Does Your Doctor Listen to Your Ears?

[Dr. Nagler]

This is not true. If I try and listen to a sound where my T presents itself I hear nothing but my T. This is proven in my hearing tests.

That is not because of your tinnitus. It is because you have a threshold shift around the frequency of your tinnitus. Many folks believe that were it not for their tinnitus, they could hear better. But they are wrong.

 

[ruben ruiz]

Lets face it ENTs and many general Dr'. don't have a clue. My general asked me what Tinnitus and Hyperacusis are!
She also asked how to spell them.
Dr. Naglar, do you know of a Dr'. as competent as you in the Western United States.
I live in Tucson. Ive seen 3 ENTs. I feel I still haven't been examined. I feel I have pulsitile
tinnitus. So many people are suffering many of them have a chance. I asked my general to find me a neurologist who specializes with hearing for a referral.
Thank you. I know you have many people asking you questions, I am patient.

 

[Telis]

That is not because of your tinnitus. It is because you happen to have a threshold shift around the frequency of your tinnitus.

Right, I have a threshhold shift so I don't hear properly in that range. This is the point @Carm was trying to make. If I listen to your tinnitus and it is at the same frequency as mine, I will totally miss it.

 

[Dr. Nagler]

Right, I have a threshhold shift so I don't hear properly in that range. This is the point @Carm was trying to make. If I listen to your tinnitus and it is at the same frequency as mine, I will totally miss it.

That's why they have hearing aids, amplification stethoscopes, and the like.

 

[Telis]

That's why they have hearing aids, amplification stethoscopes, and the like.

Ok so it can be an issue then. Glad we cleared that up.

 

[Martin69]

I guess my doctor had to connect the stethoscope to my brain and he would hear all kind of crazy sounds.
No one listened to my ears.

 

[nogood]

@Dr. Nagler
nope... never had that done..

number of ent i seen, 5 in total last year.
[in the order i meet them]
1- Otorhinolaryngologists/professor of a very famous private medical college
2- Head of department of a government medical college
3- 3 ent doctors [including my own aunt]

just now recently meet a maxillofacial surgeon cause of my TMJ issues [He brought in an ENT doctor before he gave any treatment to me, even though it was brief counselling you can count him as number 6].

i gave up on ENTs already. sighs........

they all go about doing the standard procedure:

antibiotic
meniere's syndrome treatment
blood pressure issues
psychology issues
lastly.. "will refer you to a Psychologist" and a prescription to benzo for sleep.

i am not sure the TMJ issues and T are related, i know this much that i do wake up with stiff jaws and often having issues with locked jaws, poping and cracking of jaws. the t goes crazy with ear pain and jaws pain.

 

[Dr. Nagler]

Ok so it can be an issue then. Glad we cleared that up.

Hearing loss can always be an issue. That's where hearing aids and (in this case) amplification stethoscopes come in.

But I thought we were talking about tinnitus. Like I said earlier - tinnitus can interfere with concentration, but it doesn't cause hearing loss.

 

[Dr. Nagler]

Dr. Naglar, do you know of a Dr'. as competent as you in the Western United States.

In this one tiny highly selective subspeciality I have carved out for myself - no, I do not know any medical doctors anywhere who are as competent as I. But tinnitus and hyperacusis is all I do. And had I myself not developed severe intrusive tinnitus, I wouldn't be interested in it either.

I live in Tucson. Ive seen 3 ENTs.

So get in your car and go see Dr. Michael Robb in Phoenix, which is 100 miles north of you. Dr. Robb is a highly regarded neurologist whose practice focuses on the auditory system. And he is very knowledgeable about tinnitus. You are so lucky to be just a short drive away from him.

 

[Brianna]

Tinnitus can in some cases interfere with one's ability to concentrate, but tinnitus does not interfere one's ability to hear.

That's for sure. Since we have varying decibel and frequency (hertz) levels of T, getting past that can be difficult. I attempt to get past the T and just translate cochlear implant speak. Scrambled brain produces misunderstanding and incorrect responses.

 

[Sailboardman]

@Dr. Nagler,

In 2005, I had a mild case of T that resolved itself in about a month. But I noticed that certain noises, like leaf blowers, would cause my right ear to pulse, with the sound of my heartbeat. Once the sound stopped, the pulsing stopped. I assume now, this was the start of symptoms leading to my current level of T.

In 2007, I had a mild concussion. Post concussion symptoms of faintness and dizziness, lasted about 6 months and diminshed completely over time. No T symptoms at this time.

Fast forward to April 2014, I awake with high pitched T in my right ear and as my hearing test indicated, 65-70 db sensorineural hearing loss, from 2-8K. Probably higher, but it was a standard test that stopped at 8K. MRI concluded no apparent problems. I also had an Intratympanic injection performed, with zero success. I now notice, no pulsing in my right ear, regardless of external noise. I assume again, once sensorineural hearing loss set in, the game changed.

I can also change the sound, by pushing on my lower jaw, biting down on my teeth and jutting my lower jaw out. Seems many here have the same symptom.

Would you suggest I see, any other specialist, other than another ENT? Or, just accept the cochlear damage and high pitched T, as a done deal? (btw, I have been seeing an acupuncturist for 8 months.)

Thanks, Sailboardman

 

[Dr. Nagler]

Dr. Nagler,
In 2005, I had a mild case of T ...

Best to ask this sort of question on the Doctors' Corner.

 

[Dr. Nagler]

OK. So now we are up to 100 responses in this highly unscientific survey of ours. The results? 95% of the respondents, individuals whose tinnitus was severe enough to merit a trip to the ENT for evaluation, had an inadequate ENT examination. We are not talking here about ENTs who might feel for whatever reason that tinnitus is something you just have to learn to live with. Rather, we are talking about ENTs who are paid to perform a service the most basic elements of which are taking a history and performing a physical examination. And 95% of them get that wrong! (In my opinion, anyway.)

 

[FuzzyFrey]

Had just one visit thus far and it consisted of a visual check, a tympannometry test and removal of wax from one ear. Still not much closer to solving the puzzle. But it's a work in progress I guess. I hate the NHS waiting times.

 

[MattK]

OK. So now we are up to 100 responses in this highly unscientific survey of ours. The results? 95% of the respondents, individuals whose tinnitus was severe enough to merit a trip to the ENT for evaluation, had an inadequate ENT examination. We are not talking here about ENTs who might feel for whatever reason that tinnitus is something you just have to learn to live with. Rather, we are talking about ENTs who are paid to perform a service the most basic elements of which are taking a history and performing a physical examination. And 95% of them get that wrong!

It kinda makes me think each of us should go back and tell our ENTs to listen for it. Who knows? Some here might get lucky enough to find they have a treatable case.

 

[skoupidis]

It kinda makes me think each of us should go back and tell our ENTs to listen for it. Who knows? Some here might get lucky enough to find they have a treatable case.

I had 3 MRIs. One for the brain, one for the neck and one for the acoustic canals. In 2 of them there were findings: Neck hernias (possibly causing T?), and microvascular compression of the VII and VIII nerve which potentially causes tinnitus. All of the ENTs and neurologists I visited looked at them. Do you know what they replied? It is a natural phenomenon, tinnitus is not caused by those findings. They took their money to say just that and prescribe antidepressants or other useless stuff. Of, course they left it to that. I have findings suggesting tinnitus but they choose to disregard them without reason! "Do you have a heart beat sound?" They said. No, I replied. Then since it is not pulsitile tinnitus it is not from the MRI findings. As simple as that. And I had to ask them to get this reply! Only one of them said mvc MAY cause T (checked my audiograms, no acoustic trauma showed there but very high freq T and possible hearing loss) and gave me neurontin. One month after no results, even that doc gave up on me and said that nothing can be done.
Talking about persistent doctors....

​

 

[Beth]

Thanks Dr Nagler. I'm not sure how easy it will be here in England to find a ENT doctor that's interested in treating tinnitus sufferers?

You are right, it is not easy. When I was particularly distressed about my tinnitus I asked my GP if the ENT she was sending me to was experienced in dealing with tinnitus patients. She continued looking at her computer and said, 'ENT stands for ear, nose and throat so there is a clue there for you'. I left her office with even less hope than I'd had before going and during the whole consultation she never once made eye contact. If I wrote what I really thought about my local GPs I'd be banned from using this site. Sometimes the kindness of Dr Nagler makes me cry; I wish he'd train our absolutely useless GPs in patient management.

 

[Twitch]

Hi All -

In another thread I posted a story about a patient of mine:

The third patient is a female in her mid-30s who lived in the Midwest. She presented with a six-month history of increasingly loud ringing in her left ear. She had been to three ENTs, all of whom told her that she had tinnitus and had to learn to live with it. She became distracted, distraught, and depressed. She tried a number of different medications and treatment protocols all to no avail. In desperation she flew all the way to Atlanta to see me. (Talk about scraping the bottom of the barrel!) I took a history and reviewed all of her records. The next thing I did was examine her (which is sort of what doctors do!) I looked in her ears, and then I listened to her ears with a stethoscope. I also listened to her neck and all over her head with a stethoscope. Nothing particularly noteworthy in any of that. Finally I inserted a small electronic amplifier into both ear canals and listened again. It was at that point that I was able to detect a sound in her left ear similar to the sound she was describing. It was a venous hum, the sound of turbulent blood flow coursing through the low-pressure venous system (as opposed to a bruit, the sound of turbulent blood flow in the high-pressure arterial system). I turned my attention again to her neck and in a very quiet room was able to trace the origin of the sound to a point high up in her left jugular system. I asked one of my colleagues in vascular radiology to do a selective venous jugular study. He found a tight stenosis, which he gently dilated up over two sessions. And she was cured! Although she had been told by three different ENTs that she had tinnitus, as it turned out she did not have tinnitus at all. What she had was a somatosound emanating from her distal jugular venous system. (And the very last thing she needed was the TRT that she came to me for originally!)​

Almost everybody on this board has been to an ENT at one time or another because of tinnitus. I would like to know how many of those ENTs actually took the time to listen to your ears as part of your examination.

Thank you.

I literally LOLed after reading the highlighted bit. Dr Nagler you are by no means 'bottom of the barrel'. A few of us here at TT including myself hold you in very high regard and to me, you are a legend.

Back on topic, the ENT I saw listened to how I thought my tinnitus began with interest however he only checked my ears with a regular stethoscope and felt my neck and told me I had tinnitus and had to live with it. My regular GP won't refer me for private MRA scans so I asked for a second appointment with an ENT who would refer me on for an MRA however I don't think there's any harm in asking him to 'listen to my ears' as it seems like my tinnitus is also coming from my left ear. Did your patient mention how her tinnitus started?

 

[Christian78]

not for first 5 times, then i then i done MRI of spine, MRI of brain circulation, MRI of brain specifically hypophysis gland, 5 audiometric with phonometry for hearing scales and eardrums, several complex blood tests, and almost entire body ultra sound, and

conclusion is I was graded that i can go be astronaut ...

 

[Dr. Nagler]

I literally LOLed after reading the highlighted bit. Dr Nagler you are by no means 'bottom of the barrel'. A few of us here at TT including myself hold you in very high regard and to me, you are a legend.

I'm a legend held in very high regard, huh? So where the hell were you when my son and daughter were teenagers? I sure could've used you then!

Back on topic, the ENT I saw listened to how I thought my tinnitus began with interest however he only checked my ears with a regular stethoscope and felt my neck and told me I had tinnitus and had to live with it.

Well, at least your ENT looked, listened, and palpated. That puts you ahead of 95% of the folks who responded to my poll!

Did your patient mention how her tinnitus started?

Several months prior to the onset of her tinnitus, she was struck high up on the left side of her neck by a line drive during a softball game. Judging from where the jugular vein stenosis was located, that would be the most likely possibility, but who knows? The stenosis might have been entirely unrelated to the softball injury.

 

[Chelles]

My doctor was going to listen to my ear but there was no point since my ear wasn't spasming during the appointment (of course after I left my ears started doing it).

 

[PaulBe]

My doctor was going to listen to my ear but there was no point since my ear wasn't spasming during the appointment (of course after I left my ears started doing it).

That is one of the problems we have. For some of us symptoms come and go, and the going so often coincides with appointments.

 

[Dr. Nagler]

That is one of the problems we have. For some of us symptoms come and go, and the going so often coincides with appointments.

If your car is making a weird noise, and you have to take it in to the shop to get it checked out, what happens? Right. It never makes the noise when the guy is test driving it. So sometimes ya gotta take it back a second or third time.

Same with your ears!

 

[Twitch]

I'm a legend held in very high regard, huh? So where the hell were you when my son and daughter were teenagers? I sure could've used you then!

Kids, eh? Who'd have 'em? haha I think we've all been there and done that in our rebellious teenage years though

Well, at least your ENT looked, listened, and palpated. That puts you ahead of 95% of the folks who responded to my poll!

Several months prior to the onset of her tinnitus, she was struck high up on the left side of her neck by a line drive during a softball game. Judging from where the jugular vein stenosis was located, that would be the most likely possibility, but who knows? The stenosis might have been entirely unrelated to the softball injury.

I'm afraid I'm one of those 95%. Not being from a medical background, I confused an otoscope with a stethoscope (doh). I guess it's something I'll ask of the next ENT, hopefully the task won't be as strenuous as for the 95% of the ENTs the participants of this poll had the pleasure of meeting

Joking aside, I think you're really onto something here Dr. ENTs are quick to condemn us to a lifetime of tinnitus telling us there is nothing that can be done if our tinnitus isn't pulsatile but as in your patients case she was persistent and that worked in her favour which reminds me of the famous quote, "If at first you don't succeed, try, try, try again".

My first ENT referred me fo an MRI of my IAC (to rule out AN). The follow up ENT referred me for a head MRI scan even when I begged him for a referral for angiogram instead. My personal belief is those whose tinnitus has no known cause (not caused by ototoxicity/acoustic trauma), the arteriovenous system should be investigated thoroughly. I'm sure an MRA/V would likely have picked up the stenosis in your patients case and I think you rightly suggest, go back a second or third time.

 

[Leah]

Nope, and inhale been to a few.

 

[japongus]

Good topic. You should package it up and get it published somewhere. And no, at no stage did anyone listen to my ear. Three didn't bother with a history, and the only people who looked inside were a Junior consultant and a Junior Registrar....then I was referred "upstairs" where the credible medicine ended (you need a psychologist) because thresholds looked fine. The mention of the word "tinnitus" killed any further examination, but in one case did result in a referral to an Audiology chain that promoted Neuromonics....part owned by the guy that did the referral. Yes I have tinnitus, but my problem is Decreased Sound Tolerance which the "brains trust" at the other forum keep telling me isn't hyperacusis. At 18 months on I consider myself undiagnosed, except for TTTS and/or SM which Myriam at least identified.

Decreased sound tolerance isn't hyperacusis, it's phonophobia, in the same way that when Joe Gatto takes a dump in Murr's toilet, Murr has shitophobia

 

[Dr. Nagler]

Decreased sound tolerance isn't hyperacusis, it's phonophobia, ...

I believe you are mistaken.

Decreased sound tolerance (DST) encompasses both hyperacusis and misophonia, which can coexist or occur independent of one another. Phonophobia is a type of misophonia in which the limbic expression is fear.

And what any of this has to do with whether or not your doctor listens to your ears? Well that is totally beyond me.

 

[canyonero]

Have heard that sound before in my none T ear. I thought it was a fly, the first time, second time I realized it was coming from inside my ear. It never came back luckily.

 

[Danny Boy]

I tell you what, my doctor doesn't listen to my ear...Then again, he doesn't listen to my mouth either.

 

[PaulBe]

Decreased sound tolerance isn't hyperacusis, it's phonophobia, in the same way that when Joe Gatto takes a dump in Murr's toilet, Murr has shitophobia

Charming analogy, but no, it isn't Phonophobia at all. (Murr's toilet indeed!! honestly some days I think Joe's taken his dump on my oval window, not Murr's)