Sudden hearing loss for a young guy

Quick background. Im 23 and I was born with a moderate to severe loss in my left ear. All the docs that I've seen said it was just nerve damage and I've managed to survive.

About 10 days ago I started to feel real clogged in my left ear and with that was a major hearing loss on top of my preexisting condition. I could tell that it made me nearly totally deaf.

This may or may not have something to do with it but  I was suckerpunched on my right jaw a slightly prior to the symptoms occurring.

I figured I'd wait a few days and see what happens. I had mild ringing but nothing too severe. Over the week I had no change.

Of course I decided to go to the doctor over the weekend but Monday was Xmas eve and Tuesday was Xmas so I only got to the ENT today.

The audiologist confirmed that my hearing in my left took a big dump (i had a test from a few months prior to compare). He said it may be viral but didn't really say much at all.

I saw the ENT and he also didn't say much. Looked in my ear and up my nose. He said I should get a MRI but he made it seem like if it was expensive due to my insurance that it wasn't necessary. But he never really said what happened, although he did say there were some fluid behind my ear drum. Can this combined with my past loss cause this?

He prescribed prednisone and amoxiclav. Although I am worried bc I thought I should have gotten some anti-viral medication. Should I be okay with the combo I have now?

I am also debating if I should take some decongesitant..any recommendations?

Also what are my realistic outlook? Right now my left ear is unaidable, and I just want it to be good enough to get a hearing aid. The doctor didn't really say much (audiologist said possible viral, ENT said possible nerve damage and fluid behind my ear drum). I just want a reasonable outlook. Thanks

[matthanuf06]

Oh one thing if I tap the back of the left side of my head it feels very funny(on the level of my ear but right my head begins to curve). It kind of feels very full and fluidy and makes me slightly dizzy for a split second. Actually the best way to describe it is it feels loud. But if touch the same spot on my right side it feels normal.

[Wear/a/Jimmy]

I have to agree with you, he went half way. He treated as if it were viral with the prednesone (sp) but did not Rx an anit-viral, such as valtrex etc.  Then he treated you as if it is an acute bout of Otitis media with antibiotic.  

You may already know this, but you have a limited amount of time to recieve proper medication or else the damage done is usually permanent. The popular speculation is that sudden onset hearing loss, is associated with a viral attack. (Herpes to be exact) Not necessarily the sexually transmitted herpes, just a member of the herpes family.

If it were I, I would be proactive and get a second opinion from another ENT (ASAP).  I do not know the severity of your current loss, so I really can not discuss things such as the probability of  a full recovery, hearing aid use etc.

[matthanuf06]

Thanks a bunch. He did say there was fluid behind my ear which makes sense for the antibiotic. But the audiologist I saw (same doctors office I took my test 5 minutes prior to seeing the ENT) said it was probably viral. So it seems contradictory.

I think I am going to continue the steroid and antbiotic medication and try to see another ENT as quickly as I can.

One more question. In terms of something like this, what exactly would a MRI accomplish? What are they looking for? I have no pain, no headaches etc. I'm just curious since I'm not sure yet how much it will cost me out of pocket. But I do want to get this cleared up regardless of cost

[Wear/a/Jimmy]

They are looking for a CVA or a tumor. CVA cardio vascular accident, stroke etc. At your age I doubt this is an issue. Tumor, which is an acoustic neuroma is benign, usually slow growth and usually not associated with a sudden hearing loss.

If you do get a MRI, make sure it is done with and without contrast. If you do not get it done this way, you really will be wasteing a lot of money.

But if I were you I would go after this issue like it is a viral attack. The MRI can wait compared to the viral issue. The window period is about 2 weeks. In other words you need to get properly medicated within 2 weeks of onset, or else the damage is pretty much forever.

You ENT really has no way to tell you for sure if it is viral or not. Neither does the Audiologist. All they can do is look at your hearing loss, recognize the configuration, and postulate from that point. A doctor can order a test to show if you have ever been exposed to herpes, but just because you test positive for that, which most people do, does not mean this is or is not a viral attack.  

Most ENTs I know go after a situation like your with a shotgun. They treat it both as a virus and a bacteria infection.

I wish you luck

[Momtoteenboys]

If the hearing loss occurred when you got sucker punched, you could have disarticulation of the bones of the middle ear.  That would cause a conductive loss, which means it could be surgically correctable.  If you are dizzy, etc., its probably viral and maybe Meniere's disease.  Have you had episodes of ringing in your ears, vertigo, etc. in the past?  It can come and go for years, and each time zap a little more hearing.  The vertigo can be quite severe which is a telltale sign.   If this was the start of Meniere's you may see some recovery with the steroids but could have future episodes.  They may tell you to avoid salt and caffeine too.  Good luck to you!

[Wear/a/Jimmy]

If he did have a disarticulation of the oscicular chain, it would have showed up during tympanomtry, and there would be an obvious air bone gap on the audiogram. Disarticulation is not something that is just missed.

Secondly the audiologist would never have mentioned a viral etiology if there was a suspicion of a disarticulation.

In all my years, I have never seen a disarticulation in a live person, yet....?

[Momtoteenboys]

Hubby had one from a blow while boxing, which is why it occurred to me.  I was not saying it could be both but my writing wasnt clear.  I thought of a Meniere's attack since he mentioned the tinnitus.

[Wear/a/Jimmy]

SNHL patients commonly have tinnitus along with vertigo. Many times people complain about flu like symptoms right before the attack.

Your husband probably had baratrauma rather than a blow to the head. Baratrama via boxing is a direct blow to the ear.  

[matthanuf06]

I feel fine except for the hearing issue. I do have slight ringing in the ears which is off and on but nothing too bad. Ive never had vertigo in my life. In fact I feel fine that I can still work, run, and lift weights nearly everyday. My ear just feels extremely clogged and wet. Sometimes it feels that fluid is just going to ooze out of my ear. I scheduled a MRI for next Wednesday, I'll have to only pay 100 and since i did have a pre existing hearing loss i figure i might as well do this just to see if anything is up.


I do think ill call the ENT tomorrow and ask about the viral thing and see if he can prescribe something for that prior to the long weekend. Is this something that can be done over the phone?

[Wear/a/Jimmy]

He should be able to RX the valtrex over the phone, he should have one of his staff call the local pharmacy and you go pick it up...

[Nancy T]

What dose of prednisone did he prescribe? The standard for sudden hearing loss is a high dose--I THINK it's 60 mg daily to start, tapering off over two weeks.

I agree with what W/a/J said. However, it seems oddly coincidental that you got punched right before the hearing loss started. Did you tell the ENT about the punch?

Of course, when the (general) ENT at my second visit said my sudden severe/profound hearing loss was probably caused by a virus, and I asked in astonishment whether it was then just a coincidence that I lost my hearing suddenly at the exact moment I sneezed, he said, "I don't think the sneezes had anythign to do with it." What!!!! My jaw dropped to the floor. They darn well DID have something to do with it--you don't sneeze and lose your hearing in the same instant by mere coincidence! (Later, a neurotologist did explore my middle ear surgically and ruled out perilymph fistula, as I had dizziness too, though not severe.)

And, what kind of ENT did you see? If you didn't see a NEURO-OTOLOGIST (also spelled neurotologist), you definitely should. They are the real specialists for the inner ear--hearing loss, dizziness, etc.--as they are ENTs with extra training in that area. You can see a list at the American Neurotology Society Web site (though some of those listed are neurologists or PhDs, not neurotologists).

Do be sure to get your MRI WITH CONTRAST. That is the gold standard for ruling out an acoustic neuroma. Acoustic neuromas CAN start with a sudden hearing loss, though gradual hearing loss is more common.

As for prospects... a widely cited study found that 1/3 of people with sudden hearing loss regained all their hearing, 1/3 regained some, and 1/3 regained none. If your hearing is going to come back, it will likely do so within 10-14 days. After that, it's much less likely. As W/a/J said, there's no way to prove whether it's viral or what. Best thing is to hit it with all treatment possibilities, at least ones that are reasonably affordable and likely.

If your good ear has good hearing, you can probably get a BAHA--bone-anchored hearing aid, although in the US we now like to call it by other names such as bone-anchored hearing apparatus or system, since the word "hearing aid" is anathema to insurance companies. I have waited two years for my insurance to pay for one and they won't, so I'm switching insurances with fingers crossed. For info on the BAHA, google it or go to the Cochlear Americas site. The BAHA was developed by a Swedish (?) company called Entific but Cochlear Americas bought it out.

Another possibly is a CROS aid (contralateral routing of sound), but that requires you to wear an aid in your bad ear which transfers sound via radio waves (?) to another aid in your good ear, thus allowing you to hear sound coming from the bad side in your good ear. All the doctors and audiologists I talked to said they didn't think I'd like a CROS aid because it requires you to plug up your good ear, which is usually more bothersome for patients than helpful if their hearing is very good on the other side.

BAHA works on the same principle--sending sound coming from the bad side to the good side, but it involves a titanium implant in your skull behind the bad ear (like for dental implants, a minor outpatient surgery) which osseointegrates, and then after a few weeks or months you snap on an external processor. The implant vibrates and thus sound is efficiently transferred to your good ear via bone conduction. You don't get directional hearing, but at least you're not missing everything said on your left side!

Best of luck and do let us know how it all turns out.

Nancy T.

[Nancy T]

P.S. If you google "BAHA users" you will find a UK-based forum with lots of people with BAHA experience.

[matthanuf06]

All he prescribed was a one week cycle, 5mg pills and i took 6 the first day, 5 the second and so on. I'm on day 3.

I called today and he thinks the antibiotics will do the trick. I mentioned how the audiologist thought it was viral. So I'm not really sure what I should do at this point especially considering its the long weekend.

I have my MRI on Wednesday and the first time I can see him again is the following Monday.

I'm not sure what type of ENT he is. Frankly all I did was look up in my insurance what ENTs were provided and they were all out of the same outfit and they sent me to this ENT. Although I do get the vibe they aren't taking it too seriously.

I was planning on getting hearing aids anyways since I did already have a significant loss. My left prior to this episode was already pretty bad but I was managing and it was aidable. My right has a mild loss. However, now with my left nearly totally gone I'm not sure what to do. As long as it is aidable I'll be okay since I was planning on that anyways. Although the test I took a couple days ago confirmed that it was too bad so I need to get some hearing back..

Thanks everyone for the responses. I greatly appreciate it

[matthanuf06]

Oh I told both doctors audiologist and ENT possibly everything that I knew of that would help. So I'm clueless and kind of frightened

[matthanuf06]

I think it is a good idea for me to go to one of those specialized ENTs,  but my problem is I am not going to be able to see one until probably late next week. I doubt any of those doctors are going to work Monday or Tuesday, and I have my MRI on Wed

[Wear/a/Jimmy]

Another possibly is a CROS aid (contralateral routing of sound), but that requires you to wear an aid in your bad ear which transfers sound via radio waves (?) to another aid in your good ear, thus allowing you to hear sound coming from the bad side in your good ear. All the doctors and audiologists I talked to said they didn't think I'd like a CROS aid because it requires you to plug up your good ear, which is usually more bothersome for patients than helpful if their hearing is very good on the other side.


Actually in your case it would be a BiCros hearing aid system that you will need if your current hearing situation does not completely resolved.  That said, if you polled a 100 audiologists, you would probably not find a one that honestly supports the uses of CROS or BiCros systems, especially witha adults. CROS systems are great in theory and on paper, but in practicality they perfrorm really poorly.

Hearing aid have an amazing ability of collecting background noise & amplifying it, and dumping it into the ear. Now if you have a bad ear, with a device hanging on it, collection back ground noise, and then beaming it over to the better ear....  I think you can see where there can be some issues.

I have tried them before, used the best directiona/digitial technilogy available....  and it was still worthless.

The good thing is, if you really want to try it, you can try it before you buy it. At least that is the policy in the US.

The sucker punch was to the right jaw not to the temporal area if I remember correct. The left temporal area of the brain is responsible for hearing & language etc. So it does not surprise me that no one has really been too concerned about that. That said, I did have a patient that had a permanent sensory loss, due to being kicked in the head.....   So basically when it comes to the brain, anything is possible.

[Nancy T]

Holiday weekends stink!!! well, at least if you have a medical problem.

I think my ENT must have looked things up, because he prescribed me the proper high dose of prednisone. Yours didn't! It's supposed to start at 60 mg--you're getting half that.

Get thee to a NEURO-OTOLOGIST. Where do you live? Check out www.vestibular.org and click on the find-a-doctor tab, but that listing does not include all the neurotologists that there are, because not all neurotologists have joined that organization (Vestibular Disorders ASsociation). The American Neurotology Society Web site might be helpful, or else ask your regular doctor to tell you who is the best EAR specialist, i.e., otologist/neurotologist, in your area, and call them up ASAP.

Sorry to hear you have some loss in your other ear too. Was that also congenital? Was your hearing loss unchanging all those years until 10 days ago? When your situation stabilizes you could ask your neurotologist and audiologist about a BAHA, whether you would meet the criteria for it. They're hugely expensive if insurance doesn't pay for it, though--I got quotes of $14,300 and ballpark $20,000 from two different offices. Now that Medicare pays for it (after FDA approval for its use for single-sided deafness), more insurances are going along, but definitely not all of them. Some of them will pay for the surgery but not the device itself, which runs approx. $4000 I think.

Best of luck--hope you can see a real ear specialist soon. I don't understand why some ENTs are so wishy-washy about sudden hearing loss. I have heard similar stories from other people about general ENTs.

Nancy T.

[matthanuf06]

I've had both losses my entire life, although the loss in my right ear has gotten slightly worse but not much more. I've always functioned off of my right ear even prior to this episode.

Nancy you've been a great help. I think I may try to get an appointment with one of those specialized ear ENTs that you mentioned. I wish I could get in ASAP but with the holidays I know that its going to take awhile.

I think what I'm going to try to do is go get my MRI on Wed and see one of those specialists you recommended on Thursday or Friday (if they'll see me then) and possibly cancel my appt with the ENT I've been saying the following Monday.

Due to my age and general inexperience with this sort of thing how would I get my records to the specialist I hope to see? Would I just tell the MRI imaging area to send a oopy over to the new doctor and have the office of my current ENT fax over my records? Or do I have to manually pick up my MRI/records from ENT to bring to the new doctor? Or how would I go about that?

[Nancy T]

Matt, I would recommend calling a neuro-otologist on Monday and not waiting. It won't hurt to call and see if you can get in. Doctors' offices won't necessarily be closed because it's New Year's Eve--it's not a holiday--and ear doctors DO understand emergencies. Even if they're closed, someone should be on call.

Be SURE to tell the person you speak with that:

1. you have previous significant hearing loss already, and you're only 23,
2. you have had a SUDDEN further significant loss within the last few days, and
3. you are concerned that your current treatment may not be correct and you want to do everything possible to save your remaining hearing. Make these things very clear.

I would worry less about your records at this point than about getting seen ASAP. If you get in to see the neuro-otologist, they will have a form you can sign and they can then request that your current ENT fax records over. If you have an MRI scheduled, go ahead with that, but be sure that the MRI is done WITH CONTRAST, otherwise as W/a/J said it will be a waste of money. Bring any audiograms or other records that you already have.

Again, you want to see someone qualified in OTOLOGY/NEUROTOLOGY. Another place to look besides the ones I mentioned above is www.entnet.org; click on the find-a-doctor link and choose neurotology as the subspecialty. But whoever you call, make sure to ask the staff or doctor if they have a certificate or qualification in otology/neurotology, so you're not wasting time seeing just another general ENT.

If you have a congenital hearing loss, a further hearing loss at some point in the past, and now yet another one, you have to be doing everything you can to save your remaining hearing. Don't let the holidays stop you!

Very best of luck and please tell us how it goes.

Nancy T.

[Nancy T]

P.S. Call right away Monday morning, starting at 8 or 8:30 when they might be open.

[matthanuf06]

I found three Neurotologists in the Tampa area and I am going to call first thing Monday. Hopefully I can get in Mon but I'm realistic plus I'll be calling from work. But I am going to call all 3 and get in ASAP. My goal is Thursday at the latest considering New Years and my MRI.

My Prednisone cycle ends tomorrow so sooner the better.

But I am glad I got the help I did in this thread. Seeing a real specialist, which I didn't know exist, will definitely help me. I'm pretty resigned to the fact that I won't be able to get a hearing aid in my bad ear, but I am hopeful that there is a chance I can get some hearing back. But more importantly I'm hopeful the specialist can give me real answers and help me in the coping and preparing for the future process.

[hava]

While you are waiting, do these exercises everyday and you will help the ear get better.Within 4 weeks you will experience better hearing.
Anulom Vilom - Deep Breath-in through left nostril keeping right nostril closed
then - Breath-out through right nostril keeping left nostril closed
then -Deep Breath-in through right nostril keeping left nostril closed
then - Breath-out through left nostril keeping right nostril closed
and repeat this cycle for upto 30  minutes twice a day(maximum 60 min/day).

Bhramri Pranayam -Close eyes. Close ears with thumb, index finger on forehead, and rest three fingers on base of nose touching eyes. Breathe in through nose. And now breathe out through nose while humming like a bee.
Duration : 5 to 15 times

[Nancy T]

Good luck! Dr. Silverstein and Dr. Wazen are very well known in that area (and nationally), which is not to say that other otologists/neurotologists won't be just as helpful. It really depends. I hope you find one who can help you.

That said, please don't be too surprised if you still cannot get any hearing back--unfortunately the doctors are not miracle workers, and once damage is done to the hearing, it can very well be permanent. Inner ear hair cells do not regenerate. By going to a specialist ASAP, you are maximizing your chances, but there are still no guarantees, and sometimes not the best doctor in the world can help you.

But--regardless of your hearing outcome, there may still be much you can do to take advantage of your remaining hearing.

Please keep us posted!

Nancy T.

[Wear/a/Jimmy]

To put your mind at ease, Rush Linbaugh went totally deaf, and through the use of a cochlear implant he still is gainfully employed and functions quite well. So there is always hope.

Good luck to you and have a happy new year.

[matthanuf06]

Thanks everyone. I got an appointment at a specialist on Thursday and I have my MRI tomorrow. I can already tell that my care is going to be much better. Hopefully they can shed some light on my original hearing loss also.

I do feel very slight improvement, not much, but it is something at least. Like I said earlier I was in the process of getting hearing aids PRIOR to this episode. I just lost so much that hearing aids wouldn't help, so my goal is just to get back to that hearing aid threshold.

I'll try to do those exercises, hopefully they help.

[matthanuf06]

I do think I got a little bit of my hearing back. I know it isn't scientific but I've sort of been testing my hearing using automated messages on my phone. Note that since I've always had bad hearing I never really used this ear to talk on the phone so I can't really compare to what it used to be. When it first happened I couldn't even tell if it was ringing or if someone was talking (on the phone). I'd be able to faintly hear a noise but I couldn't identify it. Then a few days ago I began being able to distinguish between the rings and the actual message. Now I can definitely tell the rings and when its talking. I can't understand most of the words, but I do get a few here and there. This is when my volume on my phone is at full blast so it is still really bad, but an improvement.

[Nancy T]

Good news!! I hope you continue to improve!

If you can subjectively tell such a difference, even if it's not scientific, you surely did regain some hearing.

In the early years of my hearing loss, I sometimes used to think, momentarily, that my left-ear hearing had come back when I turned off the shower or my Eustachian tube popped open or I got the wax cleaned out of my ears. But my "instant hearing test" (snapping my fingers beside each ear and comparing it) immediately disillusioned me! The snap was never crisp on the left.

But if you can tell such a difference in the ringing and messages, it sounds like you really are getting some improvement.

Don't forget to insist on the MRI WITH contrast, or it will be a waste. Make sure they know when you're registering that you need contrast and that they actually set you up for it. They first do some sequences without contrast, then roll you out and inject the contrast, then put you back in and do some more scans. Acoustic neuroma can only be definitely ruled out if you have contrast. Usually I think they will position the IV in your arm before starting, then when they roll you out halfway through, all they have to do is add the contrast agent.

Nancy T.

[matthanuf06]

I got my MRI today, it was with and without contrast. Ill be seeing the neurotologist tomorrow. Hopefully my MRI gets looked at by then. I'll let you know what he says

[matthanuf06]

Update...

My MRI came back normal so that is good. The doctor I saw today told me that going on a low salt diet and a diuretic for the time being should clear up my aural fullness and help with the ringing. Although I don't have an imbalance problem he thinks I have Meneires in my cochlear.

He also felt pretty confident that I could get back to my baseline hearing in that ear especially since I am noticing some improvement.

He wants me to wait a few days and get another hearing test and see where I stand at that point. He also brought up the direct shot of steroids into the ear. Although he did say it did have a low success rate but left it up to me.

I'm not sure if I mentioned it but my baseline is around 65 Db. The drop I experienced brought my hearing down to 95Db. That is for my left and is nearly flat across the board. My right varies much more, it starts out a little better than my left but then gets much better. My word recognition in my left prior to the episode has usually been around 25-35 percent. After the episode, only one test though, it dropped down to 20 percent. My right has recognition of around 80-93 percent. In fact the hearing test I took after the loss shows the best hearing Ive had in my right ear in a long time.

[Nancy T]

Matt--good news that your MRI was normal and also that you are continuing to have some improvement.

I am surprised he thinks it's Meniere's because that usually involves dizziness, but really the whole issue of what Meniere's is apparently is very complicated, and much is unknown about what causes it and in what different ways it can manifest.

Low salt and diuretics are indeed the standard treatment for Meniere's. Sounds like this doctor is going to be on top of things for you, following your hearing with another test in a few days and considering further treatments if necessary.

If your speech discrimination in your bad ear was only 25-35 percent even before the loss, you really have no functional hearing in it, you can't understand speech for all practical purposes. My original audiogram for my bad ear 8 years ago showed 25 percent speech discrimination (word recognition) and I think the neurotologist mentioned it was 40 percent recently, but he said that is still too low to be usable for speech, which is true! I don't believe my hearing has improved one bit from the day I lost it, probably just differences in the testing (and being a good guesser!).

If it's Meniere's I hope you don't have any further attacks and that your good ear stays good!

Let us know how your hearing improvement progresses and what more you find out.

Best of luck,
Nancy

[Wear/a/Jimmy]

Meniere's does not always involves dizziness. It sounds to me you were a hearing aid candidate prior to this event.

You need to check them out....   I am not going to recommend any particular brand or discuss them. Technologies... sure I will freely discuss that..

good luck to you and thanks for keeping us posted.

[matthanuf06]

Thanks. I'm getting a hearing test next Thurs to see where I stand. Although I do think my hearing got worse today. Its been back and forth.

[Nancy T]

If your hearing is fluctuating it really does need to be monitored--it's good you are being followed. Since you are seeing a neuro-tologist, you should be in good hands. Still, if you have any further sudden clear-cut drops in your hearing, I would call the doctor and let him know right away (the same day) and see what he wants to do.