Ear Pain and singing

Like two months back i went to a concert and there i was singin rather screaming with the loud music. There some how i developed intense pain in my left ear. Now its been almost three months and the pain persists. I am a professional singer and i i have noticed that whenver i sing or listen to music the pain worsens. However; if  i dont sing or listen to music the pain is very less. almost un feelable. I may highlight that i had my audiometery done and nothing abnormal was observed apart from that the pressure in my left ear( the ear which has pain) is slightly changed. HEnce consequently the doctor gave me some nasal spray in order to fix the cited pressure. the pain is a bit better but it isnt going for good. I am very very worried as music is my passion and it is very difficult for me not to sing or listen to music for even one day. However i have stopped my practice and have banned music for the last four days and the pain is a bit better. but still it isnt going please advice what shoud i do. should i avoid singing/music? will it help and is it normal? it is something seriosu?

please help as i am already very dejected and disturbed :(

ali  

[Wear/a/Jimmy]

This is the deal. There is a phenomenon called "recruitment." It means abnormal loudness growth. It occurs when there is cochlear (inner ear) damage. I want you to google recruitment more such that I do not have to type further about that.

Now, audiometry is great...  but it does not always tell the full story.  Depending on your age, I would recommend OAE testing. Oto Acousting Emissions testing. OAE testing helps to determine if there is outer hair cell damage.

As you probably already know, hair cell damgae = hearing loss....  But here is the kicker, OAE testing is more sensitive than a hearing test. In other words, I could do a Pure tone audiogram in the left and right ear, and it would be normal, but do an OAE test on your left ear and it would be abnormal, & normal in the right.

This is what I suspect I would find.  But it is pure speculation until you get it done.

Good luck

[Enoch Choi, MD]

Wear/a/Jimmy has good ideas, but i think your doctor is trying to treat you for post-nasal drip that's clogging up the ends of your eustachian tubes.

Eustachian tube dysfunction is blocking of the eustachian tube which can cause pain & ringing (tinnitus) with sounds similar to an ocean roar that may coincide with your breaths. It most commonly occurs after weight loss or after anti-cancer radiation to or near the nose & throat. The symptoms can disappear when you lie down. Patients sometimes complain of an unusual awareness of their own voice (autophony) and of ear discomfort. The cause of these symptoms is a eustachian tube that remains abnormally open, allowing too much and then too little passage of air to the middle ear space when you breathe.

Decongestants, nasal steroids (rhinocort, flonase, nasonex, beconase, etc), nasal saline irrigation washes can all help this problem.  Are any of these treatments ones that your doctor is using?

[Wear/a/Jimmy]

True, and Tymponemtry which I think the OP was trying to say by sateing that the pressure was slightly changed would be in agreement with your theory Dr. Choi.

Not too mention, there may be enough middle ear issues going on to even cause the OAE to be abnormal. But I would suspect that an air bone gap / conductive loss would be apparent which would rule out the need for an OAE any how.


Interesting case.

[Enoch Choi, MD]

OAE?  Wear/a/Jimmy you sound like an audiologist?

[Wear/a/Jimmy]

& you sound like an ENT, but apparently you are a GP? If so you know a lot about ENT affairs, very impressive. But yes I am an AuD. (I too speak Mandarin, but not Cantonese)

[Enoch Choi, MD]

thanks for the encouragement, you've been a great help to many folks here on this forum.  I grew up with Cantonese since my folks are from Hong Kong, but now am trying to pick up Mandarin for my kid's sake since they're in a Mandarin Immersion school.

Yes, I'm a GP, in the US we call ourselves family physicians, specialists in Family Medicine...  I see a lot of sinusitis, otitis, pharyngitis, laryngitis, allergic rhinitis, etc...

[Wear/a/Jimmy]

GP...  No wonder you take more time than ENTs.  I think you will find I bash away on ENTs a lot..  Whew!

But a bit of advice, buy a tympanometer if you haven't already. Look into a GSI 38, extremely easy to use, gives good information, & validates otoscopy. I don't know if GPs can use the CPT code for Tympanometry?  I would hope they could, I have seen pediatricians use them.  

But keep in mind that the GSI 38 is limited in that it can not acuratley test anyone less than 6 months old. Oh, and depending on which model, they also can do pure tone testing. So essentially it would be handy to have around for those that complain about sudden sensory neural type situations. You could rule out OME etc with such a machine.

Any how, thanks for being here...  it really is nice of you to spend your time here.

Mandarin is a beautiful language, I picked it up while living in Taiwan.

[Enoch Choi, MD]

I think i can.  Since PAMF started a pediatric urgent care, i've been only seeing adults so that device would work for me.  I'll bet they have one, i should go over to their department and check.

It's really great that you hang out here too.

I feel like this is really good work we get to do here.

My dad trained in acupuncture in Taiwan, where did you stay?

[Wear/a/Jimmy]

Taibei
Neihu
Miaoli
Lotung

I lived in each one of those areas for 6 months at a time, lived in Hualien for about 3 months too.

I have also seen a lot of China, but I would not say I have lived there, more like visited. Collected time, around 3 months in China. Singapore, just a short 1 week stay.

Been in Thailand now for almost 2 years...   Sadly, I really dislike Bangkok, where I am pretty much located, but I do get to travel up north, and it is really beautiful up there. (Changrai & Changmai) I need earnestly try to learn Thai. I have yet to do so. In Taiwan, learning Chinese was one of my main tasks/goals.

Audiology is really underdeveloped on this side of the world & I stay pretty busy.

[aliwaqar]

Hello
Thank for all the posts and help you guys are giving vide your comments.......
Currenlt i am using the nasal spray named Nasacort AQ (Triamcinolone Acetonide).
I may highlight that before using the medication some times i felt that my ear is toltally open and air can pass easily through it. But now it feels as if some pressure is building. But still the discomfort remains and the pain starts for increase gradgually whne i listen to music and sing. Moreover; its been 10 days since ive been using the medication.
Please comment and once again thanks..................
Regards,
Ali Waqar

[Enoch Choi, MD]

It sometimes takes 2 weeks for the effect of nasal steroids to kick in.

I'd keep it up and let us know if it's not better in a couple days...

[edsweet]

Thanks for the info about open Eustachian tubes. I'm trying to figure out why I get a huge rush of air in my left ear when I sing and that is something to explore while I try to get an ENT referral. My family doctor thought it might be a perforated eardrum, but I've experienced the sensation for years and it just occurs a lot more now that I'm singing.