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Medical Forum / Diseases and Disorders / Tinnitus / September 2005

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My visit to the ENT

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Wayne - 05 Sep 2005 15:58 GMT
Just a post for the sake of posting, but I finally got to see an ENT
for the first time since realizing I had a high pitched T and posting
to this group. I'm not sure if I am disappointed or relived by what
transpired. I was in and out pretty quickly, but during my time there I
was first subjected to several hearing tests. I had some strange
results (so I thought) and had the nurse even thinking I was pulling
her leg. One test involved masking one ear from background noise (using
white noise) and then clicking a button when I could hear a sound that
was originating from behind the other ear. Problem there was I was
hearing it through the opposite ear I was supposed to hear it from!!
Either my hearing is rotten or some wires are crossed somewhere!

Despite the odd hearing test results, however, the ENT didn't mention
any crossed wires, but he did mention that my hearing has become
impaired slightly. He told me that my hearing was still pretty much in
the normal range but with a "dip" at the high tones and he said the
ringing in my ears is me "hearing that damage". I guess that sounds
reasonable; the ENT tried to explain it by saying that the brain is
good at blocking out background noise usually (e.g., blood pumping in
vessels etc), but the "ear damage" is making me hear the high pitched
noise and likely its not that the sound has gotten louder, but for
whatever reason my brain has become less adept at blocking it out. One
of the potential reasons the ENT cited was stress/tension and in
particular he mentioned neck/shoulders so that would tend to agree with
some of what Elly has been writing. What else did the ENT say? Steer
clear of coffee (although he only said that after I brought it up), get
exercise, get a head/neck/shoulders massage, consider posture (I sit in
front of my PC just about all day every day) and basically try to
relax.

One thing that caused me a little concern is that after the hearing
tests, the ENT didn't seem to be too concerned about anything else I
had to say that wasn't directly related to the hearing test results. It
was like the test results confirmed something for him and the fact my
ears feel full, and sometimes I get ear pain etc didn't really concern
him. I also mentioned to him my history with orthodontic treatment and
possible (self diagnosed currently) TMJ. My jaw has been popping a lot
lately, but am I only noticing it more now that I am conscious of it?
Anyway I do get to go back to him later so I can bring up the other
things again if necessary. My ENT did refer me to an oral surgeon who
turned out to be the same oral surgeon I saw from ages 12-20. For now I
think I am going to give that a miss since the 15 minute ENT
appointment cost $165, and I have more appointments scheduled.
Definitely not good for the bank this whole T thing is it?

So my next steps are to undertake an MRI scan next week (the ENT noted
that the hearing loss is more to one side which apparently is an
indication of something potentially sinister; he said if it was
completely symmetrical then no MRI would have been required). After the
MRI I have some puretone and speech discrimination tests, and auditory
brainstem response tests. I think the latter is basically listening to
clicking sounds for an hour with electrodes attached to my head and
neck. Looking forward to that one.

As for the now, my T is still quite obvious, although not at its worst,
but I've been ignoring it fairly successfully recently. It always gets
to be its loudest when I write these posts presumably because it's the
foremost thing in my mind at the time...

Until the next update.

Cheers,
Wayne H.
Howard Gutnick - 05 Sep 2005 20:05 GMT
> Just a post for the sake of posting, but I finally got to see an ENT
> for the first time since realizing I had a high pitched T and posting
[quoted text clipped - 7 lines]
> hearing it through the opposite ear I was supposed to hear it from!!
> Either my hearing is rotten or some wires are crossed somewhere!

When testing by bone conduction (when sound was originating from behind the
test ear) it is necessary to mask the non test ear because interaural
attenuation by bone conduction is assumed to be 0 dB. To state it another
way, a bone conducted signal is will be equally loud in both ears even if
presented on one side. So you have to introduce noise into the non-test ear
to eliminate its participation in the test.

> Despite the odd hearing test results, however, the ENT didn't mention
> any crossed wires, but he did mention that my hearing has become
[quoted text clipped - 13 lines]
> front of my PC just about all day every day) and basically try to
> relax.

All not bad recommendations. Do you drink a lot of coffee or just one or two
cups a day? Cut back and see what happens. If there is no difference, then
don't worry about the coffee unless you're over doing it, which would not be
good for you in the first place.

Do you find that background sound tends to reduce the loudness of your
tinnitus? If so, play music in the background or get a noise generator, for
instance from Brookstone. They are reasonably priced.

> One thing that caused me a little concern is that after the hearing
> tests, the ENT didn't seem to be too concerned about anything else I
[quoted text clipped - 10 lines]
> appointment cost $165, and I have more appointments scheduled.
> Definitely not good for the bank this whole T thing is it?

The fullness and ear pain are meaningful symptoms and should be paid
attention to. You very well may have myofascial pain syndrome that can
result in causing/exacerbating tinnitus.

> So my next steps are to undertake an MRI scan next week (the ENT noted
> that the hearing loss is more to one side which apparently is an
[quoted text clipped - 4 lines]
> clicking sounds for an hour with electrodes attached to my head and
> neck. Looking forward to that one.

Asymmetric hearing and tinnitus are red flags for in the ENT business for
the potential of an VIII nerve lesion. So he's running an MRI to rule that
out. But...after the MRI is done, which is the gold standard for this
diagnosis, I don't know why an auditory brainstem response would be
indicated. It usually is ordered prior to an MRI as a more cost effective
screening device. Then if the ABR is positive, the MRI is ordered. Ask your
ENT why s/he is considering the ABR after the MRI.

> As for the now, my T is still quite obvious, although not at its worst,
> but I've been ignoring it fairly successfully recently. It always gets
> to be its loudest when I write these posts presumably because it's the
> foremost thing in my mind at the time...

Yep, exactly. Which is why support groups often are counterproductive for
people with T. "Let's get together, talk about our tinnitus, and leave the
meeting with the T ramped up because we just used all of our energy
concentrating on it and listening to other people complain about it."

Signature

HNG

A Zen Thought: I just got lost in thought. It wasn't familiar territory.

Howard N. Gutnick, Ph.D.
Body Pride Personal Training
BodyPride@cox.net
www.BodyPrideOnline.com
757 496-3270 Home
757 630-9208 Mobile

Wayne - 06 Sep 2005 18:39 GMT
> All not bad recommendations. Do you drink a lot of coffee or just one or two
> cups a day? Cut back and see what happens. If there is no difference, then
> don't worry about the coffee unless you're over doing it, which would not be
> good for you in the first place.

I've been binging on coffee lately, so I have recently switched to
decaf. You're right though; I was definitely drinking too much mainly
to compensate for lack of sleep which is another thing I need to
seriously review.

> Do you find that background sound tends to reduce the loudness of your
> tinnitus? If so, play music in the background or get a noise generator, for
> instance from Brookstone. They are reasonably priced.

Background sound used to drown it out completely, but even right now as
I type this I have background music playing but I am still very aware
of the T. Fortunately, however, it's not keeping me awake at night. If
that starts to happen I'll have to look at a generator and hope my wife
and my 3 year old daughter who has a habit of sharing our bed can both
put up with it too!

> Asymmetric hearing and tinnitus are red flags for in the ENT business for
> the potential of an VIII nerve lesion. So he's running an MRI to rule that
[quoted text clipped - 3 lines]
> screening device. Then if the ABR is positive, the MRI is ordered. Ask your
> ENT why s/he is considering the ABR after the MRI.

My ENT ordered them all at once, I assume because there is a long lead
time in getting the response tests and also getting back in to see the
ENT. The appointments just worked out such that the MRI will be
conducted first, however, the ENT definitely wanted both done before I
saw him again. I'll ask him about it.
Elly Byrne - 05 Sep 2005 21:56 GMT
>He told me that my hearing was still pretty much in
>the normal range but with a "dip" at the high tones

And that dip in the high tones most likely corresponds with the pitch
of your tinnitus. Hearing loss and hearing damage are not the same
thing.

>sometimes I get ear pain

If there is no medical cause found for the earpain then it is a result
of your muscular tension.
http://eebee.net/earpain.shtml

Elly's Tinnitus Resources
http://eebee.net/

>Just a post for the sake of posting, but I finally got to see an ENT
>for the first time since realizing I had a high pitched T and posting
[quoted text clipped - 59 lines]
>Cheers,
>Wayne H.
Wayne - 06 Sep 2005 18:40 GMT
> And that dip in the high tones most likely corresponds with the pitch
> of your tinnitus. Hearing loss and hearing damage are not the same
> thing.

Yes, my ENT basically said the same thing. :-) Thanks for the ear pain
link.
Ingenuous - 07 Sep 2005 01:03 GMT
> If there is no medical cause found for the earpain then it is a result
> of your muscular tension.

Really?
Elly Byrne - 08 Sep 2005 03:16 GMT
>> If there is no medical cause found for the earpain then it is a result
>> of your muscular tension.
>
>Really?

an email I received.

"Hello, I just found your web site. I have had bad pain in my left ear
for 6 years. On and off. It gets worse when I am exposed to loud
music. I just tried the excercise you recommmend (putting hands behind
back and stretching the top of the head upwards) and the pain went! iu
too am sure something must be wrong with my neck. Thanks for a great
site."

Elly's Tinnitus Resources
http://eebee.net/
Larry Lix - 08 Sep 2005 23:28 GMT
Very nice to hear. I bet you feel good about that one!

> >> If there is no medical cause found for the earpain then it is a result
> >> of your muscular tension.
[quoted text clipped - 12 lines]
> Elly's Tinnitus Resources
> http://eebee.net/
fyfpoon@gmail.com - 06 Sep 2005 01:12 GMT
I think sitting in front of the computer over a prolonged period might
have something to do with it.  Get yourself a good neck massage and
take a tablet of gingko biloba each morning and see how you feel.  It
can be simpler than what you think.

FP
==================================
> Just a post for the sake of posting, but I finally got to see an ENT
> for the first time since realizing I had a high pitched T and posting
[quoted text clipped - 59 lines]
> Cheers,
> Wayne H.
Wayne - 06 Sep 2005 18:45 GMT
> I think sitting in front of the computer over a prolonged period might
> have something to do with it.  Get yourself a good neck massage and
> take a tablet of gingko biloba each morning and see how you feel.  It
> can be simpler than what you think.

I shall give that a try. Thanks for all the good advice people! :-)
fyfpoon@gmail.com - 13 Sep 2005 03:45 GMT
Doctors have all sorts of theories explaining how tinnitus comes about.

Take a tablet of gingko biloba in the morning empty stomached and see
how you feel.  Talk to a doctor that has prescribed that med to people.
 
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