The difference between hearing tests? Is there a standard one?

[Per]

When I did my hearing test I received many high frequency sounds that I was supposed to confirm by clicking a button. Many of these signals met the same high pitched frequency as my T signal so then I started to think: "how am I supposed to hear a signal when its identical to the static signal I'm always hearing?" If I can't hear that signal because it masks the T 100%, isn't it wrong to classify that as a loss in hearing? You can have perfect hearing and still not hear the specific signal that masks the T. I did one hearing test and it went all right, the ENT said "not perfect but not too bad either" - it was no reason to believe I had severe hearing loss but I wonder if I could have done even better cause of the phenomenon I describe. It lead me to raise some questions on these tests.

Are there many different hearing tests out there? What hearing test is defined as the standard? Any medical test names? And who is the best to preform these tests, an ENT spec. or an audiologist?

 

[thenobody]

I had a hearing test at an ENT and at an audiologist. The one at the audiologist was more extensive and tested for higher frequencies (up to 10kHz).

 

[Angelique]

There is a place in Brisbane that states they do T assessment tests. I wonder how their T assessment test is different from the standard test? Has anyone has one done?

 

[Markku]

Usually hearing tests only measure up to 8 kHz. (However, it is possible to test above that!)

Sometimes the frequency of tinnitus tone is considerably above 8 kHz.

Lesson learned: if your hearing test shows "normal", and you have high-pitched ringing, there's a possibility that the hearing test only measured up to 8 kHz and you still have some hearing loss at the frequency of your tinnitus.

Of those who experience tinnitus, 90% have some level of hearing loss.

"Hearing loss occurs with roughly 90 percent of tinnitus cases." (Source: Hearing Health Foundation)

 

[Per]

I wonder how they can divide T patients into percentages because I've seen many different statements on this. For instance 5% of all T sufferers have it severe (what is severe) or 10% have stress related T etc. Don't think these numbers are very scientific? How could they be. The causes of T seems to be so diverse and we all develop, mostly towards the better as far as I can understand.

Well, I will do another hearing test to have the other frequencies covered. Thanks for the tip.

 

[Per]

I had a hearing test at an ENT and at an audiologist. The one at the audiologist was more extensive and tested for higher frequencies (up to 10kHz).

I'll make sure I'm assessed by an audiologist. Wish I could do it tomorrow but due to circumstances I won't be able to get to one until sep/oct. at earliest.

 

[Angelique]

I will see about getting tested again for the higher frequencies, this time I will ask, if they don't do that then does the ENT have this ability?

 

[Markku]

I will see about getting tested again for the higher frequencies, this time I will ask, if they don't do that then does the ENT have this ability?

Just as an example, from Australian Hearing:

Normal, young, healthy human ears can hear frequencies as low as 20Hz and as high as 20,000Hz. However we only test hearing in the range of 250Hz to 8,000Hz, as most sounds of speech occur in this frequency range.

(source)

The above is also a good page about audiogram as a whole: worth a read.


The word we're probably looking at is "Extended High-Frequency Audiometry" - EHFA.

One study where EHFA was used:
http://www.ncbi.nlm.nih.gov/pubmed/18393354

More results from Google:
https://www.google.com/search?q=Extended High Frequency Audiometry

Maybe you should contact your audiologist and/or ENT office and ask whether they have the means to measure the higher frequencies of the hearing (above 8 kHz).
If they don't, I'm sure they can refer you to someone who does.

 

[Hudson]

Just for information, I had my hearing tested at the Iowa Tinnitus Clinic above 8000 hz, up to 20000 hz. It was fine. I was shocked. I thought for sure I had high frequency hearing loss that could explain my tinnitus. Nope.

That of course does not rule out more subtle forms of damage, just what is measurable on an audiogram.

 

[Per]

Just for information, I had my hearing tested at the Iowa Tinnitus Clinic above 8000 hz, up to 20000 hz. It was fine. I was shocked. I thought for sure I had high frequency hearing loss that could explain my tinnitus. Nope.

That of course does not rule out more subtle forms of damage, just what is measurable on an audiogram.

Hudson, that's good to know. It seems to me that too many ENT spec. tell their patients that tinnitus is and will always be a consequence of hearing loss. I had a telephone chat with a retired ENT that has worked with T for many decades and he said he used to tell his colleges that it's not so. When I read new material on T causes and treatment it seems like the 90% hearing loss with T is an obsolete theory. Another factor is that it's impossible to really know if there's any physical damage to an inner ear, leaving room for a lot of speculations.

Seems to me that T is based on more neurological aspects than hearing loss and/or physical damage to the cochlear or inner ear hair cell damage. I'm just thinking out loud here, based on the material I read and the people that get better from both T and hyperacusis (I have both) it all seems to be because of habitation and mental training - telling the brain to not treat T as a threat or any external sound as dangerous (in case of Hyperacusis) seems to be the norm. If habituation is the most successful treatment concept then it must be a lot of truth to this.

When it comes to hearing test I am definitely going to have high frequency range test, I'm going to send that result to the ENT that diagnosed me. As an annoying gift from me to him. He told me that hearing loss was the reason of almost all T but the same guy couldn't spot any wrong with the test he made on me. That lead to a very short assessment. "You just need to deal with this" was his recipe.

 

[Molan]

Seems to me that T is based on more neurological aspects than hearing loss and/or physical damage to the cochlear or inner ear hair cell damage.

I think you may both be interested in reading this,

http://www.acoustics.org/press/159th/liberman.htm

It talks about the evidence emerging that significant degeneration of the cochlear nerve occurs after noise exposure, even when there is no hair cell loss, and even when hearing thresholds have returned to normal. So if true there exists the potential for someone to have perfect hearing but still have Tinnitus related problems due to cochlear nerve degeneration.

 

[Per]

I think you may both be interested in reading this,

http://www.acoustics.org/press/159th/liberman.htm

It talks about the evidence emerging that significant degeneration of the cochlear nerve occurs after noise exposure, even when there is no hair cell loss, and even when hearing thresholds have returned to normal. So if true there exists the potential for someone to have perfect hearing but still have Tinnitus related problems due to cochlear nerve degeneration.

Molan, as long as they can't get a visual reference of this it will be speculations. Perhaps its the nerves in conjunction with the acoustic neurological shock? May be its a mix between these two situations. The scientist are not looking to the ear when trying to find a solution to tinnitus, they look to the cortex in the brain that deals with sound frequencies. Both people with and without hearing loss have tinnitus, so it can obviously thrive in both occasions. In case of my hyperacusis every single progress story I have read is about brain habituation.

http://www.hyperacusis.net/hyperacusis/success stories/default.asp

My resistance was towards those who say that T is always a result of hearing loss. That's not the case. In so many cases T occurs without hearing loss as you also pointed out. I'm obviously not a neurologist but from what I can understand from this the T is produced in the brain - not in the ear. The latter is just doing what the brain tells it to do. Perhaps that's why stress is such a bad thing for T? I can also relate to damaged nerves in the inner ear cause it seems logical, it also feels like that some times. But our brains perceive more sound and delivers it to the auditory system, so my hope is that we can affect our T and hyperacusis by manipulation of the brain.

 

[Molan]

Molan, as long as they can't get a visual reference of this it will be speculations. Perhaps its the nerves in conjunction with the acoustic neurological shock? May be its a mix between these two situations.

The scientist are not looking to the ear when trying to find a solution to tinnitus, they look to the cortex in the brain that deals with sound frequencies. I'm obviously not a neurologist but from what I can understand from this the T is produced in the brain - not in the ear.

Of course it remains speculation at this point but I thought you might find it interesting nevertheless.

There are many ideas of where Tinnitus originates. Some say the brain and some say the ear or maybe it's both? Regardless I found this paper quite intriguing see below,

http://www.ncbi.nlm.nih.gov/pubmed/7671835

This study showed that out of 151 patients 101 reported complete relief of Tinnitus when they had their Cochlear nerve severed. Worthwhile improvement was noted in 43 patients and 7 patients obtained no improvement. This would seem to show that for some people at least Tinnitus originates in the inner ear and not the brain. Once the brain stopped receiving the signals from the ear a significant percentage (67%) of people said they could no longer hear their tinnitus.

 

[Per]

There are many ideas of where Tinnitus originates. Some say the brain and some say the ear or maybe it's both? Regardless I found this paper quite intriguing see below,

http://www.ncbi.nlm.nih.gov/pubmed/7671835

Yes, that's interesting. However I find this line somewhat disturbing "The majority of patients can now be successfully treated either by conservative medical treatment or by specific surgery." That's a bald statement. Do they mean the majority of patients that fits the exact T diagnosis they can do surgery on? What is difficult is to identify the T type, or the cause of the T. In context of cochlear nerve surgery the article says "proper selection of patients with intractable tinnitus for cochlear nerve section offer a good chance for success."

The ability to scan the inner ear would be a considerable advancement, seems to me that a visual reference to identify potential damages is of utmost importance to be able to find the suitable treatment. I understand it's connected with considerable health risk to do inner ear surgery as well...

 

[Hudson]

I think we're missing the target here.

What is hearing loss, really? It's a dysfunction of the auditory system. What is tinnitus? Well, you could argue that is a dysfunction of the auditory system as well. Whether it arises in the brain or the ear.

Molan, that paper you found is interesting. I would assume that most of those people had their auditory nerve severed for a given ear due to acoustic neuroma, correct? That is a strange paper because you will find almost no surgeons are willing to sever the cochlear nerve because of tinnitus. It's a complete destruction of one's hearing ability, without guaranteed results. If the nerve was severed because of acoustic neuroma that may explain why some benefit was seen. I am imagining that people with tinnitus due to the more common "hearing loss" cause probably would not benefit from that. I am just guessing of course though. I have read the opposite argued by tinnitus researchers before regarding the severing of the cochlear nerve. I'll see if I can find some papers this afternoon.

 

[Molan]

Yes, that's interesting. However I find this line somewhat disturbing "The majority of patients can now be successfully treated either by conservative medical treatment or by specific surgery." That's a bald statement. Do they mean the majority of patients that fits the exact T diagnosis they can do surgery on? What is difficult is to identify the T type, or the cause of the T. In context of cochlear nerve surgery the article says "proper selection of patients with intractable tinnitus for cochlear nerve section offer a good chance for success."

The ability to scan the inner ear would be a considerable advancement, seems to me that a visual reference to identify potential damages is of utmost importance to be able to find the suitable treatment. I understand it's connected with considerable health risk to do inner ear surgery as well...

Well I certainly don't advocate anyone becoming deaf to try and cure their Tinnitus! It's a good paper though to highlight that at least in some cases of Tinnitus the problem is actually located in the inner ear region and not the brain.

EPFL and Harvard medical school have got together to develop new technology that will allow them to actually see what is going on inside our ears.

http://medicalxpress.com/news/2012-10-epfl-harvard-loss.html

Hopefully we won't have to wait too many years for this.

 

[Molan]

I think we're missing the target here.


Molan, that paper you found is interesting. I would assume that most of those people had their auditory nerve severed for a given ear due to acoustic neuroma, correct? That is a strange paper because you will find almost no surgeons are willing to sever the cochlear nerve because of tinnitus. It's a complete destruction of one's hearing ability, without guaranteed results. If the nerve was severed because of acoustic neuroma that may explain why some benefit was seen. I am imagining that people with tinnitus due to the more common "hearing loss" cause probably would not benefit from that. I am just guessing of course though. I have read the opposite argued by tinnitus researchers before regarding the severing of the cochlear nerve. I'll see if I can find some papers this afternoon.

I'm unsure of all the details because I have not seen the full paper yet. However I can certainly understand why surgeons are reluctant because as the paper shows it's not 100% guaranteed that the Tinnitus will disappear and of course there is no going back once it's been done.

The world of research is always interesting because of the opposing views on the same topic. Financial and political interests can come into play also.

 

[Per]

EPFL and Harvard medical school have got together to develop new technology that will allow them to actually see what is going on inside our ears.

http://medicalxpress.com/news/2012-10-epfl-harvard-loss.html

Hopefully we won't have to wait too many years for this.

That's interesting news. Getting a visual reference to what caused or not caused the T is of utmost importance. I really hope they are able to finance this further so they can put it to use! This can help rule out so much wild speculations. Sooner or later they will have to develop this technique cause it can obviously help in other medical terms as well.

 

[Per]

Just as an example, from Australian Hearing:

Normal, young, healthy human ears can hear frequencies as low as 20Hz and as high as 20,000Hz. However we only test hearing in the range of 250Hz to 8,000Hz, as most sounds of speech occur in this frequency range.

(source)

The above is also a good page about audiogram as a whole: worth a read.


The word we're probably looking at is "Extended High-Frequency Audiometry" - EHFA.

One study where EHFA was used:
http://www.ncbi.nlm.nih.gov/pubmed/18393354

More results from Google:
https://www.google.com/search?q=Extended High Frequency Audiometry

Maybe you should contact your audiologist and/or ENT office and ask whether they have the means to measure the higher frequencies of the hearing (above 8 kHz).
If they don't, I'm sure they can refer you to someone who does.

Thanks for the advice Markku. I didn't know these figures, I'll take them with me when I get in the position to seek domestic medical treatment. I'll definitely get a new hearing test that cover more frequencies.

 

[Per]

Just wanted to follow up in my own post instead of making a new post that concerns the same topic. I found this frequency test and I had a go at everyone of them to listen if I could hear them. First I listened only trough the laptop speakers and the only one I couldn't hear was the highest one, that is the 13000 Hertz on this list. Then I listened with my Koss PortaPro headset and I was able to hear the highest one as well, alltough it came into my conscious sound picture late.

Please see bottom of page:
http://www.visaliasynergychiropractic.com/tinnitus-solutions/

Does this mean my T is at the same frequency as the one I could hear the least? Seems odd because from what I experienced my T frequency corresponded with more than just one frequency. When I listened to the others it seemed like many of them came in stronger on my right ear when I played them trough speakers, that's where I feel my T is the strongest. But when playing them all in my headset I didn't quite notice any difference between right and left ear.

 

[McGee]

Hi Per, I hope today finds you well

In regards to your original post I too thought the exact same thing. I had a hearing test done up to 8k Hertz and the results came back with mild SNHL left ear and mild loss in right ear. I was devastated (my big fear is it will get worse) and started to think "Well maybe I just couldn't hear the tones because they were at the same frequencies as my T sounds" I looked into this on the net for hours and eventually came across some info that explained that a lot of Audiologists, when they hear their patient has tinnitus, will use whats known as "warbled tones" instead of the standard "pure tone" test. The warbled tone is a wavering sound that apparently makes it easily distinguishable from the persons own T sound.

I tried and tried to remember whether the tones I heard in my hearing test were "pure" or sounded wavering and was more than frustrated when I couldn't. I was holding onto to every hope that my hearing test had been wrong and I think actually convinced myself it was and I had no hearing loss. Anyway, a copy of my results arrived in the mail a few weeks later and sure enough in the bottom corner of my test were the words "Warble tone used"

That's of course not to say that your test won't come back perfectly fine. Like I said, I had the exact same thought you did and I think it makes sense, especially if "pure" tones were used in your test. Perhaps when you do get your test done again you can ask what type of tones they use or specifically request they use the "warbled" kind. I hope this helped with your original question, best of luck

 

[Per]

@McGee

Thanks for great advice. I will hold an "ear out" for those warbled sounds and ask the audiologist if those sounds are used in my test. It makes sense what you write cause no one would be able to identify two identical tones played at once, one being your T sound and the other being the hearing test tone. I have now even talked to the audiologist on the phone because my referral system has started to roll so to speak, I'm getting referred to them after my next (and second) ENT appointment. So they said I would be looking at going there sometime in the beginning of Oct. I'm not looking forward to the ENT visit but I'm kinda exited about the audiologist because they take special interest in hyperacusis over there, and since I have that in addition to my T I'm hoping they would start some treatment with white noise or something to decrease the freaking painful noise levels I get from so many environmental noises