Audiogram Results with High Frequency Testing and DPOAEs

Ears, nose and throat
1

Hello, I've had Tinnitus for about 15 months now, 99.5% of the time on my left ear, occasionally I can sense some very very minor ringing on the right ear.

I got my third audiogram done yesterday at UCSF Medical. The previous two were done at a local audiology center and at Stanford. The first two tests only measured frequencies up to 8 kHz.

The results, per the audiologists, was that I'm within normal hearing range.

On this last test, they tested up to 20 kHz.

On my right ear, I was able to hear up to 20 kHz.

On my left ear, I was able to hear only up to 16 kHz. I could not hear 18k or 20k.

They performed a Bio-logic Otoacoustic Emissions test as well.

Seems like I had normal hair function on my left ear and near normal on my right ear.

I would assume I'd do worst on this test on my left ear than my right.

I'm 38 years old.

Three questions:

#1. Would you consider not hearing 18k and 20k frequencies on my left ear, which is my problem ear, the reason I have tinnitus? I've been told that most adults don't hear these frequencies so that it's not the problem.

#2. My left ear, dipped a bit more at frequencies 3.5k and 4k than on last year's tests. The audiologist said it was not enough for her to consider it hearing loss or damage. She said she could do second test and I could test better. Is it normal for tests to fluctuate and what would be a normal decibel fluctuating range?

#3. Based on these results, can my Tinnitus be 100% attributed to ear problems? I feel I hear normal. 

I'm attaching my results, any advise or suggestions would be greatly appreciated; hopefully just positive. 

2

The normal audiograms rule out Meniere's Disease.  Do you have other symptoms apart from tinnitus?  What medications are you currently on?

Eleftherios S. Papathanasiou, PhD, FEAN

Clinical Neurophysiologist

Fellow of the European Academy of Neurology

3

Other syptoms? Well, sometimes I feel ear fullness and dull hearing on my left ear, along with left ear crackling sounds (sometimes right ear crackling too). I think these get worst after a few days of taking Claritin. I sometimes feel my eustachian tube screech. This mostly after I blow my nose or doing the Valsalva maneuver, which I find myself doing often. 

I was tested for allergies and I was allergic to mostly all trees, grass and weeds, some molds, all dust mites, feathers, cockroaches, cats and dogs.

I've seen 4 ENTs regarding ETD and my ear pressure results come back ranging from 0 to -50 on my left ear and -15 to -35 on my right ear. Not enough for the ENTs to consider it ETD. Though when these tests were done, I was not having the ear fullness or crackling noises. I get those randomly during the day or not at all for a few days. 

I clench my teeth as well. My dentist did a small test and he said I had mild TMJ on my left side, which is my problem side. I saw a doctor about it and he did some tests. He said I had mild TMJ and recommended a 6-9 month splint treatment, but they probably recommend a splint treatment to everyone that goes to see them.

Last year though, besides tinnitus, I would also feel pressure inside my head that lasted for hours. I only felt this a couple of times though. 

I also have sleep apnea too which I started using a CPAP for about 7 months ago. 

I'm taking Vitamin B12 and D3, as I was deficient, I'm also taking a MuscleTech Multivitamin.

Thanks for your response/time. 

4

Also, the x-rays show that the wisdom tooth on my left side is impacted. The doctor recommended not doing anything with that unless I was having problems. 

5

It is a bit odd to have the symptoms that you mention, including the feeling of ear fullness, and the audiogram to remain normal.  What have your physicians concluded.  Do they have some idea as to why you have tinnitus?  Did you have a previous ear episode, say a few years ago?

Eleftherios S. Papathanasiou, PhD, FEAN

Clinical Neurophysiologist

Fellow of the European Academy of Neurology

6

I had never had ear problems in the past.

After I developed my first symptoms, my personal doctor thought I had wax on my left ear and had it syringed. She then said she saw water inside my left ear and had me use flonase and Zyrtec. That didn't help. The first time I used the flonase, that's when my left ear ringing got stronger for a few minutes just after I sprayed it in. 

About a month later, another doctor and a PA claimed they saw a mild infection on my right ear and water as well. They gave me antiobiotics for it.

My ENT's were convinced I never had water and told me a story of how 65% of people are misdiagnosed with having water when they don't.

Audiologist #1 said my hearing was normal and that she typically sees cases like mine with people that have allergies or where it's caused by weather changes. She said she believed there was a 90% chance the tinnitus would go away eventually. She said my left ear, which is my problem ear tested better than my right ear.

To her, a reading of 25 db or lower is normal hearing. My right ear had a dip of around 22 on my initial audiogram.

ENT #1 and #2 - (one a local ENT and one from Sutter Gould) both said it was due to minor hearing loss, noting the dip on my right ear at 500 hz, even though my left ear is the probem ear. To them, normal hearing is 20 db or less. They pretty much said to learn to live with it and walked out.

Audiologist #2 at Stanford also said I had normal hearing and thought my tinnitus would go away eventually. 

ENT #3 at Standford said I had minor hearing loss and that I had minor ear damage on my left ear at 4,000 hz because it made a small dip,even though it was still within normal hearing limits.

The Tinnitus "expert" at Stanford said the audigrams meant nothing to him. I had Tinnitus, it didn't matter why and all I could do is learn to cope with it.

ENT #4 at Sutter Gould also said I had minor hearing loss, very mild but that would be enough to cause Tinnitus. He said used to be in board of the American Tinnitus Association before it became what it is now, or before it had that name. He said within 3-4 years they're expecting an FDA approved drug to help with tinnitus.

Audiologist #3 at UCSF Medical, as I mention on my first post, she said I was within normal hearing limits. She did not view the dip at 4,000 hz as inner ear damage or considered it notched. Since she tested me at higher frequencies and on my left I did not hear at 18 or 20 hz, she said it's possible my tinnitus lives in there since my right did register these frequencies, so there's an imbalance there.

She also mentioned hidden hearing loss can be another possibilty. 

Regarding my ear fullness and normal audiogram. I don't think I had the earfullness when the audiograms were given or the ear pressure tested. I get fullness at random times, for minutes or hours. It comes and goes. I do notice that when I'm feeling the ear fullness, dull hearing, ear crackling and left side of my throat thicker, my tinnitus is louder. Once those symptoms subside, eventually so does the tinnitus, but not completely. I have tinnitus 24/7 but mostly at low levels. Sometimes it's a seashell sound, sometimes it's tonal, a few times it's thin screeches. 

7

I am still concerned as to why you have the tinnitus, especially at this young age.  All things being equal, I would repeat the audiogram in 6 months time, and the next time to ask them to use both bone- and air- conducted sound. Also. there are specialized tinnitus clinics, depending on where you live.  I know of one in the UK, but that depends on where you are.  They would help you handle the tinnitus symptoms if they are overwhelming.

Eleftherios S. Papathanasiou, PhD, FEAN

Clinical Neurophysiologist

Fellow of the European Academy of Neurology

8

Thank you for your responses. I'll get the audiogram done again in 6 months.

So in your opinion, based on the results, you believe I shouldn't have noise induced tinnitus or tinnitus due to hearing loss? 

9

I believe that there is always a reason to have tinnitus, and it is good to know why.

Eleftherios S. Papathanasiou, PhD, FEAN

Clinical Neurophysiologist

Fellow of the European Academy of Neurology

10

Is it possilbe that what I have is Cochlear Hydrops?

11

I am not sure yet.  To have cochlear hydrops, you need to demonstrate a hearing loss less than 2kHz on the audiogram.  That is why I advice repeating the audiogram in 6 months, as sometimes not all the symptoms appear at the same time.

Eleftherios S. Papathanasiou, PhD, FEAN

Clinical Neurophysiologist

Fellow of the European Academy of Neurology