otolaryngology

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.”

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.

Needles of Sound in the Ear

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Part III
After seeing my audiogram, I instantly recognized that the pulsitile tinnitus could not be my main problem, but a symptom of something greater. What could come next? Internet searches on hearing loss and tinnitus brought up a myriad of responses from quack cures, health related bulletin boards, and medical journals. I would spend the next two weeks concentrating on the other note scribbled on the audiogram form, “SHL.”

The tears started to flow spontaneously, as one of my great joys in life was the phenomenon of hearing, especially surround and stereo sound mixes. I had purchased hundreds of libraries of sounds recorded to Compact Disc, Apple iTunes, amazon.com Music, and Google Play tracks. I had dual sophisticated 2.1 and 5.1 channel home theaters with Nakamichi and Yamaha Receivers with Vandersteen and all identical JBL speakers, including the surrounds. I had conditioned AC power and speaker cables the size of bananas with perfect copper single crystal conductors. I only ripped my CD library to the highest bitrate possible MP3 or AAC files, since I could hear the difference between the compressed format and original. I did not make it out to the symphony that often, but when I did, I relished in the instruments creating sound without amplification. I would consider myself a sound snob.

I stopped listening to CD’s, the radio, traveling in crowds, visiting stores with canned music soundtracks, and sought the silence of my crawlspace. In the 22″ cramped cold space between the ground and the raised floor, all I could hear was my damn brain’s gushing blood flow through who knows what artery or vein. I was alone in my own personal maelstrom, with no one to share its agony.

The audiologist referred me to see an otolaryngologist, to see if my problem could be medically related. My appointment would not be for another week. I now had some information, and all the possible illnesses were not good but included Ménière’s disease, acoustic neuroma, or hereditary deafness. I needed more information, and surely our advanced medical arsenal would proffer a solution.

Struggling with Cures

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Part II
On 12 February 2014, just four days after experiencing the most surreal sounding pulsing noise, after a physical examination, I got the referred to the Otolaryngology Department as a new walk in patient suffering from hearing loss. I immediately called the department, but at the time I did not know the extent of my illness, and my appointment at this busy practice would be in four weeks, on 12 March 2014 with the audiologist. I did not have the faculty to insist that this was an hearing emergency, and any hope of effective treatment needed hours not days to initiate. What hindsight gives to a complex medical problem!

While I waited to see the audiologist I tried pseudoephedrine, zinc lozenges, hydrogen peroxide to clean the ear wax, curanderos to rid me of the mal aire, and prayer, but the pounding sound continued unencumbered. My neighbors, friends, and family could not comprehend what I was going through. Some thought I must be making up a story, must feel dizzy, or just lazy, as my home construction project floundered, while I could not concentrate as the sound permeated my intellect. I finished the rough plumbing on my addition, slithering under a 1950’s WWII era crawlspace connecting water supply lines to my addition.

Family birthday parties came and went along with scheduled Church Services and public plays and dramas. Folk medicine failed to show any improvement. Finally my appointment with the audiologist arrived, and I tried my best to distinguish the pure tone test frequencies of air and bone conduction sounds. After a 20 minute exam of hearing, word recognition, tympanic response, and ancillary questions I got my audiogram. It showed what I did not expect: moderate to severe hearing loss in the left ear in a characteristic cookie-bite pattern, while the right ear stayed completely normal.