, it felt at times that was the only think I could hear. On my final cycle of Audiology to Otolaryngology, I asked if blood circulation could be a factor in the tinnitus. My Doctor thought it was a stretch, but agreed to refer me to get a computed tomography (CT) of the head and neck. My doctor wanted to see me for the last time to check if my eardrum had healed after the multiple last bore injections. I decided to postpone that final encounter well after the CT and at least 30 days after my last corticosteroid middle ear injection.

After my near simulated deafening from the MRI, I wondered if the CT would have a similar debilitating effect. The CT is an altogether different machine than MRI. Instead of using power electromagnets, the CT is a computer aided x-ray machine. A contrast agent would aid in distinguishing tissues, blood flow, and abnormalities. I would only wait 1 week before my scheduled CT, in the medical imaging department of my local hospital.

Medical Journals Mostly Discouraging

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Part VII
Personal evaluation of one’s hearing is incredibly difficult. If I had known I suffered from SSHL, I would have run to the emergency room, demanded the corticosteroid protocol, and hoped for results. On 27 March 2014 I had my 2nd appointment with the otolaryngologist and audiologist. I read on the Head and Neck academy Clinical Practice Guidelines that a corticosteroid response could take up to six months, but I had a hearing test anyway. The frustration of straining to understand the simple 2 syllable words like doorbell, baseball, and ice cream in a soundproof room became stressful. I asked the audiologist what I should do if I could not understand, and got the response, “Guess.”

In one week my speech discrimination score improved from 60% to 90%, so I heard some progress. The pure tone score remained low with a PTA of 40 dB. The painful intratympanic injects seemed to work! I may not be recovering my natural hearing potential, but I could least have a usable disabled ear. The otolaryngologist expressed incredulity on my supposed progress as he had never seen any change after 1 week. His reservations were justified, and after all these events, there is no scientific studies that definitively shows the corticosteroid therapy does anything more than placebo. The most promising therapy might have been Constraint-Induced Sound Therapy or simply a 75 mg dose of zinc twice a day, but I endured a perforated eardrum in any effort to improve hearing.

The most disheartening academic paper I read concluded unless hearing could be reestablished to a ear differential of under 10 dB, which is hardly a whisper, the ability of the brain to integrate the two ear signals into a cogent sound field would fail, and I would live with two independent ears. I could hear naturally through the right ear, and get sound related information from the left, but it would sound so different, it would take much effort to do anything with the extra left ear information. My left ear with a 50dB loss would never work to together with the right to form a stereo pair, but just two monophonic instruments. If I could get the left ear signal tangible, I would at least eliminate a head shadow.

Inside the Imaging Tube

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Part VI
After the 20 minute hold on the gurney, I transitioned to standing. The medicine slowly flowed down the eustachian tube into my throat, leaving a mildly unpleasant taste. I needed to make several follow-up appointments for more injections while testing for hearing improvement from the audiologist. The otolaryngology department kindly printed the entire monthly calendar, showing my six upcoming appointments.

The doctor, by protocol, also needed to screen for other possible reasons for my SSHL: a brain tumor or vascular constriction of some sort. My medical imaging came in-between the office visits. 1st came the MRI of the head and neck followed by a CT of the same region. I did not delve to deep into the possible outcomes of the scans, as anything is possible when it comes to the brain.

I had my MRI scan on a Saturday afternoon at a 24 hour hospital. I gave blood to check for a certain kidney function tolerance to the contrast agent used to explore my cerebrum. Lurking around the eight cranial nerve might be an acoustic neuroma, a benign tumor compressing the hearing nerve. I only thought of my breathing in the MRI tube, as with constant pulsing tinnitus, I felt like my brain might implode as the magnets slowly imaged my head. After four passes, the technician asked me to dress. Modern medicine is so compartmentalized, that even with the radiologist right in front of me, I got the standard answer, “Wait for the results from your doctor.”

In less than 48 hours my doctor forwarded me the radiologist report: “No significant abnormality.”

Alien Abduction or Medical Treatment?

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Part V
Before any major medical procedure, one signs a consent form. Before you get a large bore needle filled with corticosteroids injected directly through the eardrum without any anesthesia, you get a very stern lecture that this treatment may leave a permanent hole in the eardrum, cause horrible scaring and possibly exacerbate the deafness. I thought, “What choice to I have? My hearing is already irreparably damaged. Could it really get more destroyed?”

A trackpad and pen recorded my digital signature on a long form stating, “To try to recover the hearing.” If successful, I would undergo three injections of corticosteroids spaced out over three weeks. Each week the doctor would ask me if I wanted to continue or stop the protocol. While lying on an exam table, with my head slightly below my waist and turned to one side, the doctor prepared the solution. He warmed it up to not be too shocking when passed through the eardrum. The high gauge needle burned and stung without any anesthesia. The doctor did offer a topical anesthetic, but said if I could take the pain and not flinch, my eardrum would heal better.

I almost suggested I bite on my belt, but concentrated on pleasant thoughts while the otolaryngologist, using a specialized telescope, passed the needle through the round window membrane into my middle ear. As the anticipation of the agony of the needle passed, the warming sensation of the medicine led to a euphoria and dizziness, but quickly passed. I stayed in the supine position for 20 minutes alone. The most amazing thing happened as I waited, the horrible pulsatile tinnitus quieted for just a time, as my middle ear lay flooded in the brine of medicine.

Sudden Sensorineural Hearing Loss Treatments

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Part IV
I used Candy Crush Saga to pass the time between audiology to otolaryngology. On 20 March 2014 the doctor with the funny head mirror appeared. He asked if I complained about pulsatile tinnitus and now the dreaded SHL, sensorineural hearing loss. He reviewed the audiogram and almost shrieked at the collapse of just one ear. He asked when I first noticed symptoms, now nearly 40 days ago. I was outside the window for any treatment and he suggest I just give up on my hearing.

I asked if there was anything that could be done, or it was completely pointless and would do more damage to my eighth cranial nerve? There was a protocol for sudden sensorineural hearing loss (SSHL), but it involved the use of corticosteroids injected directly into the cavity behind the eardrum. Another treatment involved taking a large dose of oral corticosteroids in an attempt to reduce swelling of the hearing nerve embedding inside my skull. After a few minutes of pleading, the doctor decided to combine the treatment into a glorious cocktail to recover hearing.

Another part of the audiogram I had ignored earlier, the SRT and speech discrimination, now also became very important. My right ear scored 5 dB for speech recognition threshold (SRT) while my left needed 45 dB to understand. Who knew the words hotdog, baseball, and cowboy could make the difference from hearing and deafness. Using amplification, my speech discrimination score was 100% in the right ear, but just 60% in the damaged left ear. I had mentioned to the doctor that my left ear was so broken, I may never gain its use. The corticosteroids regiment success or failure would teeter on whether I recovered my damaged hearing or could at least understand more words at amplification.