Abnormal Tympanogram

[cspc]

I went today to the 4th ENT. He found an abnormal audiogram in my right ear. He said it was a flat line instead of a pick. He said my tympanis behave like they have fluid behind them especially the right one.

He told me to do the valsalva maneuver (I know I read many things on the forums about this) to check if both of my ears popped to rule out ETD. They did pop.

He told me to do a CT scan. He didn't test for bone conduction though. He tested the nerve. My audiogram from today showed 10 db across all frequencies in my right ear and 10 db in the left ear except from 500Hz to 2000Hz which was at 15db. I'm not sure for the validity of this test because it wasn't in a soundproof room.

My previous audiograms (Sensorineural hearing check) from the past 5 months were at 5db with some fluctuations to 10db in 4000Hz and 8000Hz.

In April I travelled by plane and experienced extreme ear pain and ear pressure on both flights ( from to, to and from). I made an audiogram a week after that. This audiogram which showed 10 - 15 db hearing loss in 125Hz 200Hz and 500Hz but this audiogram wasn't taken in a soundproof booth either. I have no clue if the audiograms that are taken elsewhere than in soundproof booth are false.

I have to mention that I was on two courses of antibiotics for the past two weeks. One for otitis (Augumentin) and another one for tonsillitis (Zinnat). I was given azithromycin (5 days) for tonsillitis but from the first pill I had a permanent spike in my tinnitus along with reduction of hearing in both ears and contacted the doctor (GP) to change the antibiotic. He said that this wasn't listed as a side effect from the medicine.

I read the leaflet of the antibiotic later and found out that tinnitus and reduction of hearing was indeed a side effect that affected 1 in 10000 if I remember correctly. I really lost my trust to doctors.

I don't know if the CT scan will show something.

Is the CT scan noisy as an MRI is?

I had an MRI two years ago (I didn't had tinnitus at the time) it was extremely loud but tolerable.

 

[cspc]

** to clarify for some reason he wrote a CT scan for sinuses not for the ear.

 

[dingaling]

If the tympanogram shows a flat line, I'm not expecting the Valsalva manoevre to do much - if anything.

Did he give you any medication, nasal drops or otovent balloon?

I would expect a conductive hearing loss below 1kHz but without doing bone conduction, the audiogram is only part of the picture. Were you tested in a noisy environment?

 

[cspc]

If the tympanogram shows a flat line, I'm not expecting the Valsalva manoevre to do much - if anything.

Did he give you any medication, nasal drops or otovent balloon?

I would expect a conductive hearing loss below 1kHz but without doing bone conduction, the audiogram is only part of the picture. Were you tested in a noisy environment?

Only Betaserc and a nasal spray (nasoxyl) to put on the flight the next time I will travel.

Indeed. It was a room near a corridor. As I got tested I could hear a lady walking with high heels past the door for a 10 - 15 seconds. The testing conditions weren't ideal. Wondering why doctors in my country don't test conductive hearing. It's the 4th one and he didn't test it.

 

[cspc]

I found this for tinnitus spikes after an antibiotic: https://www.drugs.com/answers/tinnitus-temporary-azithromycin-2988330.html. It says that it can take up to 10 days for them to clear up even after a single dose.

 

[Tinker Bell]

A CT scan is quieter than an MRI. It also takes considerably less time. An MRI uses magnetic fields while a CT uses radiation through multiple X-rays.

The doctor likely wrote the script for a sinus CT because if you have poor ear pressure, the problem is related to the Eustachian tubes. Eustachian tubes are connected to the sinuses and visual near them. Scanning only your ear would fail to show any sinus blockage.

Is your hearing at or above 15dB? If so, that's perfect hearing and not considered a loss — even for children. If your hearing is above 15dB, there is no reason to do a bone conduction test. The loss would appear with the audiogram. The bone conduction test would be necessary to try to rule out why you would have hearing loss.

What country do you live in?

 

[dpdx]

A CT scan is quieter than an MRI. It also takes considerably less time. An MRI uses magnetic fields while a CT uses radiation through multiple X-rays.

The doctor likely wrote the script for a sinus CT because if you have poor ear pressure, the problem is related to the Eustachian tubes. Eustachian tubes are connected to the sinuses and visual near them. Scanning only your ear would fail to show any sinus blockage.

Is your hearing at or above 15dB? If so, that's perfect hearing and not considered a loss — even for children. If your hearing is above 15dB, there is no reason to do a bone conduction test. The loss would appear with the audiogram. The bone conduction test would be necessary to try to rule out why you would have hearing loss.

What country do you live in?

What about 20db?

 

[Tinker Bell]

What about 20db?

What frequency was at 20dB?

Really, that does not matter because at and above even 20dB is considered normal. Again, even for children.

 

[Tinker Bell]

This audiogram which showed 10 - 15 db hearing loss in 125Hz 200Hz and 500Hz but this audiogram wasn't taken in a soundproof booth either. I have no clue if the audiograms that are taken elsewhere than in soundproof booth are false.

To clarify, are you saying that you were between 10-15dB at those frequencies or that your hearing was even lower? Like it dropped down 15 more dB and was at 30dB? Just wanted to make sure I understand because being at 10-15dB is not hearing loss.

 

[dpdx]

To clarify, are you saying that you were between 10-15dB at those frequencies or that your hearing was even lower? Like it dropped down 15 more dB and was at 30dB? Just wanted to make sure I understand because being at 10-15dB is not hearing loss.

My Audiogram was as follows:

October 2017: 5db on 3hz and 4hz on L ear
January (before Caloric/VEMP) 10db on 3khz and 4khz
February (After caloric/vemp) 25db on 4khz, 20db on 3khz

 

[Tinker Bell]

I went today to the 4th ENT. He found an abnormal audiogram in my right ear. He said it was a flat line instead of a pick. He said my tympanis behave like they have fluid behind them especially the right one.

Sorry, another clarification: do you mean your audiogram is flat or the typanometry results were flat? They're not the same test. A flat audiogram is not abnormal, a flat tympanometry is.

Here are some examples:

 

[Tinker Bell]

My Audiogram was as follows:

October 2017: 5db on 3hz and 4hz on L ear
January (before Caloric/VEMP) 10db on 3khz and 4khz
February (After caloric/vemp) 25db on 4khz, 20db on 3khz

Let me make sure I am understanding:
October: 5dB
January: 10 dB
February: 20 and 25dB

Did your other frequencies stay the same?

Fluctuations even like that would still be considered normal. Possible testing error on the part of the audiologist or the test taker. It is easy to miss the beeps, especially if you are feeling anxious. Even the earbuds or headphones not positioned correctly can make a difference. One audiologist nearly fell out of her chair, I completely failed a test. Moved the earbud just a pinch and immediately retested with better results.

However, let me clarify that these fluctuations are considered normal unless it's an ongoing trend. It's been almost six months from your last audiogram, do you have another test scheduled? I lost track of how many audiograms I had last year, looking to make sure there was not an ongoing loss pattern. Once we established there was not a clear ongoing downward trend, it was recommended I undergo only annual testing.

 

[dingaling]

@cspc

Can you post your audiogram and tympanogram please so we can have better clarification? (leave out personal details)

 

[cspc]

A CT scan is quieter than an MRI. It also takes considerably less time. An MRI uses magnetic fields while a CT uses radiation through multiple X-rays.

The doctor likely wrote the script for a sinus CT because if you have poor ear pressure, the problem is related to the Eustachian tubes. Eustachian tubes are connected to the sinuses and visual near them. Scanning only your ear would fail to show any sinus blockage.

Is your hearing at or above 15dB? If so, that's perfect hearing and not considered a loss — even for children. If your hearing is above 15dB, there is no reason to do a bone conduction test. The loss would appear with the audiogram. The bone conduction test would be necessary to try to rule out why you would have hearing loss.

What country do you live in?

Nice to know!!

Okay.

It's on 15db in some frequencies. I just noticed some correlations between the audiograms that are strange due to environmental parameters. I notice frequent fluctuations in my hearing both conductive and sensorineural along with tinnitus changes from low tinnitus to high tinnitus which is something strange. I am a little concerned of my hearing but I'm more concerned about the ear pressure and the outer ear infections I continue to get. I get 2 per year (even though I'm using cotton wool when I'm in the bath and don't put my head underwater). I used to clean carefully with q-tips once a week in the past. Now. I dry my ears with a towel now and dry them with a hairdryer for 5 - 7 seconds too. I get random redness in one ear at a time along with itching I don't know what this is. Ents comment for the lack of earwax in my ears but I only clean them once a week or once every two weeks only on the outside (I'm very careful because it happened to me to get outer an ear infection some years ago by cleaning my ear too much or too deep). I suspect that I get fungal infections now and I don't know how to deal with them. That's why I'm thinking it's a good idea to get a bone conduction test or a CT for the ears.

 

[cspc]

Sorry, another clarification: do you mean your audiogram is flat or the typanometry results were flat? They're not the same test. A flat audiogram is not abnormal, a flat tympanometry is.

Here are some examples:
View attachment 20235

He told me the audiogram was ok. He said the tympanogram is a flat line but he didn't give it to me.

 

[dpdx]

Let me make sure I am understanding:
October: 5dB
January: 10 dB
February: 20 and 25dB

Did your other frequencies stay the same?

Fluctuations even like that would still be considered normal. Possible testing error on the part of the audiologist or the test taker. It is easy to miss the beeps, especially if you are feeling anxious. Even the earbuds or headphones not positioned correctly can make a difference. One audiologist nearly fell out of her chair, I completely failed a test. Moved the earbud just a pinch and immediately retested with better results.

However, let me clarify that these fluctuations are considered normal unless it's an ongoing trend. It's been almost six months from your last audiogram, do you have another test scheduled? I lost track of how many audiograms I had last year, looking to make sure there was not an ongoing loss pattern. Once we established there was not a clear ongoing downward trend, it was recommended I undergo only annual testing.

Well my T increased since February to Severe Levels. I am sure the caloric test/vemp has caused a drop. The audiologist asked me if I am taking any medications because the last time I seen him was in October, and that my hearing had dropped about 20decibels on 4hz. I said nope its just that my Tinnitus had jumped from Mild to Severe. I will make an appointment again in September but let me tell you something I def hear less. I shout more and I need to turn the tv to volume 40 to hear it (still cant mask the loud tinnitus).

 

[GregCA]

** to clarify for some reason he wrote a CT scan for sinuses not for the ear.

Your experience with this doctor is a bit strange...
I would have expected him/her to test bone conduction, first with Weber/Rinne fork tests then with PTA (with buzzer) to check if you have any air-bone gap.
I would also have expected some check for stapedial reflexes.
Then possibly a CT of temporal bone.

The whole description of a hearing test without a soundproof environment is already a bit of a red flag to me, to be honest.

Which country are you in?

 

[cspc]

Your experience with this doctor is a bit strange...
I would have expected him/her to test bone conduction, first with Weber/Rinne fork tests then with PTA (with buzzer) to check if you have any air-bone gap.
I would also have expected some check for stapedial reflexes.
Then possibly a CT of temporal bone.

The whole description of a hearing test without a soundproof environment is already a bit of a red flag to me, to be honest.

Which country are you in?

The doctors which I went did a tympanogram first and then an audiogram (only nerve hearing). Some have soundproof booths some don't. I didn't know that he didn't had a soundproof booth. I wouldn't go if I knew. The last two doctors commented about pressure behind the ears while they were doing the tympanogram. The tympanogram of May was type A but it had an oval pick. The tympanogram of July was type B from what he told me.

As for my country I would like to answer this privately due to GDPR. I can say that I'm in Europe in a county which is within the smallest of Europe (top 10).

 

[Sam Bridge]

Your experience with this doctor is a bit strange...
I would have expected him/her to test bone conduction, first with Weber/Rinne fork tests then with PTA (with buzzer) to check if you have any air-bone gap.
I would also have expected some check for stapedial reflexes.
Then possibly a CT of temporal bone.

The whole description of a hearing test without a soundproof environment is already a bit of a red flag to me, to be honest.

Which country are you in?

My ENT requested a normal brain mri for me. I assume that covers the ear?

I also had a slightly abnormal pressure test in my t ear.

 

[dingaling]

Also...why on earth did you have a caloric done...? What was the clinical justification for this?

And...why on earth are you drying your ears with a hair dryer - goodness knows what these things pump out !!!???

 

[cspc]

@dingaling Hairdryer: It helped dry out the drops of water that were left inside my ears. My earwax is too soft and water gets trapped easily behind it. It was the only way to dry my ears without getting an outer ear infection. The towel is not as efficient as this. The towel can scratch the ear canal easily also it doesn't dry the water drops most of the time. They stay trapped along with minimum earwax. I'm drying the ear with a hair dryer to make the water drops evaporate.

 

[Tinker Bell]

Nice to know!!

Okay.

It's on 15db in some frequencies. I just noticed some correlations between the audiograms that are strange due to environmental parameters. I notice frequent fluctuations in my hearing both conductive and sensorineural along with tinnitus changes from low tinnitus to high tinnitus which is something strange. I am a little concerned of my hearing but I'm more concerned about the ear pressure and the outer ear infections I continue to get. I get 2 per year (even though I'm using cotton wool when I'm in the bath and don't put my head underwater). I used to clean carefully with q-tips once a week in the past. Now. I dry my ears with a towel now and dry them with a hairdryer for 5 - 7 seconds too. I get random redness in one ear at a time along with itching I don't know what this is. Ents comment for the lack of earwax in my ears but I only clean them once a week or once every two weeks only on the outside (I'm very careful because it happened to me to get outer an ear infection some years ago by cleaning my ear too much or too deep). I suspect that I get fungal infections now and I don't know how to deal with them. That's why I'm thinking it's a good idea to get a bone conduction test or a CT for the ears.

It would be far better for your ears to bathe without cotton balls. Cotton can leave small fibers in your ears. There is no reason to dry your ears with a blowdrier. You mentioned both a lack of wax and soft wax, soft wax is better than hard wax. Soft wax will eventually come out. Water in your ear will dry naturally.

The redness and itching may be from the cotton ball fibers irritating your ears and your ears being dried with a blowdrier, which is just blowing any fibers around your ear.

You're likely doing more harm than good and possibly contributing to the outer ear infections.

 

[dpdx]

Also...why on earth did you have a caloric done...? What was the clinical justification for this?

And...why on earth are you drying your ears with a hair dryer - goodness knows what these things pump out !!!???

I did the caloric because I started to have balance issues I have developed high blood pressure as a result of T/H. My boood pressure was very high for my age 27. Tinnitus is going to send me six feet underground.

 

[cspc]

It would be far better for your ears to bathe without cotton balls. Cotton can leave small fibers in your ears. There is no reason to dry your ears with a blowdrier. You mentioned both a lack of wax and soft wax, soft wax is better than hard wax. Soft wax will eventually come out. Water in your ear will dry naturally.

The redness and itching may be from the cotton ball fibers irritating your ears and your ears being dried with a blowdrier, which is just blowing any fibers around your ear.

You're likely doing more harm than good and possibly contributing to the outer ear infections.

I used to do bathe without cotton wools and got ear infections frequently.My dad and his sister (my aunt) have the same problem too. They were told to dry their ears with a towel ( but I suspect that they use q-tips after each bath). I use q-tips once a week or once every 2 or 3 weeks. The water in my ears doesn't dry on its own. It always causes me outer ear infections if I let it to dry on its own. Since I don't clear my ears frequently I suspect that the lack of earwax is due to previous bacterial infections and/or current fungal infections or previous fungal infections. The previous ENT prescribed me nystalocal for bacterial/fungal outer ear infections but it made the ear pain and the itching worse and I stopped putting it. I heard so much wrong advice from Ents about outer ear infections ( such as it's ok to use qtips or its ok to clear your ears with q-tips every 2-3 days, etc) that I don't trust any of them. I went to get my ears cleaned professionally after not using q-tips for a long time some years ago. They did microsuction and prescribed me ear drops to put in the ear. After a day of putting them I had severe ear pain and developed an ear infection. I went back to the ENT and he prescribed an antibiotic. 2 weeks ago I went to check my ears because I had ear pain. To my dissapointment the ENT cleaned my ears fully with a qtip. I didn't requested any cleaning though and she applied antibacterial and antifungal cream. She didn't gave me any ear drops. A day or two later I developed an outer ear infection and was prescribed an antibiotic again. I am always getting an outer ear infection even after professional ear cleaning (3/3 so far).

I am not sure for what's happening. I suspect that my ears developed some kind of eczema and allergy to smoke, certain chemicals which are in shampoos, etc. The ENT today told me to use vaseline along with cotton wools.

 

[GregCA]

As for my country I would like to answer this privately due to GDPR. I can say that I'm in Europe in a county which is within the smallest of Europe (top 10).

What's the issue with GDPR? (off topic)

 

[cspc]

What's the issue with GDPR? (off topic)

The personal information you give online are used as is by websites and advertising companies for personalization - custom made content, advertising, data analysis, etc. Ive seen websites advertise content I have searched in another website. I don't wish to post the name of my country at the moment.

Clean CT SCAN for the nose. Nothing found to justify the type B tympanogram, no ETD, no issues with eustachian tubes so far. I will update again on Monday if the doctor finds anything else.

 

[cspc]

Clarification: My previous tympanograms in March, April, May were type C for both ears I'm sure I had an ear infection in March, a cold in April and allergies in May. I had an ear infection again end of June/beginning of July.

My tympanogram in July is type B for both ears but it's more flat on the right ear.

https://www.audiologyonline.com/ask-the-experts/common-types-of-tympanograms-361

 

[cspc]

I found this: https://en.wikipedia.org/wiki/Patulous_Eustachian_tube
and this: https://en.wikipedia.org/wiki/Superior_canal_dehiscence_syndrome

 

[cspc]

The tympanogram was in smaller size paper behind the audiogram. I saw it today. The line is a flat line at zero in both ears and both dimensions. In the right ear the pressure was -392daPa and in the left ear it was -292daPa. The compliance was 0.25ml for both ears. I will upload them later today or tomorrow without my personal info and also give an update as I will visit the ent today.

 

[cspc]

The tympanogram was in smaller size paper behind the audiogram. I saw it today. The line is a flat line at zero in both ears and both dimensions. In the right ear the pressure was -392daPa and in the left ear it was -292daPa. The compliance was 0.25ml for both ears. I will upload them later today or tomorrow without my personal info and also give an update as I will visit the ent today.

I went today with scan for my neck and nose. He found a deviated septum/nasal scoliosis (which I had since I was born -- nothing new, clear nasal passages/no nasal congestion). He believes it's from my nose but my nose is clear. I've used avamys and mucoproxol for a week in the beginning of July.