Low Pitch Tinnitus Due to Conductive Hearing Loss?

[crd3]

Hi everyone,

I'm 25 years old and have been experiencing "chronic" tinnitus for about 2 and a half years. I have at least one very high pitch (hard to tell if it's one or multiple) and one low, 490 Hz pitch. Both ears for all the above.

While I've been concerned about my tinnitus ever since I realized it was chronic, I never really freaked out about it until I realized I was also starting to develop mild hyperacusis (which I didn't know existed until I looked it up).

I had assumed my tinnitus to be noise induced since I'm a musician (a drummer, no less) and haven't always been the most careful with my ears.

However, after 2 and a half months of almost nonstop stressful and obsessive research, I came across this article (linked below) that indicates that maybe my low 490 Hz tone (the one I find most intrusive) is not due to NIHL at all, but rather conductive hearing loss from ear fluid. This is the EXACT FREQUENCY cited in the article as being the mean frequency for conductive hearing loss, and it's well below the range for sensorineural. I feel that it's just too unlikely for this to be a coincidence.

I have known I have had ear fluid problems ever since I was about 10 when I began to experience crackling of the ears when I swallow or move my jaw in certain ways.

I am scheduled to see Dr. Marsha Johnson at the Oregon Tinnitus and Hyperacusis Clinic after not knowing what else to do and feeling extremely depressed and borderline suicidal as my tinnitus has apparently increased in volume and become very loud in silence (though it is fairly easily masked). The ENT I saw after Thanksgiving referred me to her. Now I'm thinking of seeing another ENT and talking to him about the possibility of tinnitus caused by ear fluid or ETD. It's my understanding that this would be more easily treatable.

What do you guys think? Am I giving myself false hope?

http://www.randombio.com/tinnitus.html

 

[GregCA]

What do you guys think? Am I giving myself false hope?

Do a hearing test - you'll see what your audiogram looks like. Noise induced hearing loss matches a pattern with a dip at 4 kHz (sensorineural losses).
If you have conductive hearing loss then something else in the middle ear is amiss. It could be fluid of course, but it could also be something like otosclerosis.
If you're unlucky like me, you can get both sensorineural and conductive hearing losses.
When I was diagnosed with otosclerosis, I had a large air-bone gap in the lower frequencies, and also severe hyperacusis.
Coincidentally, I'm also a drummer, but I don't have noise induced hearing loss.

 

[crd3]

I had an audiogram last month and it came back normal, although it was hard to hear some of the tones over my tinnitus. Having another one on Tuesday.

I think my high pitch tones are probably sensorineural due to cumulative noise damage, but I increasingly think the low pitch is not. I don't think I've seen anybody else with noise induced tinnitus say they have a pitch that low.

 

[Dawna]

Do a hearing test - you'll see what your audiogram looks like. Noise induced hearing loss matches a pattern with a dip at 4 kHz (sensorineural losses).
If you have conductive hearing loss then something else in the middle ear is amiss. It could be fluid of course, but it could also be something like otosclerosis.
If you're unlucky like me, you can get both sensorineural and conductive hearing losses.
When I was diagnosed with otosclerosis, I had a large air-bone gap in the lower frequencies, and also severe hyperacusis.
Coincidentally, I'm also a drummer, but I don't have noise induced hearing loss.

Hello Greg, your air-bone gap caught my attention. My audiogram during symptoms showed one at the 250 Hz level. I have episodes of low frequency tinnitus that I can feel, fullness, and a buzzy weird head feeling. Sometimes lightheaded. It fluctuates but is more present than not. My audiograms are normal when I'm NOT having an episode. My ENT says no to Otosclerosis because it's only in my left ear. She's pondering either atypical Ménière's or tensor tympani syndrome.

What type symptoms do you have? Did you have vestibular testing? It's hard to be myself with this intrusive crap! Thanks for your time.

 

[Gman]

Hello Greg, your air-bone gap caught my attention. My audiogram during symptoms showed one at the 250 Hz level. I have episodes of low frequency tinnitus that I can feel, fullness, and a buzzy weird head feeling. Sometimes lightheaded. It fluctuates but is more present than not. My audiograms are normal when I'm NOT having an episode. My ENT says no to Otosclerosis because it's only in my left ear. She's pondering either atypical Ménière's or tensor tympani syndrome.

What type symptoms do you have? Did you have vestibular testing? It's hard to be myself with this intrusive crap! Thanks for your time.

Sounds a lot like the tensor tympani and maybe trigeminal nerve that innervates it. Sounds very similar to what I get fairly regularly but not always. Dizzy/lightheaded (but not vertigo), middle ear fullness, buzzy hum, lower pitch tinnitus. It is possible to get temporary conductive hearing loss due to dysfunctioning middle ear muscles. My tensor tympani actually cramps too, which is very uncomfortable.

When you experience this type of tinnitus and the other symptoms, does it feel uncomfortable to hear sounds? Like unbalanced between the ears, or just kind of weird?

 

[Greg Sacramento]

Sounds a lot like the tensor tympani and maybe trigeminal nerve that innervates it. Sounds very similar to what I get fairly regularly but not always. Dizzy/lightheaded (but not vertigo), middle ear fullness, buzzy hum, lower pitch tinnitus. It is possible to get temporary conductive hearing loss due to dysfunctioning middle ear muscles.

If it was the trigeminal nerve pathway which is long or any other main oral nerves or blood vessels - pain would be well noticed. Retrodiskal tissue damage or other small tissues associations would also be painful. There are also hundreds of theories and actual purposed data in many relationship crossover conditions of facial (facial nerve as one of about 20), neck another 20) and brainstem. Most relate to veins and arteries with blood flow and that can associate to all that you mention above. This is how the trigeminal could have involvement with the fissure as mentioned below.
https://en.wikipedia.org/wiki/Petrotympanic_fissure

Example - this is often mentioned to be in the top ten to what you mention in quote above.
The ligaments of malleus are three ligaments that attach the malleus in the middle ear. They are the anterior, lateral and superior ligaments.

The anterior ligament of the malleus is a fibrous band that extends from the neck of the malleus just above its anterior process to the anterior wall of the tympanic cavity close to the tympanic fissure. Some of the fibers also pass through the fissure to the spine of sphenoid bone.

The lateral ligament of the malleus is a triangular fibrous band that crosses from the posterior aspect of the tympanic notch to the head or neck of the malleus.

The superior ligament of the malleus is a delicate fibrous strand that crosses from the roof of the tympanic cavity to the head of the malleus. https://en.wikipedia.org/wiki/Tympanic_cavity

 

[Dawna]

Sounds a lot like the tensor tympani and maybe trigeminal nerve that innervates it. Sounds very similar to what I get fairly regularly but not always. Dizzy/lightheaded (but not vertigo), middle ear fullness, buzzy hum, lower pitch tinnitus. It is possible to get temporary conductive hearing loss due to dysfunctioning middle ear muscles. My tensor tympani actually cramps too, which is very uncomfortable.

When you experience this type of tinnitus and the other symptoms, does it feel uncomfortable to hear sounds? Like unbalanced between the ears, or just kind of weird?

I never feel anything cramping in my ear. Sometimes thing sound weird, most noticeable when I try to talk on the phone-distorted like they are talking through some altering device and I have to change ears, but only when I'm having a super bad episode. Bass sounds bother me during episodes only. Certain noises like the shower, or traffic noise when I open my window at home, make the noise in my ear/head louder. I never ever have pain though in my ear or face. The best way for me to describe the noise I hear/feel is as if I'm sitting in an airplane in flight, the cabin noise. In one ear tho. It's not a localized sound or feeling, it's half of my head ‍

Any of this familiar?

 

[GregCA]

Hello Greg, your air-bone gap caught my attention. My audiogram during symptoms showed one at the 250 Hz level. I have episodes of low frequency tinnitus that I can feel, fullness, and a buzzy weird head feeling. Sometimes lightheaded. It fluctuates but is more present than not. My audiograms are normal when I'm NOT having an episode. My ENT says no to Otosclerosis because it's only in my left ear. She's pondering either atypical Ménière's or tensor tympani syndrome.

What type symptoms do you have? Did you have vestibular testing? It's hard to be myself with this intrusive crap! Thanks for your time.

I suggest you get another opinion and do the tests required to diagnose Otosclerosis (or rule it out). The fact that it's only in one ear is not a reason to rule out Otosclerosis. In a non negligible amount of cases (such as mine), Otosclerosis affects only one ear.

Does your audiogram show any air-bone gap?

 

[Dawna]

I suggest you get another opinion and do the tests required to diagnose Otosclerosis (or rule it out). The fact that it's only in one ear is not a reason to rule out Otosclerosis. In a non negligible amount of cases (such as mine), O affects only one ear.

Does your audiogram show any air-bone gap?

Yes it did show a gap only at 250 Hz level.

How did you definitively get your diagnosis?

 

[GregCA]

Yes it did show a gap only at 250 Hz level.

How did you definitively get your diagnosis?

You can't be sure until you do exploratory surgery (so the surgeon can confirm it), but you can look at a bunch of clues. For me, it was these clues: Air-Bone gap on audiogram, Weber and Rinne tests positive, Stapedial Reflexes missing, CT scan radiolucencies... perhaps some more that I'm forgetting.

Can you post your audiogram? (blank out personal info)

 

[Dawna]

You can't be sure until you do exploratory surgery (so the surgeon can confirm it), but you can look at a bunch of clues. For me, it was these clues: Air-Bone gap on audiogram, Weber and Rinne tests positive, Stapedial Reflexes missing, CT scan radiolucencies... perhaps some more that I'm forgetting.

Can you post your audiogram? (blank out personal info)

I don't have my audiograms but I plan on getting all of my test results in hard copy next time I see the ENT. I've had a few hearing tests and the low frequency loss is only evident if I have the test during an episode. Otherwise it's normal! I know that my stapedial reflexes are normal. I have some abnormal vestibular testing. My ct and mri show nothing abnormal.

 

[Gman]

@GregCA Wouldn't otosclerosis cause constant issues, rather than episodic?

 

[GregCA]

@GregCA Wouldn't otosclerosis cause constant issues, rather than episodic?

Yes, I think it would. I'd be surprised if @Dawna had Otosclerosis.