eardrum

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.

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.